My CBT Treatment

[orton99]

My first CBT session was today so I thought I’d say how it went and then update each week so that people who aren’t too sure what CBT is can hopefully see how the process works. It will be a bit stop-start at the beginning as I’ll have to miss a session in two weeks while the therapist is then away for two weeks at the end of June/start of July, but I’ll update when I can. Today went pretty much as I thought, as it was more of an introduction with me telling her as much as I could so she knows exactly what it is we’re dealing with and what thought processes and behaviour need to change. I was told at the end to keep a diary for the next week about any anxious thoughts for discussion next week. Anyway, by way of introduction to this thread below is a summary of what I told her about where I am with this phobia right now.

I’ve probably been phobic about this since the age of 10 (the last time I was actually sick), but for most of time it really hasn’t been a problem and hasn’t affected my life too much. In fact, a few years ago I started referring to it in my mind as my “theoretical phobia” as it never got tested and I used to think that if you’ve got to be phobic about something then it might as well be something that you never have to face!

However, that ended earlier this year when I suddenly started experiencing the worst manifestation of it that I’ve ever had. February and March were utterly miserable and exhausting, from waking up every morning with the thought that I’d have to make sure I didn’t vomit that day (the relief of waking up to realise that I wasn’t ill during the night would be instantly wiped away by the clock resetting to zero in my own Groundhog Day as the focus then switched to not being ill at some point in this new day) to questioning pretty much everything I ate (especially anything meat or fish-based, imagining that it “tasted funny”), to endless hand-washing and distressing psychosomatic symptoms (phantom stomach aches, “sharp” feelings in my cheeks) which made me worried that a bout of nausea was coming.

It has eased to an extent since the start of April, probably because I’ve started a little bit of DIY CBT, for example by challenging myself to not wash my hands quite so much and pointing out to myself that all these psychosomatic symptoms, however much they may have talked the talk, weren’t exactly walking the walk by developing into anything. Once I thought that - hey presto! – these physical “symptoms” haven’t been so prevalent, which also strongly suggests they were/are the product of my mind, not my body! The general therapy I started in February to try and uncover the causes has helped as well, as I’ve realised just how anxious I am about a whole range of things (my therapist’s view is that the phobia is a metaphor for other, emotional things that “aren’t coming out”, to counterpoint the phobia in itself which is of course a fear of something physical “coming out”!) and talking about all other various causes of worry and anxiety is certainly beneficial.

However, the last month or so has seen a bit of slippage as the weather has warmed up. The reason for that is phobia by association, as I was very nearly sick on a Tuesday night last August (for the first time in over 27 years) when I caught a stomach bug from a family member. I run four times a week and did so that night and although I’m certainly not going to stop running stepping out of the door on a summery evening does make me feel a bit anxious in case “history repeats”. What’s more, I’ve been reluctant to wear the same top I wore that night (either the one I ran in or the one I changed into to play football later), to do the same session (running up a hill 10 times) on a Tuesday night or even to drive forward into a parking space (I’ve reversed in ever since) at the sports centre as I did that night, all in case doing the same things produces the “same result”. My rational side knows that’s nonsense but my irrational has the upper hand right now. I even went as far as being edgy earlier this month on Tuesday 10th, as May is the first time since August that the 10th has fallen on a Tuesday, while I’m currently already anxiously looking ahead to Tuesday 9th (a year since the day) and Wednesday 10th (a year since the date) of August this year and just want to get past these two “doom-laden” dates.

That near miss last year really shook me as it showed that I wasn’t as invincible as I’d thought and so I definitely felt my anxiety levels rise. I wasn’t being phobic every day yet but I was starting to think about it more than I had for years. With hindsight I was teetering on the brink and all it needed was one good shove to push me into the phobic abyss, which duly arrived when my Dad passed away just before Christmas. This didn’t have an immediate effect (although sad, his death wasn’t a huge surprise and I thought I coped quite well), but a couple of weeks after the funeral I suddenly became hyper-aware of a few people at work who’d been off with stomach bugs and realised I was absolutely terrified I’d catch something and be returned to (as I saw it) the horrors of August. Goodbye normality, hello Emet City. The pattern of underlying stress being expressed in this phobia has been seen before (and also in a few other ways health-wise although they’re not the subject of this post!) and here I was again.

Anyway, that’s where I am right now. Hopefully that will all change as the summer progresses and I’ll post again next week after my first “proper” session.

[Tasha'93]

Firstly, i'm so glad you're finally in therapy; so the wheels are definately in motion now, as they say. I think it's good that you're being made to keep a diary of what anxious thoughts you're having so you can share them with her, challenge each little thought so that eventually if the thoughts repeat you'll know how to handle them, nice!

- I wont write too much here as this is your thread but good luck with it and definately keep them posts coming and make sure they're as detailed as they can be!

P.S. I'll keep you posted with mine starting on Tuesday

[olschesky]

really enjoyed reading your post......cant wait for the next installment......see alot of myself in your writing...

good luck

[orton99]

So after a week of diary keeping to track my various anxieties and scares it was back to the therapist today to compare notes in my first “proper” session.

To begin with she went through how the treatment will work, which funnily enough I already feel quite familiar with given that I’ve been reading around the subject of CBT and phobias in preparation. (Incidentally, I can really recommend “The Anxiety and Phobia Workbook” by Edmund Bourne which I recently bought from Amazon. I’ll probably post on this another day when I’ve finished reading it, but suffice to say I’m finding it really useful.) In short it will focus around two things, both of which reinforce the other.

