Brainstorming CBT Strategies

WARNING: This post contains conversation about, and descriptions of people vomiting. If you are uncomfortable with this please do not read any further.

During last week’s visit to the CBT guy we talked further about strategies that might be effective in treating my specific circumstances. I gave him the breakdown of clearly identified problems, but told him was really at a loss as how to proceed. He threw out some ideas and after spending a bit of time talking them over he suggested I go home and give it some more thought. Continue reading

Identifying The Problem

In my last post I vented my frustration at the process that lies before me. I was already coming around in my view of the situation, but I still needed an outlet for my disappointment. Now it is time to get to work. My plan is  to make sense of this by writing out the problem on paper, and I will post the results of that writing here. Be patient as these posts may ramble a bit.There is no obvious path ahead of me and the problem is a large and complex web of interrelated fears. There is only one way to deal with large complicated problems, and that is too break them down into smaller manageable pieces. The actual problem needs a clear and specific definition. The first question that needs to be answered is simply what it the problem? The problem is clearly emetophobia, but that is not specific enough for this purpose. Emetophobia references fear of vomit and/or vomiting that my actually mean a variety of different things depending upon the individual. So what specifically am I afraid off? Continue reading

The Extinction Curve And Making A Plan

This past Friday I had the second appointment with the CBT guy who is supposed to help me work through this emetophobia. The appointment included a required background questionnaire that frustrated us both as we plowed through a bunch of extraneous crap that wasted a lot of what could have been otherwise useful time. Eventually the conversation did turn to the topic at hand, and I was able to fill in some cracks in his understanding of my circumstances that became apparent to me after I had time to process our last appointment. I also detailed a somewhat new realization that pretty much every time I have found something that gives me some joy in life it is eventually sabotaged by these fears. Continue reading

Peeling Back The Cover

Last Friday when I went to my appointment I expressed my concerns about the depression versus anxiety diagnosis and laid out the degree to which this fear of vomiting has impacted my life. I was surprisingly nervous going into the appointment and wasn’t realty sure I was going to do it until I started talking. I find it a little strange that after six plus years of seeing this guy I still have trouble expressing myself, but talking about this is still something I have some trouble with particularly with male doctors. For some reason I am more comfortable verbalizing my fears and insecurities to a woman. He listened politely to the entire story; I laid it out from the beginning and asked that he be patient with it as I explained seemingly unrelated parts of the puzzle and brought everything together in the end. I had had the conversation in my head a number of times in the days leading up to the appointment so once I got talking the ideas flowed pretty easily despite my apprehension.

When it was all said and done he agreed that the fear of vomiting thing was a significant issue that needed further exploration. He strongly suggested I seek out psychotherapy and suggested a guy he knew he has a special interest in dealing with phobias. I was not thrilled at first for a couple reasons. First this guy’s office is in a very busy area in the center of one of my work routes. I drive a company vehicle that may as well be a billboard on wheels. I take my privacy concerning this stuff very seriously and I was concerned that I would be too conspicuous. Second as I mentioned in the first paragraph I am not thrilled about talking with men, and this was going to be some difficult work. I just didn’t know. I was further discouraged when the office ladies indicated that there was a waiting list to see the guy and the wait would probably be several weeks. In the end I decided that the wait would give me time to decide if I really wanted to peel back the cover these issues at the moment. One could imagine my surprise when later that afternoon the office called me back to arrange and appointment for the following Wednesday. I am off this week so traveling to the appointment in a company vehicle wasn’t an obstacle so I decided to give it a go.

As I write this I am several hours removed from that first appointment and have had some time to reflect on the conversation. My first thought is why the hell these doctors don’t talk to each other. I spilled my guts about this just a few days ago. It was hard, and I didn’t relish doing it again, but I figured these guys are in the same practice so the talking doc should have at least seen the notes from the visit that led up to this. Nope. We started from scratch. The guys first question was “what are you looking to accomplish by being here?”. This is certainly a fair questions and even a good starting point unless the patient, me, thought you were already going to have the answer to that. Shit. He followed up with “Why don’t you tell me about what has been happening”. I am out of practice with this stuff. I didn’t have the first clue where to start. It’s not like I am talking about some bump or bruise that just happened the other day. This guy is looking for a what? A summary of thirty years of anxiety? Does he really want me to sum up something that has affected every part of my life for this amount of time in a sound bite? It has become such a large complex issue that I am not sure it is even possible. This isn’t MSNBC or Fox News it’s the actual truth that matters here not just the words.

