Exposure Therapy – the final step

Back in the early 2000s, before YouTube or TikTok, I designed my own emetophobia treatment plan – exposure therapy – and worked through it with my therapist. I don’t really know how I overcame the fear of vomiting myself, however. The exposure I designed was only for the fear of seeing/hearing someone else vomit. So the final step for me was to volunteer in a hospital for 2 weeks straight. I was lucky that I was trained as a hospital chaplain but of course never sought a job in a hospital due to my emetophobia. It worked and I overcame the phobia. I still get a jolt of electricity every once in a while when someone like a grandchild vomits but it goes away immediately. However, most of my clients are more afraid of themselves vomiting and if someone vomits because of morning sickness or drunkenness, they don’t even care and might actually be able to help that person.

When our clients are afraid of themselves vomiting, looking at pictures and videos is not enough as emetophobia treatment. I used to advocate for “training” oneself in slow breathing and progressive muscle relaxation – a skill that could be learned and then used whenever the client felt anxious about vomiting. However, said training takes about 30 minutes per day for at least 90 days and most clients don’t have that kind of time or they give up about a third of the way through. Besides, current research on anxiety disorders tells us that people must learn to tolerate the feelings of anxiety, rather than trying to control them or lower the number from 0-10.

The penultimate step is for the client to give up all their safety and avoidance behaviours and partake in exposures in vivo (in real life) such as eating at restaurants, etc. This is quite difficult but I am amazed at the courage and persistence shown by my clients with emetophobia. Nevertheless, they often still have obsessive thoughts about vomiting and daily anxiety around it. The final step is crucial, therefore, and the most difficult: interoceptive exercises and deepened extinction. The client does not need to vomit to overcome the phobia but they have to be able to say with confidence “Vomiting is not dangerous or harmful. It doesn’t matter if I vomit” and be open to doing things that might make them vomit such as spinning around to get dizzy, eating flavoured jellybeans, gagging themselves with a toothbrush and so on. Ken Goodman in his book “The Emetophobia Manual” writes that they must say to the phobia “Bring it on! Make me vomit!” Without this final and important step, emetophobia treatment may give clients some relief and ability to do more, but the phobia will probably always haunt them.

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