• Challenging the negative/anxious thoughts I have as a result of the phobia.
• Exposure to some of the situations so I see that they aren’t as scary as I’m fearing.

In essence, the above is the phobia. Because I’m anxious about a situation I will avoid it or at least change my behaviour compared to how someone who isn’t phobic would react. Bit awkward but it keeps me safe, right? In the short term maybe, but in the long all it does is reinforce the phobia as I’m telling myself that there’s something to be scared of, as I keep doing specific things to avoid it. Therefore, I never get exposed to these situations and so never see that they aren’t actually scary at all and so the phobia gets maintained. “Safety” in this context is actually just a cruel illusion and isn’t helping me at all.

For example, below is one of my diary entries for a scare last week. As you’ll see, it’s very structured as a way of pinpointing exactly what thought patterns and behaviour need to change. My therapist was quite pleased that I added the two bottom lines myself, that of questioning my assumptions and recording the result.

Situation: Man ahead of me in queue at Drs (ironically as I waited for my first CBT session!) said his elderly parents has both been up last night with v&d.
Thoughts: Worry he hadn’t washed his hands since dealing with them and was “infecting” door handles etc which I would then touch and get ill myself.
Emotions: Quite strong feeling of anxiety. Was on my mind for the rest of the day.
Physical symptoms: General feeling of tension, although mine only get bad if I feel really ill. Otherwise, tension is more mental.
Behaviour: Pushed the door handle to leave with my elbow (!) and then changed the shirt anyway, reasoning that avoiding touching that sleeve all day long would be too difficult and it would be a lot easier to just change. Washed hands twice for rest of day before eating anything.
Questioning: He may not have had any physical contact with them at all. Even if he had, my fear rested on him not having washed his hands since which he could well have done. Both ill together – more likely to be fp? My Mum works part time at a Drs as a receptionist twice a week and has never caught anything from there (as far as I know), despite opening and locking up each time. Yes, she touches door handles!
Result: As of a week later, I haven’t come down with anything.

That one is pretty standard, both for me and probably for most people on here. In fact, with hindsight the stupidest thing I did in relation to this phobia was Google “how infectious are stomach bugs” when it all started back in February because if I hadn’t done that I’d never have known that noro can live for days and days on surfaces, so causing me to wash my hands after touching almost any public surface. I commented today that if I hadn’t read those wretched internet articles then half of the diary entries could be dismissed at a stroke as they’re based on how there “might” be noro on that door handle, so I “have” to take precautions accordingly. Then again, I wasn’t always so hyper-aware of the “ever-present” “risk” of noro, yet strangely I never went down with it in all those years when I wasn’t so obsessive about hygiene. Food for thought!

It also occurred to me the other day (and again my therapist agreed I was on the right track when I told her today) that part of the problem here is the attempt to 100% guarantee that I won’t get ill. For example, the situation above concerned me in that I might have been exposed to something, so I washed my hands twice before eating anything just to make sure. But that’s a mistake, because you can never fully guarantee anything like that and you end up with these ultimately unanswerable questions that just overwhelm you. How do I know that person ahead of me hasn’t had a bug recently? Yes, but how do I know? Have they washed their hands? I think they’re pretty clean, but how do I know? And so on. You can’t ever know for sure and it’s chasing this chimera that keeps you scared as you want something you can’t ever have and ultimately get led down a path of madness as you keep chasing it regardless, your behaviour getting ever more obsessive as you go.

The non-phobic meanwhile reasons that they’ve never actually caught a stomach bug from someone at work (despite the fact that someone was off ill with it and has only just come back today) and so they don’t need to know. They’re happy with “well, it’s never happened before so I’ll probably be okay”. And why can they happily substitute that “know” for a “probably”? Because their next thought is “if the worst happens and I get ill, so what?” rather than our “I cannot get ill because it’s the worst thing ever so I must 100% guarantee that I can’t possibly get ill”. It may well be a lot easier said than done, but it seems to me that being able to live with “probably” and not insisting on guarantees is the whole crux of this.

Okay, enough for today. I was given a task to do for next time, of trying to summarise my diary entries for the past week into a diagram so we can easily see what themes and situations keep coming up and can go from there to try and work out exactly what paths the treatment needs to take. I won’t actually be able to make next week’s session, but I’ll work on the diary analysis and post my thoughts here in a week’s time anyway.

[rachel1989]

This is very interesting Orton- your experience and situation sounds similar to mine. Your thread about the v* streaks was interesting too. Please keep us up to date with your CBT. x

[sage]

Thanks so much for writing this. Your therapist and you both seem like you're on the right track! (If it works out well for you in the end, please PM me with her name and location so I can recommend her to others from there - thanks!)

[orton99]

Wow, I've got Sage's attention - thank you!

I'm actually seeing two therapists right now, the CBT one I'm directly talking about on this thread which is through the NHS and a private one I've been seeing for three months or so which is more general therapy. I started seeing her as an attempt to work out the causes of the phobia as a means of preparation for the CBT but it has since evolved into much more general discussions about anything that makes me anxious.

I'll happily supply their names in due course if it would help anyone else though!

[orton99]

As I said last time, there was no session this week as I couldn’t make it (dental check-up), although I have now done the exercise I was asked, of summarising the diary so far and analysing the (if we’re being honest) 10 pages of phobic ravings that they represent.



