_This site is a resource to help therapists to treat emetophobia, or for emetophobia sufferers to help themselves desensitize to vomit. The use of this site is completely free, with no ads. You can use anything on this site that will help you treat an emetophobic without my permission. You just can't cut-and-paste any of my words into your own site without citing me, reproduce anything, email it, publish it, post it or otherwise steal it by presenting it as your own.

Anna Christie, B.A., M.Div., RCC: I am a registered as a clinical counsellor with the BC Association of Clinical Counsellors. My practice is full, with a short wait-list and all of my clients are emetophobic. I offer family counselling for families who have emetophobics (adult or children) even if only one family member comes to me. I do coaching and mentoring of emetophobics using the same cognitive-behavioural therapy (CBT) techniques that helped me to recover from emetophobia. I will also gladly consult with any therapist treating emetophobia free of charge. Thanks to Skype, which is free, I can talk to you, or your therapist anywhere in the world. I own the website and blog at www.emetophobiahelp.org which provides both information and inspiration on emetophobia. I also moderate the discussion forum at the largest emetophobia website in the world www.emetophobia.org  I am fully recovered from emetophobia which I had for over 30 years. I was successfully treated in 2001 by a conventional Cognitive-Behavioral Therapist (CBT) who was willing to learn about emetophobia and work with me through a hierarchy of fears which I constructed myself. I spent about 50 hours with this therapist. (My clients spend on average half this time.)

Since my own recovery I studied to become a Clinical Counsellor, and completed a great deal of research on emetophobia as well as those things that emetophobics obsess over: norovirus facts, eating/food digestion facts and vomiting facts. I try to offer factual, scientific information about these things. Facts generally calm people down. Instead of fearing everything, we can begin to identify and sort their fears in a concrete way.

Although I have searched extensively, I believe I am the only therapist who treats exclusively emetophobia. I am grateful for Dr. David Veale, a psychiatrist in London, England, who treats emetophobia along with other health anxieties and BDD. He is in a position to do scholarly research and while our theories of treating the disorder differ slightly, we're on the same page. Dr. Veale references this website resource in at least one of his articles.

Both therapists and emetophobics may feel free to contact me for more information or help.

This site is safe for emetophobics.   No matter what you/your client click on in the menu bar, you will see the same thing - the header only at the top of the page. There are no surprises here, and every word, drawing, cartoon or picture is at the bottom of the given section with a clear explanation of what you will see at the top of the page before you scroll down.  I have also included some assessment tools that I'm working on - you're free to download and use them with your clients. My clients usually enjoy filling them out and feel better that I must understand the nature and severity of their phobia as they identify with the questions.

The exposure page has 11 levels for desensitization setting up a "hierarchy of fears" for emetophobics in this order:

• a picture of simply the word that many emetophobics fear
  
• a list of words and phrases
  
• sentences and paragraphs to be read or spoken aloud
  
• silly cartoons
• drawings
  
• people looking unwell
• pictures of people before and after they vomit
  
• pictures of real people being sick (less graphic to very graphic)
• YouTube videos - cartoon characters, babies,
  
• YouTube videos - real people being sick (from less to more graphic)
  
• Sounds (less graphic to more graphic) -  mp3s
• Special sections for emetophobics with specific triggers such as animals, hospitals, toilets. 

I have found that about half my clients can look at the cartoons and drawings before they can read the sentences and paragraphs. When starting with the word "vomit" if it doesn't bother them I ask them if they see it as a noun or a verb, and ask them to tell me what they picture in their heads. This gets them out of avoidance behavior by just saying to themselves "it's just a word and it doesn't mean anything."

_Although you can certainly use these resources to help yourself, those who have a counsellor or mentor to journey with them through this difficult process ultimately do better in the long-term. We can structure your treatment - slow it down or speed it up - based on what we observe are your personal needs and the unique way in which you experience the triggers for your phobic response..

