Hierarchy question for Sage or member

[carri]

Hi..


I am currently working with a therapist and we are preparing, or thinking about, exposure therapy.


I was wondering if you could please help with the hierarchy steps for exposure therapy. And maybe for Imagery therapy also.


Thankyou.


Carri

[happyteacher]

carri,


I am about 8 months into an exposure program. I think you have to think think about what bothers you the most in order to create a heirarchy that's right for you. Even though it is a close race, sound is definitely at the top of my hierarchy. Here is what my therapist created for me:


1. Still pictures, increasing in intensity (I am at the end stage of this process).


2. Vomit scenes in movies, starting with watching in slow motion (frame by frame on a DVD player), moving up to regular speed, increasing in intensity, sound off.


3. Watching a tape with people really vomitting, sound off.


4. Starting with step 2 and moving to step 3, with sound.


5. Real life experience (yikes!)





happyteacher

[kel12347]

Take a look at the treatments thread. In the "info for professionals" article, Sage wrote up a hierarchy. I'm using a variation of hers. Here it is.


1. drawing of a stickman, with a line coming out of his mouth


2. drawing of a stickman vomiting


3. looking at the stickman and pretending he's real


4. looking at the most common words for vomiting (I picked the top five and worked with those)


5. reading sentences and paragraphs that involve vomiting, going from not graphic to extremely graphic


6. listening to tapes of people coughing


7. listening to tapes of people gagging


8. looking at pictures


9. looking at pictures, pretending its me


10. videos


11. videos, pretending its me


12. going to amusement parks, bars, anywhere where vomit is likely to occur


13. working in a hospital or detox ward


Hope this helps. I should be finished with my hierarchy by the end of this year, although the timeline is subject to change.

[carri]

Thankyou for your help!!!!


Thankyou for sharing with me.


It is comforting to know that other people are having therapy..hopefully successful. It is quite daunting, but I really want to get over this phobia!


[img]smileys/smilies_01.gif[/img]Carri

[kimb]

I tried exposure and it really did feel like it was working. I had to stop because I moved to another city but I am seriously considering finding someone here who can help me because my phobia is so bad. I think exposure is a really good therapy for this phobia.

[veebum]

I dont think I can put up with that kinda exposure, it is because it looks like theyre in so much pain that I it scares me to think about it.. can I just ask you guys what degree of this phobia were u at before the program? like were u really scared of it to the point where you can't even mention the word v*? Just wondering.. cause I might go into therapy for this.

I can watch videos of ppl v*-ing as long as its not TOO graphic, im a little bit more disturbed with still pictures...I dont mind hearing ppl gag or v*. I dont mind if ppl are v*-ing alcohol... just ... REAL v* and having to deal with that one day I might v* and Im going to get panic and anxiety attacks. Its really the panic and Anxiety thats killing me

[gumdropper1]

One way to get desensitized and to quickly learn what kinds of pictures make you more desensitized than others is to visit Rate My Vomit. They have a gallery of close to 1000 pictures. The pictures of vomit itself make me nervous, but the pictures of people vomiting don't. You can view them in gallery mode and then click on the ones you'd like to see more detail on. As you go throuh the site, some of them become routine to look at (meaning you've become desensitized to them) while others still cause anxiety. Those are the pics to work on.


The gallery: http://www.ratemyvomit.com/?action=g


Doug

[kel12347]

Veebum, before I started my exposure therapy, I was going through an extremely rough time with my emet. I was having panic attacks every day, I lost 15 pounds because I couldn't eat, and I had high anxiety all the time. I started medication (Prozac) and exposure therapy at about the same time. I WAS scared to the point where I couldn't mention the word v*. Now, with exposure therapy, I can say all the words for vomit, with very little anxiety. Hell, I can even make jokes about it. I've still got a long way to go, but the exposure therapy is working.

[happyteacher]

Veembum,


I have a SEVERE fear of other people vomiting and a mild to moderate fear of myself. Exposure is very difficult, but you need to do things that are difficult in order to get well.


I started out shaking for 40 minutes before I could even look at a simple picutre and I had anxiety for 2 days after. I kept at it and now I will be ready to move on to looking at motion soon. I can look at most pictures now without even batting an eyelash! i have come a long way!


Be careful looking at www.ratemyvomit.com. Many of the pictures are VERY disturbing. I don't recommend looking at it yourself. My husband screens the picutres for me.


happyteacher

[gumdropper1]

Just to clarify about ratemyvomit.com. I don't recommend that you go through it picture by picture since it shows them randomly and you don't know what kind of picture is coming. I think it is more helpful to view the site in gallery mode by going to the gallery: http://www.ratemyvomit.com/?action=g


Then you can see the picture in thumbnail form where you can't see much of the detail but you can get an idea of what is happening in the picture, and then you can click on it. Then you go back to the gallery, and so on.


You are right, happyteacher. It can be very shocking when a very explicit picture shows up on your screen full size. It is better to take small steps and only look at the pics you think you can handle. Like I said, I can look at the ones where someone is vomiting, but the ones that are like closeups of the vomit itself cause me anxiety.


Doug

[carri]

Before I started therapy I had managed my phobia for over 30 years!! It had been easier in my twenties, maybe just my stage in life where I felt more confident. Not sure. But I had a really bad incident with my daughter when she was 5 and it made me realise I had a problem. I lost my mum 3 years ago and a lot of stuff turned to custard for me. As you all know there is usually some history attached to this phobia!I also wasn't able to find anyone in the town I live in that would help me through this, I started to investigate..and I found this site and a wonderful therapist who has been helping me through a whole lot of 'stuff'!! She is amazing and I trust her whole heartedly..I have shared with her bottled up emotions that I have stored for years. She has helped me grieve and understand this phobia! We have been doing EMDR and although I am not sure if it is helping I want more..because this has been over so many years it will take a while to sort. One day at a time.


I wasn't having panic attacks but I was avoiding so many situations..I still do. I am now tired of my irrational mind controlling me!


I only see my therapist for 1 hour once a week..so it will take a while to recover, but it is my goal.

[happyteacher]

carri,


However long it takes, I know you can stick with it and do it. 30 years of avoidance behaviours takes a long time to unravel!


gumdropper1,


I'm like you, I have a big problem with picutres that have "splatter factor" on the ground. The good thing is that my big problem is almost not a problem anymore because of my therapy. Good luck with your exposure.


happyteacher