In no particular order, the points I identified were:

• Over-reaction to any perceived threat of a stomach bug, with no mitigation as I must keep myself “safe”.
• Imagination is key. The example I gave last week was textbook, as I speculated on what had happened and almost instantly decided that this was “fact”, or at least took the safety first view that I would be better off assuming so.
• A lot of the anxiety is anticipatory, thinking “Wouldn’t it be awful if I was right about xyz and I did catch something…” suggesting a failure to live in the moment. (All so far, needless to say, have come to nothing.)
• A worse example of imagination in overdrive is the “touch touch” principle (see below), which accounts for an awful lot of the scares. But again, it’s largely imaginary. I don’t know how far these speculative chains of logic actually stretch, but simply assume they go on and on, so my anxiety similarly goes on and on.
• Psychosomatic element. I’ve apparently “smelt” vomit in so many places in public since February. I never seem to see it, but again the safety first mentality kicks in, as I assume it is around somewhere and so have to take precautions accordingly, thinking that I might have touched something that had it on etc. My rational side knows that I’m taking the law of averages to absurd extremes by supposedly keep on smelling it (the town centre on a Sunday morning aside I'm actually struggling to remember the last time I saw a pool of vomit in public) so am I just imagining it all or perhaps taking anything that smells a bit “sharp” and simply filling in the rest for myself?
• Food Poisoning – Looking for it. I must’ve thrown more food away in the past 3 or 4 months than the last 3 or 4 years! Excessive caution.

I think they’re clear enough by themselves, but I can summarise them still further as:

• Need for control, whether it’s my environment (ie excessive precautions if I think someone has a stomach bug) or by what I eat (hyper-awareness of food poisoning).
• Hyper-vigilance, seeing (metaphorically or literally) it almost everywhere.
• Imagination. A lot of this actually rests on things I don’t know for sure, which is kind of ironic given how much this is about control and being definite all the time…

"Touch-touch" incidentally refers to the tortuous and torturing logic that goes, "Suppose I stepped in some vomit in the street, so it's now on the bottoms of my shoes. So I go home and track it inside, putting it on the floor. So anything that goes on the floor also picks it up, as would I if I touched something that had touched the floor..." You get the idea. As I said last week, the single most ill-advised, badly thought through and simply stupidest thing I ever did with this phobia was to Google stomach bugs when it all started, so giving myself the idea that noro is everywhere. In short, if noro didn't exist then the insanities of "touch-touch" wouldn't exist either.

This also brings up the point that you can sometimes have too much information. Before this all got bad I must have (by current standards) been at "risk" of noro all the time yet I never caught it. However, once I was "armed" with the info, I can't stop thinking about it. By any measure, I feel worse for having researched noro on the net, not better.

Still, there are a couple of causes for some optimism. Firstly, I've nearly finished the Anxiety Workbook I referred to last time and much of it chimes with what my private therapist says, that anxiety is overcome by a holistic, multi-treatment approach and not a simplistic, "That's the cause of the phobia so go and tackle that." (An early chapter talks of ten risk factors for developing phobias and anxieties and I ticked seven of them!) In practice this would mean that, say, working on control issues (whether directly linked to the phobia or not) would by definition have a positive effect as control is part of it. I see the treatment as not so much searching for the key to fit the lock but more as a war of attrition, wearing the phobia down by attacking its constituent parts in a variety of different ways.

The second (and final point for this time) is that a lot of the scares, however threatening they are at the time, seem a lot less so the following morning, especially if it's on to the new day's worries. Now by the "rules" of exposure to stomach bugs 24 hours may well not be long enough to feel fully in the clear yet I am (up to a point) thinking that. Plus, I really mean the second point, in that nothing makes me forget yesterday's scare than today's new one, in spite of the fact that yesterday's may still be technically "valid".

What this tells me is that however I may perceive the "risk" of a particular situation is actually not the whole story and this is as much about almost the habit of thinking this way as any actual "risk". That in turn tells me that this really is just rogue thought patterns, which is encouraging. When this phobia is just fear it's hard to get a grip on - where do you start? - but if I can see it for what it is (thought patterns) then it all of a sudden looks much more manageable and beatable.

[emmalinda]

i never realised treatment involved so much work. keep it up. i thin you will pull through it! i have the card of a physocologist with me but im too affraid to call and make an app. incase she will make me do cbt. but it doesnt sound to bad.

[orton99]

Bear with me kids, this is gonna get complicated…

Okay, so I started by explaining about my summarised observations about my diary entries and we agreed that it all seems to come down to control. But then I was pressed further on what thoughts go through my head if I contemplate the prospect of being sick and what it would mean to me.

Firstly, as also picked up in my general therapy, there’s a strong element of perfection in this, that my body is never meant to let me down (to all intents and purposes the only illnesses I have are the occasional cold and even they pretty much stopped once I started running regularly), so it’s almost a fear of the unknown. Hardly a surprise, as the near miss last summer notwithstanding I haven’t actually been sick since 1983 so it’s understandable that over the years being sick has become the lost human experience, this alien, foreign thing that I can scarcely relate to and so can’t grasp and deal with.

