Relief for Emetophobia Sufferers Is Possible!

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Contributed by Associate Megan Pearson:


Yes! There is hope for Emetophobia Sufferers:

One of the most important things to keep in mind when considering whether to seek treatment for emetophobic fears, and deciding what kinds of treatment might be helpful, is that there is hope for substantial improvement. Many people living with these kinds of fears have experienced them since childhood and lived with them for many years, and in many instances have sought treatment without finding it particularly helpful over the long term. New research findings and increasing awareness among healthcare professionals have led to a better understanding of what the lives of people who have vomit-related fears can be like and what sorts of techniques can be beneficial in reducing related symptoms and impairment, as well as helping people improve their quality of life and accomplish many meaningful goals.

Finding the Right Therapist:

A key factor in achieving these kinds of improvements is finding a therapist you feel comfortable with and trust, which might not be the first therapist you see; sometimes people need to explore options before they find a comfortable and productive match. This process is important in allowing you to develop a strong, collaborative working relationship in which you feel safe sharing your thoughts and feelings and working on strategies and techniques that, over time, can help you reduce the intensity of your emetophobic fears and related symptoms. Seeking out a therapist who has some familiarity with and experience in treating emetophobic fears can be helpful but isn’t always necessary, since emetophobia is similar in many ways to a number of other anxiety concerns and therefore can generally be treated effectively with similar techniques. Many people who live with vomit-related fears also struggle with other mental health concerns, such as depression, other types of anxiety (e.g., OCD, panic attacks) and agoraphobic limitations on work, school, and other aspects of daily life. These issues can be addressed in therapy along with the emetophobic fears that in many instances have contributed to the other concerns.

Trying to Manage Emetophobia on your own – risks……

Many people who experience emetophobic fears do not seek treatment for them, although they often enter treatment for the associated mental health concerns that commonly accompany them, such as panic attacks or depression. There are several reasons, including (but not limited to) shame and secrecy about the fears, past lack of success in treatment, lack of knowledge or understanding among healthcare professionals, or overwhelming anxiety about what treatment would involve. Many have reported that they have attempted to engage in exposure therapy on their own, most commonly watching graphic videos (with audio) of others vomiting or using an emetic such as ipecac to make themselves vomit. People who have tried these types of self-administered exposure report that they have not seen any beneficial effects, and often say their fear has actually increased afterward. This is especially true of self-induced vomiting, which is typically NOT recommended even in a therapeutic setting, because it is almost impossible to arrange it in a way that is predictable and manageable and can be stopped at any time. Therefore, most researchers and clinicians agree that the risks associated with this specific type of exposure for treatment of emetophobia far outweigh any potential benefits, and it is not included in the treatment plan.


Effective Approaches and Treatments:

One of the most effective forms of treatment for emetophobic fears and many other types of anxiety is exposure therapy, a range of behavioural techniques that involve experiencing the feared situation(s), as well as the emotions, thoughts, and physical sensations associated with them. The purposes of these techniques are to help clients break patterns of avoidance and escape, and to teach the brain and the body that the feared situation is not objectively dangerous. Over time, these experiences typically allow people to reduce their anxiety and the resulting urge to flee, and to cope more comfortably and effectively with events and situations that created significant anxiety and distress in the past.

There are three commonly used types of exposure techniques, all of which may be useful in treating vomit-related fears:

  1. Imaginal – this kind of exposure involves thinking about and creating mental images of a feared event or situation.
  2. In vivo (“real life”) – this kind of exposure involves firsthand experience of a feared event or situation, such as viewing photographs, watching videos, or later in treatment, engaging directly with the event or situation. For example, for a person who has a phobia related to snakes, the progression might be: looking at pictures of snakes, watching videos of snakes, being in a room where there is a snake in a terrarium, moving gradually closer to the terrarium, touching the snake, holding the snake in one’s hands.
  3. Interoceptive – this kind of exposure involves safely experiencing various physical sensations associated with a source of anxiety. For example, people who suffer from panic attacks can be very sensitive to physical signals that a panic attack might occur, such as shakiness, lightheadedness, or shortness of breath.

It is important to note that in order for exposure techniques to be used safely and effectively, exposure situations must be planned, predictable, and manageable, which includes allowing the person engaging in the exposure to stop at any time. For these reasons, it is very important to engage in exposure work only in collaboration with and under the guidance of a therapist with experience in using these kinds of treatment approaches. Attempting to “self-treat” with exposure, particularly in vivo exposure, carries a substantial risk not only of lack of improvement in targeted symptoms, but experiencing INCREASED anxiety, avoidance, and distress related to the feared situation or event.

For people with vomit-related fears, even more than for those with many other types of anxiety or phobias, typical daily life itself presents numerous challenges. One reason for this is the constant and inescapable nature of the feared situations or events: while it is possible – although not always easy, convenient, or practical – to avoid or limit one’s exposure to most sources of anxiety (snakes, spiders, the dark, dogs, heights, flying, speaking in public, receiving injections or having blood taken for testing – even going to work or school), it is not possible, even while sleeping, to “escape” from one’s body or from the possibility of a natural physiological response that can happen at any time, anywhere, sometimes with little or no warning.

So many everyday situations and activities that many people are able to manage without concern can be very difficult for those with emetophobia; for example, eating a wide range of foods, having contact with other people (sometimes particularly children), getting routine medical or dental care, eating and/or sleeping away from home, using public transportation, taking necessary medications. In addition to anxiety related specifically and directly to vomiting, all of these difficult situations can be targeted by various exposure techniques. In fact, addressing these types of issues associated with emetophobia are often major concerns for people living with these fears, and as a result they become a central focus of treatment. One specific area that is often very important is accessing basic medical care, especially when a client has a very restricted diet as a result of their emetophobic fears. Attending doctor’s appointments, undergoing basic medical tests, and taking nutritional supplements or necessary/potentially useful medications can all be targets of treatment that can become less anxiety-provoking through discussion and exposure work with your therapist.

As mentioned at the beginning of this post, it is important to remember that meaningful positive change is possible, and that finding a therapist who is a good match for you and your needs is the foundation for achieving that change.

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