After something of a shaky start I was able to get out the general idea of how these fears have impacted my life and how the overriding sense of general anxiety sits on top of it all like a dark cloud. He asked interesting questions, though I could tell by some of them that his understanding of my turmoil is far from complete. It is going to take more than one 55 minute appointment to get all that across I suppose. I did like that he seemed goal oriented. My first several experiences with talk therapy were all open ended affairs. One of these therapists was fantastic and I really felt like I gained something with each visit, but even she didn’t really have a goal for our work that she articulated to me. These therapists created a safe place for me to work through some difficult times, but I came to rely on them as sounding boards which made it difficult to move on. This guy and a woman I spoke with a couple years back have both taken more of a no nonsense approach to what we are trying to accomplish. There are already actual outcomes’ being discussed which is refreshing.

There wasn’t much time today for anything more than outlining the problem and discussing a couple rough ideas for approaching them which all boil down to systematic desensitization.  I am cautiously optimistic at this point. He was easy to talk to and once we got going I felt as comfortable as I have in any other therapy office. There is a lot going on here, and I am not sure we can just tease one piece out and make it go away. This one fear has been part of my life for so long that it has imbedded itself throughout my psyche. It’s like a tumor with tentacles weaving its way into places I am probably not even aware of. Is it possible to untangle this? I guess were going to find out.

It Has A Name

Emetophobia – an intense, irrational fear or anxiety pertaining to vomiting. This specific phobia can also include subcategories of what causes the anxiety, including a fear of vomiting in public, a fear of seeing vomit, a fear of watching the action of vomiting or fear of being nauseated.

In one of my very first posts on this blog I spent a lot of time describing my experience with anxiety. In that post I mentioned a deep seeded fear of vomiting that I attributed to two traumatic experiences I had as a child. I alluded to this fear entering my everyday decision making process, but I didn’t elaborate a great deal. Some of the impacts of this fear I have barely admitted to myself let alone put into print or said aloud. Here is a partial list of the things I have or haven’t done as a result of this fear:

  • When in High School I used to tell my girlfriend that I wanted to get take-out and go eat down by the river rather than eat inside a restaurant. I used the river as “romantic” alternative to eating in a dining room, when the truth was I was afraid of getting sick in the restaurant.
  • I avoid places with large crowds because bathrooms are either hard to get to or filthy dirty should one have to hang their head over a toilet. When I do go to a concert or show I want to sit on the aisles so I can make a quick and subtle exit if I have to.
  • The biggest reason I don’t drink alcohol is fearing of being made sick
  • When I enter a new building I am sure to identify the locations of the restrooms and any trash cans in case I need a quick place to puke.
  • I adhere strictly to expiration or use by dates on food.  l also will not eat leftovers or cold cuts that have been in my refrigerator for more than a few days.
  • I never burp. I can’t distinguish between the sensation of burping and nausea. It all feels the same to me. Of course the inability to expel the gas from my body adds to and prolongs my discomfort. I have memories as a kid of leaning over the toilet thinking I was going to be sick. I could feel it coming and when I opened my mouth nothing came out except the noise and gas.
  • Periodically I will awake from a deep sleep and leap to my feet convinced I am about to vomit and rush to the bathroom. I will often fall back asleep on the bathroom floor or if I return to bed I will put an empty trash can near my bed.
  • My wife is a school teacher and when she has sick students in her class I am in full on freak out mode at home. Likewise with my 3 year old son I am paranoid of being around him when he is sick. We have been lucky thus far that he has not had a real stomach virus, but I know the days is coming and I dread it.
  • Feelings of nausea will often leave me sweating and shaking. Sometimes my mouth with salivate heavily as if the act were about to happen though it never does.
  • It has without question directly affected my professional life. I really don’t want to get into details here as it is the most painful truth, but I have worked on airplanes and boats so it shouldn’t take much imagination to see the magnitude of that problem.

Much of this list has been spoken to therapists and various shrinks, but I have never presented the entire list together. In my last experience with talk therapy a couple years ago it was brought up in the more detail than ever before, but still this word, emetophobia, was never mentioned. For years, decades actually, I have been suffering with this, living with coping mechanisms in place and I didn’t even know it had a name. I always thought it was just a personal oddness. There was no way a significant number of other people had a similar problem. If I had a nickel for every time somebody looked at me trying to be helpful, but sounding condescending, and said “Nobody likes to get sick” I would be a wealthy man.

The discovery of this word, emetophobia, came as a result of some recent personal realizations about the level of anxiety in my life, and wondering at the source of my true problems. Am I depressed which causes anxiety or am I anxious which makes me feel depressed. It feels like the classic chicken or egg scenario, but having spent some time with little to no medication in my system, and being benzo free for seven full months I am beginning to wonder if there may actually be an answer. Maybe the docs have just never asked to right questions. I want to write more about this, but it feels like a different post. For now I am just going to consider what it means to have a name for nearly thirty years of torment. Emetophobia. There is power in a name.