Perfection is also seen in the concept of streaks, which I posted about when I joined the forum. (Check out “A Solution the Problem of Streaks?” on page 4 of my old posts if you click on my username.) I know some will regard my view as controversial and maybe even heretical, but I’m now more convinced than ever that streaks are a terrible idea and do much more harm than good. Actually being sick w0uld be awful because my perfect streak gets ruined so this definitely feeds into the phobia, as I’m giving myself this reason why being sick would be bad, so a reason to avoid it and so, ultimately, a reason to be phobic. I came up with the wretched idea of streaks all by myself (although it’s very common for emets of course) at the age of 5, when I was ill over my 5th birthday and resolved to go as long as I could before I was next sick. As it happened I went well over three years to the age of 8, but then started “counting” again straight away. It was quite frustrating that I then couldn’t even go a year at first, as I was sick at the ages of 9 and 10 as well. I wouldn’t have known it at the time, but the very notion of counting and streaks would have been embedding in my subconscious that being sick is something dark and sinister, that must always be avoided and special efforts must be made to do so. As a breeding ground for a phobia, that’s pretty much perfect.

There’s also clearly a feeling of control wrapped up in it as well, as the very act of being sick sees you not in control of your body for those 10 seconds or whatever, not to mention the doomed feeling of inevitability if I feel really queasy, as I desperately don’t want the next thing (being sick) to happen, but am powerless to stop it. In short, I’d want control (to stop the nausea) but can’t have it.

But there’s something else, one more level to go, and this is where it gets strange….

Around the age of 9 or 10 I came up with a bizarre thought experiment that put huge significance on the day I was last ill. My thought was that even if I had a time machine I couldn’t go back to a day before I was last sick, as to get back to now I’d have to go through that awful day again. (Please disregard that 1. Time machines don’t exist and 2. That even if they did I could use them to hop over the day in question so solving the problem as neither are the point here!) What this means is that anything that happened before I was last sick is somehow tainted and lost to me because I could never go back to it. For example, I could watch old news footage of something that happened in May 1983 and would inwardly shudder slightly, knowing that there’s something “wrong” with that time as it’s blocked off by what happened the next month in June. Show me footage from say May 1984 however and there’s no problem, as I’m free and clear and could time-travel back to it with no concerns whatsoever.

Yes, obviously time-travel isn’t real, but I think it’s a metaphor for how I relate to the past and how I don’t want happy memories spoilt. Where it comes from I’m not entirely sure, but I’ve got two suggestions. One is it’s a lingering echo of Dad leaving when I was six (a subject that comes up again and again in my general therapy), as I do (just about) remember “normal” family life before my parents separated but by and large the future of Dad being there all the time never happened, so I’ve ended up placing almost over-importance on the precious few memories I have got of him being there all the time during my early childhood and so by extension over-importance on all happy memories, deeming that they must never be “spoilt”. The second is that my worst bout of sickness that I remember was that time over my 5th birthday and so the experience of having (for that year at least) what should have been the highlight of the year getting spoilt by illness has also left me fearful of good memories getting “ruined”.

Anyway, that’s it for today. I think I’m really onto something with the time-travel concept and will discuss it with my other therapist next week, as I’m sure it’s important. I’ve always known it was there but could never work out where it came from until I said it out loud today and had the sudden revelation of those two ideas as to what might be behind it. But I do think that this may well be the heart of it and that good memories getting spoilt is what I’m really afraid of here and so what the phobia is actually all about.

My CBT therapist is away next week, but I’ve already started a bit of low-level exposure so will keep doing so and update on that in a week’s time. However, there is one specific reason why I’m looking forward to my next session in a fortnight as I really want to see how I’ll feel. You see, it’s 30th June. That’s my date, back in 1983. The last time it happened. Better yet (and I’ll just look up my diary from then to save everyone Googling this), I can say that 30th June was a Thursday in 1983 as well! I’m not scared of this as such, but am interested to see how I’ll feel in a fortnight’s time so I’ll see how it goes and include that in the relevant update.

Admittedly though, whatever else may or may not happen in a fortnight, I probably won’t be going into the town with Dad after school to spend my birthday money on a couple of Star Wars figures as I did on that day all those years ago….

[sage]

Hi Orton99,
Just a quick response since you asked me for one. And unfortunately I really can't comment much...since I'm not in the room with you to ask you more about certain aspects of your thoughts.
A general comment (that applies to everyone, really) is not to focus too much on explanations for the phobia as there are many factors that will have contributed to it. And even if you're perfectly mentally (emotionally) healthy now, the phobia can be "leftover" from a time when you weren't. Meaning, your brain still reacts with fear whenever you experience the "trigger" (feeling sick, someone else being sick, a certain date approaching...whatever it may be).
Good luck with your therapy and thanks again for posting all this for us. It's really enlightening!

[Morgan16]

So what I'm hearing is that the only way to get over this phobia is to seek treatment? Are there things some of us can try at home? I used to struggle with severe panic attacks. I went to see someone for those, it helped. A lot of what I'm reading are some of the same things I did while trying to control my panic attacks. Can these be tried for other phobias/fears?? I learned it is about realizing that you won't die, you can get though the panic attacks, don't fight them, let them come, trying to fight them off only makes them worse. I have read in other posts things like " what happens if I V*" what is the worst thing that will happen? They are right, what is the worst thing that will happen? I won't die if I V*.....I'm glad I found this site. Good topics, I hope we can all help each other !!