The fear response is measured in terms of an 11-point scale known as the SUD scale ("Subjective Units of Distress").  On this scale 0 = no fear whatsoever and 10 = so much fear you feel terrified, horrified, may dissociate from reality and instantly "run away" (if you can). If you cannot run from the stimulus you may fight someone with surprising violence.  At level 10 you may experience a horrible panic attack.  Even so, you will not die, have a heart attack, go crazy or become ill. The panic attack will eventually subside and you will be ok. The SUD scale is "subjective" which means that only the anxious person can decide what constitutes what number on the scale.  Although many therapists work at high levels of distress (8-10) it is this author's opinion that desensitization is not as effective long-term at levels higher than 5.  So if you're doing this alone (which is not recommended), be sure to keep your anxiety at low levels. This means that if you look at a picture, and it evokes more panic than 5 on a scale of 0-10, then it won't help you to look at it. It will only be distressing, and may make your phobia worse.

Note that "exposure therapy" does not mean you have to be sick yourself. The act of being sick in and of itself may bring you temporary relief from your anxiety, but the anxiety will return with time. Your brain needs more training, through a longer desensitization process, to fully recover from your anxiety. People who fear a dog biting them don't have to have a dog bite them to be cured. They need to be calm around all dogs, as the odds of being bitten by a dog are remarkably low. So are the odds of vomiting if you don't want to. But even if you do vomit, you are not in any danger! You do not need to fear it as it's quite harmless.

If you are not using this site with the help of a qualified therapist (which is recommended) there are a few things you must learn first:

1. You should not go through all the levels in one sitting, "white-knuckling it" just to see if you can. This is useless toward helping you and you run the real risk of being made worse by being re-traumatized.
2. Begin an exercise regime of 4-5 days per week doing aerobic exercise. Increasing your fitness level will naturally lower your anxiety and risk of a panic attack. It's as though your body will say "I'm really fit. I don't need all that adrenalin, fast hearbeat and tight muscles to run away."
   
3. Most important: Learn a relaxation response involving deep abdominal breathing and practice it daily for at least a week before you begin looking at these pictures. When your anxiety goes up during these exercises, slowly and deeply breathing and relaxing your whole body will bring it back down again quickly.  (Click on "relaxation recordings" in the menu above)
   
4. When you are ready, go through this site in the following way:

• Breathe deeply and relax completely so your anxiety level is 0 or 1.
• Find the level you believe will give you some, but very little, anxiety by reading the descriptions at the top of the page - the picture or video won't be visible yet. Look at the picture/video and record your anxiety level. If it is still 0, try to get more anxious (up to 2 or 3 at least) as you look at it. If you cannot, then go on to the next level.
• If the picture/video/sound raises your anxiety to at least 2-3, stare at it and breathe/relax. Wait until your anxiety level is 0.
• Look at the picture again and try to raise your anxiety. Imagine it is YOU in the picture and you are very sick. If your anxiety goes up, breathe slowly and deeply until it comes down. Repeat this sequence of raising and lowering your anxiety until you cannot raise it any more. This is teaching your brain that YOU (your thoughts) have control over your anxiety. It makes no difference if your anxiety goes to 10 or 3: your brain is learning just the same. This is the key to ridding yourself of your anxiety altogether!
• DO NOT proceed to the next level until you can raise no anxiety looking at the level you're at, even if you try as hard as you can.

Remember there is ABSOLUTELY NO POINT in scanning through all the levels "to see if you can do it."  You can probably do it, but it will NOT help you.  In fact, it will probably make your phobia worse.  The idea of desensitization is to GRADUALLY expose yourself to the stimulus.  The key word is "GRADUAL", not "exposure."

It is recommended that you keep a journal or log of your desensitization experience.  Write numbers on the left column indicating which viewing of the picture it is.  Then make another column for SUDs 0-10.  You may wish to make two or three columns, one for anxiety and one for each of feelings of disgust and nausea.  Remember that nausea/disgust is linked to anxiety, so when one score goes down the other will too.  This is often a helpful insight.

For help or consultations via Skype (free anywhere in the world) - go to www.emetophobiahelp.org

Good luck with your desensitization!
~ Anna

Well first of all it isn't vomiting! But in means literally "in reality" or in real life. What it means for the emetophobic seeking to recover is that along with working gradually through the resources on this site, you must also be working on gradually going back to doing all those things that you now avoid because you're afraid. You will rate the in vivo items from 0-100 as to how scary they are to you. (Click on the document in the menu above.) Then you sort the list, and begin with the easiest thing (the lowest number). For instance, you may be afraid to eat yogurt that's one day past its expiry date. You may rate this 10/100. So you'll start with this. Eat the yogurt, notice your anxiety, write down 0-10 how high it goes, and work on relaxation and positive thoughts to bring it down.