[hannahk86]

Hey, how are u gettin on with the CBT? I've had 3 seperate CBT courses and none of them have worked for me, the last person I saw told me to go away and look at people being sick on youtube! This really didn't help, I couldn't sleep for 2 nights because I couldn't get the image out of my head

[Morgan16]

I didn't get CBT. At least not for the Emet.

[Fishies]

You have motivated me to sit down and do some "Anxiety and Phobia Workbook" homework tonight. It's such a big book!!!!

[orton99]

Okay, session number four today and we’re now past the purely information gathering phase and into planning some activities to do. (According my therapist that’s about right for CBT, in that the first few are more theory and the practice comes after three or four meetings.)

Ahead of this week I was asked to come up with my anxiety hierarchy, which for those who don’t know is a list of 10 things that you avoid due to the phobia, with 1 being the least scary and 10 the worst. This gives you a list of things to start gradually exposing yourself to and so a plan for attacking the phobia. My 10 situations are:

10. Being sick myself.
9. Feeling strongly nauseated.
8. Being around a family member who has a stomach bug.
7. Seeing vomit in the context of a public toilet/seeing someone be sick.
6. Doing the same thing (eg wearing the same clothes) in case “history repeats”.
5. Being around someone at work who has just come back from being off with a stomach bug.
4. Excessive caution re food, such as sell-by dates, how long it’s been in the fridge, smell etc
3. Seeing vomit in a probably alcoholic context, eg outside a pub on a Sunday morning
2. Using the water cooler at work if someone has recently been off with a stomach bug.
1. Flinching when I hear the words.

Most of them should be pretty self-explanatory with the possible exception of No 2. This is about worrying if someone who has recently come back from illness is unhygienic and hasn’t washed their hands after using the toilet and they’re the ones that change the next bottle so they take the label off and so touch….yes, I know. Some reading this may have started off by nodding in understanding and then got a bit puzzled as to exactly what the concern is here and that’s my view as well. I’ve described this fear to both my therapists as “a bit flaky” as even I think it’s more habit than based on actual evidence which is why I’ve ranked it so relatively low on the scale. The reason for splitting the “vomit in public” one in two is because they are completely different. A pool of it outside a pub is of little concern as it’s almost certainly due to someone’s excess alcohol so isn’t contagious, but if it’s anywhere else I don’t know the reason and so it is a cause for anxiety.

We agreed that before next time I would practice writing down the various words, saying them out loud and make a tape of myself saying them so I can listen to them over and over. The idea is that I will then do these exercises over and over again until I’m comfortable with each situation and can then move onto the next one. Another key part of it is keeping an “exposure diary” so I can note how I felt before I tried any of these experiments, how I felt afterwards and so on. I’m happy enough to have finally got started and do feel ready to start tackling this head-on, as even though it may cause anxiety in the short term anything has to be better than being obsessed with this phobia as I have been over the past five months.

Incidentally, I mentioned last time that today is the day, Thursday 30th June, as that was the exact date all those years ago in 1983 when I was last actually sick. So how do I feel today? Not too bad actually and in honesty I didn’t really expect to feel bad. I do remember being quite anxious on the very first anniversary in 1984 and again the first time it next fell on a Thursday (1988 I think if you work it out), but in truth there have been so many 30th Junes since then (including a further two Thursdays before today) that have obviously passed off without incident that the significance of the date has long since become less a fear of history repeating and more of giving myself a pat on the back for chalking up another year.

However, that’s the one thing I am not feeling today and have no intention of doing. I referred in an earlier post to what I think about streaks and how damaging I now think they are, so I’m taking it as a step forward that I’ve no interest this year in “celebrating my anniversary”. Sorry folks but I’m just not going there, not anymore. The point of this is to start to get better, not keep doing the same things which have maintained the phobia for so long!

The date I’m instead focussed on this year is Tuesday 9th August, as that would be a year since the day of my very near miss last summer and the day I’ll be scheduled to do some of the same things I did that night, such as play football at a local sports centre from 9-10pm (I had to drop out halfway though last year as I felt too queasy to continue) and, if I stick to the training, run beforehand as well. Although I am already quite anxious about that date for fear of history repeating, I’m also aware that the whole principle is No 6 on my list and so it would be a perfect opportunity to test it out by deliberately wearing the same clothes, eating the same food, doing the same thing etc. My therapist thinks that’s a great idea and so do I, albeit with a bit of anxiety-fuelled reluctance at this stage!

Still, if the exposure goes well over the next few weeks, will I feel much more confident and able to face deliberately doing the same things on “the” night? It’s certainly a goal worth aiming at…

[Tasha'93]

I must admit unfortunately I haven't been following this thread religiously due to a couple of reasons (mainly that i've been a bit too preoccupied to even come on the internet at all!), but i've just read your last post and am still keen to know how you're getting on. I like the thought of making a video of yourself saying the words over and over again until eventually they don't seem abnormal, so to speak! I also am in complete agreeance with you about seeing vomit outside of a puv for example, I also don't feel too anxious seeing it as the most likely reason for it is alcohol related, which is somewhat a relief.

Keep the posts coming, I think we all want to see your progress. - I wish I could say more about mine but I have been referred to a different team now due to my age, which doesn't start properly until the 4th of next month. I guess it's not too far away though, so that's good. Chat soon Andrew, hopefully

[orton99]

So today was a review of how the exposure of last week went, ie writing down all the words and phrases I could think of associated with being sick and then saying them out loud.

I came up with 40 or so and did feel a bit apprehensive as I began, as I wondered if saying them all would make me feel a bit queasy in itself. I didn’t seriously think I would make myself ill (!), but thought I could do without the hassle of feeling a bit psychosomatically queasy. However, in the end it was actually quite easy to do. I’ve spent 15 minutes each day for the past few days going over and over this list and it is actually more boring than scary! I read it out to my therapist this morning and asked her to watch my expression to see if I flinched at any point and I’m happy to say that she says I didn’t!

One thing I did notice once I’d been over my list is that it was very general and wasn’t personal to me, as despite all the phrases and slang expressions there was nothing like “I feel sick”, “I think I’m going to be sick” and so on. I did then think about putting some in but also thought it might be a bit too difficult at this stage, as if I feel ill one thing I deliberately don’t do is say (or even think) the dread phrase, “I’m going to be sick”, as it runs so counter to all the efforts to try not to be! It’s as if admitting it and saying it out loud represents giving up on stopping it happening, which is the last thing I’d ever do.

However, after discussions with my therapist we agreed that I would try to repeat the exercise with a more personalised list this coming week, just to see how it makes me feel. We also agreed that I’d start looking for scenes in movies on YouTube to see how I felt about watching them. Although I’ve never liked seeing vomit scenes in films I’m not as bad as some on here, in that I don’t refuse to watch a film with a scene in it and I’ve never had to turn the DVD off or leave the cinema if it happens. It is true that I did jump out of the chair when I was watching The Fly some years ago and Jeff Goldblum suddenly vomits (although at least he has the good grace to apologise to Geena Davis after doing so!) albeit that was as much down to it being very unexpected as what he was actually doing.

Still, regardless of how bad or not I find such scenes to watch, the point is why I don’t like them and it’s down to feeling very relieved that it’s not me being sick which in turn makes me feel uneasy as I’m confronting my own mortality if you like and being made to think about the possibility that one day that could be me in that situation. And that’s what both the personalised list and YouTube viewing are intended to achieve, to start to accept the idea of being sick as part of life and something that unfortunately happens sometimes rather than always avoiding even the idea of it, let alone actually being so myself. After all, that’s one of the side-effects of this phobia, in that you avoid the whole subject so much that being sick becomes this alien, horrifying prospect simply because you almost lose the ability to understand and deal with it. Not being sick for so many years does have its drawbacks!

So that’s where I am today. I think that certainly the personalised list will be more difficult to read out loud than the more generic one was, but if it helps demystify the concept and so desensitise me I’m all for it!

[sage]

It's so great to have this thread which is almost like a blog of your experiences! We should encourage other people in treatment to do this - it's SO enlightening for people who are afraid to try.

Emmalinda: call the psychologist! Remember they can't MAKE you do anything you don't want to do! YOU are paying the money. The only "waste of money" should be the very first session when you ask honest questions and ask exactly how treatment will go. Good luck!

[orton99]

It's so great to have this thread which is almost like a blog of your experiences! We should encourage other people in treatment to do this - it's SO enlightening for people who are afraid to try.

Emmalinda: call the psychologist! Remember they can't MAKE you do anything you don't want to do! YOU are paying the money. The only "waste of money" should be the very first session when you ask honest questions and ask exactly how treatment will go. Good luck!

Thank you for the kind comments and for "promoting" this thread to a Sticky!

I did have a sort of blog in mind when I started it as I want to go into as much detail as possible with the intention of giving people who want to get treatment but don't know what it entails as much help as I can. After all, seems a bit of a waste to (hopefully) go through this process successfully but then not tell anyone how I did it and what I had to do!

No update this week by the way, as my therapist is away so I've just been getting on with stuff by myself and will update again next Thursday/Friday when I've spoken to her again.

[orton99]

First post in a while from me, as a combination of holidays and even a day off ill for my therapist (!) have meant that I haven’t actually seen her since 7th July. Instead, I’ve just been getting on with stuff by myself in the meantime. The big step forward for me has been the way my thinking has been changing recently, in particular by having some really heretical thoughts…!

The first one is starting to rethink how I view the days I was last sick (or nearly in one case). The two dates I focus on, as I’ve mentioned before, are 30th June 1983 (the last time I actually was sick) and 10th August 2010, when I very nearly was. I had always shuddered at the memory of those dates whenever I’ve had cause to think about them, as if they are irreversibly tainted by what happened. Okay so far so emet, but my thinking now is that neither day was all bad. In fact, there was nothing wrong with either of them until about 8pm in the evening. And even then, I was only uncomfortable for a few hours. Before, my reaction to seeing, hearing or writing “30th June 1983” had always been akin to a medieval peasant crossing themselves whenever someone mentioned witches, but now I’m pointing out to myself that it was actually a nice day overall, as I went into town with Dad after school to spend my birthday money and got some toys and books that I liked, so it’s just a shame that I had to go and puke a couple of times later.

Wow!!

A non-phobic may read that and wonder what all the fuss is about, but for me to be rationalising those days is hugely significant as we all know how important the “last time we did it” is to us and the sort of phobic mythology it generates. To be thinking this way now is to start to cut the phobia down to size and get it in proportion. But if you think that’s heretical, just take a look at this next one…

I was doing my daily CBT exercise (see below) and suddenly thought, “This is all in preparation so I’m not so scared the next time I am sick”.