Here's the thing: to BE normal you have to ACT normal. "Normal" is a relative term of course, and all I mean by it is a non-emetophobic person. Normal people don't worry about germs except after using the bathroom, and before eating or preparing food. Any other time you're washing your hands or obsessing is not "normal." Someone once asked me "would a normal person throw out a mattress if their child vomited in bed?" They honestly didn't know. So some of our cognitive-behavioural work takes the form of teaching.

Worth noting again: There is little point in suggesting a client take Ipecac and vomit. First of all, most of them will run from your office never to be seen again. In anybody's office. Secondly, Ipecac is a poison that induces a lot of vomiting. It can serve to re-traumatize the client. Thirdly, they may vomit once, or several times over a few hours, but you will never be able to have them keep vomiting until their anxiety goes down. Finally, even if they vomit and feel some relief from their anxiety...without all the other skills already in place (relaxation, positive cognitions, breath control, gradual exposure) they will quickly become phobic again. And they're unlikely to come back to you, so you'll end up assuming they got better.

Cognitive therapy is an integral part of the healing process. In order to overcome emetophobia the client must begin to change his or her thoughts about vomiting. Identifying the automatic negative thoughts ("ANTS") is the first step. I've provided my own list in the menu bar above, but most books on CBT have their own (shorter) list of ANTS. Once ANTS are recognized by the client, he or she must be willing to throw the thought away without giving it any thoughtful consideration. A typical ANT of an emetophobic might be "if I vomit I may never be able to stop." This is not based in fact, it is just a thought. That's all. A thought that raises anxiety, so is of no use to you. Throw it out!

I have found in my own work with emetophobics that the most helpful positive cognition for the client to work toward is this: Vomiting is not dangerous or harmful in any way. It can't hurt me, so I don't need to fear it. Often emetophobes spend a lot of mental energy with thoughts like "I probably won't vomit because...." and although this is probably true, underlying it is the implication that if he or she did vomit that it would be harmful somehow. It's a pretty big leap for many clients - they obviously understand the cognition on a logical, rational level but their amygdalae are still not getting the message. Nevertheless this is where they have to get to in order to get better. I suggest they write this cognition on a little card and carry it close to them at all times.

Emetophobics generally fear themselves vomiting and become very anxious or panic when they feel nausea, or any gastro-intestinal sensation. The most common question is "how will it help me to look at pictures/videos/sounds when I'm afraid of myself vomiting, and not so much others?" In other words, they say to themselves "that is only a picture/video/recorded sound." The answer is this: it is important for you/your client to put themselves into the picture or video as they work through these exercises. Try to imagine it is you doing it/feeling it, in other words.

The point is that once you learn to get your anxiety up (by trying hard to imagine yourself in the pic/video) then you bring it back down by breathing/relaxation. When you do this often enough and for long enough, your brain LEARNS that you are in control of your anxiety, and no matter even if you feel nauseous one day....you can still bring your anxiety about it down eventually with only ONE BREATH. That's how it works, so long as you work hard at listening to the relaxation tapes and learning the skill of deep, slow abdominal breathing and full-body relaxation AND working on the "in vivo" exposure AND learn how to change your thoughts about vomiting (throwing out the "ANTS" and convincing yourself of the positive cognitions) then you will get better.

Again, this is really hard to do yourself but it can be done. If someone is observing you and talking you through the breathing, it works much much better. If you can possibly afford mentoring sessions, please contact me!

N.B.  Therapists who wish to use flooding or get the client's anxiety to very high levels would simply begin using these pictures/videos higher up on the hierarchy. If the client is told to imagine that it's not just a video/picture, but to try to put themselves into the situation that usually gets their anxiety up pretty high.

(c) 2010 Anna S. Christie. No part of this website including images may be reproduced or copied without permission. Wherever available, copyrighted images have been used with permission. If you own the copyright to any of these images and I have not contacted you please notify the webmaster.