Er, scuse me? Yes, needs repeating doesn’t it? Okay, word by word – “This is all in preparation so I’m not so scared the next time I AM SICK”.

Oh my word. Where did that come from??!!! In fact, I was so at ease with that thought that, like a child with a new toy on Christmas morning, I just couldn’t stop thinking it and kept going over and over it, amazed at how easily I kept doing so! For so many years my unspoken assumption had been that I would probably never be sick again and that was great because I never wanted to be and my streak had to last forever and…. And yet, to now be embracing and accepting the possibility (or should that be inevitability?) of it happening in the future is just such a massive step forward. I did recognise at the start of therapy that the reason I was so shaken by the near miss a year ago is that I probably did think I’d never vomit again and so couldn’t deal with it (nearly) happening. However, even though I said out loud that such a thought “was probably unrealistic” in early therapy sessions (and note even then my hedging use of the word “probably”), in all honesty I had my fingers crossed behind my back as I said it as I still didn’t want to accept that such a wish was unrealistic.

True, I’m still not yet about to grab that glass of saltwater with a cheery, “Hey folks, let’s go throw up!” but this is all about one step at a time and all of the above feels so significant and important. In fact, I probably haven’t embraced the reality of vomiting again at some point since my phobia crystallised at the age of 10, so to be changing a thought pattern that’s been around for the best part of 30 years feels very liberating!

So what have I been doing to bring this about? Well it’s not rocket science, just a list of phrases that I’ve written down and spent 15-20 minutes each day repeating to myself over and over. Phrases such as, “I feel sick” “I think I’m going to be sick” and “I know I look really pale. I don’t feel good either”, all of which are getting myself used to the idea of saying it out loud which I’d never dared to do before. However, I’ve also been reading from a second list I drew up which has been just as important. This is more positive and includes phrases such as “Being sick doesn’t harm you. It doesn’t kill you!”, “Being sick simply means I’m uncomfortable for a few hours”, “Those few hours have no bearing on the past or future. The only influence they have is on that day” and “My streak is irrelevant, it won’t make me a bad person if I am sick”.

The key points here are the last two (and others in my list like them) as they are rationalising and putting in proportion all the harm that streaks do and in particular my “time-travel” concept (see post dated 16th June) which is bound up with it and is I think a very large part of the phobia as I’m scared of “losing” happy memories with everything before I was last sick becoming tainted once it’s happened. In short, I’ve allowed those two dates in particular to extend their baleful influence way beyond the evenings themselves, which is just crazy. So, start to rationalise the dates and I start to unpack some of the emotional baggage that goes with it and come to see being sick as just an ordinary human experience. Not nice to be sure, but no big deal.

Anyway, I’ve just gone over the thousand word barrier again (!), so enough for today. If anyone’s interested I've pasted the full list of the phrases referred to above into a new post below - hope they help someone else!

[orton99]

Phrases

• I feel sick.
• I feel queasy.
• I think I’m going to be sick.
• If I don’t stop doing this I’m going to puke.
• I shouldn’t have had that last drink.
• Every step I take I feel more sick.
• I can’t get in the car right now as the motion will make me sick for sure.
• I can’t go out and run as I feel too ill.
• I look really pale, I know I do. I don’t feel well either.
• I can’t stop it, I am going to be sick.
• I am going to be sick.
• My streak won’t last forever. One day I will be sick again.
• To not be sick again until the end of my life is impossible.
• My streak can’t last forever.
• I just want to be sick as it will make me feel better.

Positive phrases

• Being sick doesn’t harm you. It won’t kill you!
• No one likes being sick.
• I’m not trying to be totally okay with it, just remove the anxiety.
• I coped in 1981 and 1982. I didn’t like it, but I coped.
• Even in 1983, both instances of vomiting only lasted a few seconds.
• My streak is irrelevant, it won’t make me a bad person if I am sick.
• Being sick simply means I’m uncomfortable for a few hours.
• Those few hours have no bearing on the past or future. The only influence they have is on that day.
• Everyone does it sometimes, it’s nothing to be ashamed of.
• My, say, good 1982 memories were already locked away safe and sound where the vomiting in 1983 couldn’t get at them. It never did taint them. It was all an illusion.
• Estimated time I’ve spent feeling really ill and/or being sick in the last 30 years is four occasions at an estimated four hours each. That’s 16 hours out of 262,800 or 0.006% of the time.
• Or, 262,784 hours when I wasn’t feeling really ill!
• Assuming I brought up the last meal I ate on the three occasions I was actually sick, that’s 3 meals that have gone down and come back up in 30 years.
• That just leaves 32,847 that went down and stayed down!

And finally…

I’ve also been writing out a particular sentence over and over. So far, I’ve filled two pages and written it 50 times…and counting!

• There was nothing wrong with most of 30th June 1983 and 10th August 2010.

[Orchid]

This is interesting. My thinking is I have to go back and figure out how I was feeling about myself when the phobia started, what might have triggered it and then fix those emotions and then the phobia will fix itself. For instance self-esteem, feeling out of control, perfectionism... That's what I'm digging into right now. Is that wrong to do? I guess I don't get how else to do it. I don't get the concept that thinking positive or not washing your hands, etc. will cure the phobia. I'm still learning, that's why I'm here.

[orton99]

Hi Orchid, I definitely think you're on the right track in trying to dig into the emotions surrouding the phobia and certainly in my case perfectionism is a big part of it so it may be for you as well.

The point about say not washing your hands (and this does assume that you're someone who does wash their hands more often than necessary to start with or this probably doesn't apply!) is that it becomes a safety behaviour which reinforces the phobia, as every time you do it when you don't really need to you're telling your subconscious that there is something to be afraid of as you're taking this precaution to avoid having to face possibly being exposed to germs every time. After a while of washing your hands a lot less but still not getting ill as a result you should start seeing the process in reverse, as you understand that there was nothing to be afraid of to start with.

Hope that makes sense.

[Orchid]

Thanks for the reinforcement of digging into my feelings as I've noticed you are doing as well, pretty deep at times I must say. I can definatley relate to a lot of what you're saying. I'm sure the handwashing and germkiller feeds the phobia but I just don't know if I could "not" do it, especially being in public and before I go to put something in my mouth like food or pills. This is the extent of my handwashing, tell me if it's too much. I wash my hands when I come home from almost anywhere(mostly public places-not necessarily people's houses), if I'm going to eat or take pills or cook, after I've touched dirty clothes or dishes, after shaking people's hands(esp. certain people), after I've touched farm animals(I have friends that live on a farm), after taking the trash out or cleaning the litter box out or throwing something away in a public trash can. I don't wash my hands at home except for the above(oh and of course after using the bathroom) and I don't wash my hands touching my own pets. In my mind it's just healthy to sanitize my hands in all these instances, what could I leave out?

[orton99]

A hard one to answer! Most of what you've said about hand-washing doesn't sound too bad to me, but I guess the point is that you need to ask yourself if any of the washing is excessive and work on cutting those that are. One litmus test would be to think of one of your situations and ask yourself how you'd feel if you didn't wash your hands and then ate something.

For example, most people with any grasp of hygiene would say "I'd feel a bit queasy if I emptied the bin and didn't wash" so that's okay, but if you find yourself freaking out after, say, simply touching the oven or fridge door while preparing a meal then chances are you're taking it too far and need to work on it. Or just look at it this way - ask yourself "Would someone who isn't emetophobic feel it necessary to wash their hands now?" and let that be your guide.

Overall though, don't get too hung up on hand washing if you really feel it isn't part of your phobia. If it isn't, don't waste too much time on it and concentrate on other areas that are. As far as "digging deep" emotionally goes, well, if I'm going to do this then it's got to be done properly!

[Orchid]

I like to view my hand washing as just healthy but I know there are times that others don't sanitize and I do and I do feel it's part of my phobia, avoiding bad germs so maybe I could look at it a little. As far as digging deep I totally agree with doing it right. Actually reading your posts helps me to keep in mind what direction I might need to go in also. Do you ever feel though, that you're going along and really uncovering some things and then you just stop and can't think anymore, can't uncover anymore, can't seem to find anything else but know there's something there? I've been there before. I also had a therapist that I liked and we were digging into things and piecing parts of my life together, I really found her methods intriquing. But I panicked one day on my way to therapy as I asked myself, "What will uncovering unresolved issues do to my body? Will it make me sick?" And that was the end of that, I had a panic attack every time I'd go to see her. Stupid thinking!! But I want to dig deep and see how things fit and figure out how to change.

[Orchid]

Very interesting! I can definately relate. I myself havn't come to that yet, that I will be sick some day as I have a streak going too even though to me, the streak isn't important, the vomiting is. I also look at the times that I threw up and what the day was like. One of the times in 9th grade I think back on because it was no big deal and I meditate on how I was feeling about myself. The last time, since I've been married I don't remember feeling phobic but I didn't feel the same way about myself so maybe it's worth looking into what that time was like in my life. I truly feel for me, I lost my sense of self, my confidence, my self-esteem, my feeling safe to be me and that needs to be looked at and changed. I think if one is not afraid of getting sick they are comfortable with themselves and comfortable with their bodies to let themselves be "out of control" for those few seconds. It's not a dreadful thing.

[orton99]

Firstly, silly question but did you explain all that to your therapist and did she help you? It would've been a real shame to stop seeing a therapist you get on with!

Anyway, I do sometimes get the feeling that there are unanswered questions, but I'm quite relaxed about it. Firstly, "can't think of an answer to that" could simply be no more than "can't think of an answer right now" and something emerges a couple of weeks later, so I'm not that bothered. Secondly, I don't think that we are missing anything major as I do have a reference point. I've been keeping a diary since March 1992 so am used to analysing my feelings and wondering why I think in a certain way etc. Of course, my therapist will regularly make observations and links that I hadn't thought of (and that's what she's there for!), but in general a result of all the diary-keeping (estimated 1.25 million words so far spread across 27 individual volumes!) is that I know what the issues are pretty well, it's just a question of moving them from writing them down to actively talking about them.

Finally, I also accept that human emotions aren't an exact science and never will be, so there will always be a small amount of unknowable stuff. I suppose the trick is to be okay with that rather than think you must know everything....so see it as a first step in trying to wean yourself off perfectionism....

[Orchid]

Orton99-It sounds like you are working really hard on this and you are making some deifinate progress. I agree that it is going to be a lot of work and I need to get started on it. The lists of thoughts are a good idea and the commitment to go over them daily is important. How would you rate your phobia right now? How much is it affecting your life as opposed to before you started your therapy?