12. Deepened Extinction

Deepened extinction, a phrase coined by researcher and clinical psychologist Michelle Craske, is the level of exposure you’ll want to do in order to really and finally know that you’re completely recovered. It is not easy to do, but is very easy to explain.

Deepened extinction is simply combining two or more exposure exercises.

In the table below, you can see the numbers 1-34. These are 34 SEPARATE EXPOSURE EXERCISES. (Scroll right on a mobile phone to see the whole chart.) Begin with #1 – do both the vertical and horizontal exercise at the same time (eat a big meal/when not feeling well). Then go on to #2 and so on to #34. Try to do these exercises in about two months (one every second day).

These exercises serve two purposes:

  1. Each exercise will make vomiting much more likely. They will prove that you are willing to vomit, but the goal is not to make you vomit on purpose.
  2. You will learn after doing them all that it’s not nearly as easy to vomit as you previously thought.
Eat a big mealListen to soundsWatch a vomit videoSmell vomit mixtureFake vomitingSpin aroundTaste vomit beansGag yourself
After eating a big meal——–—–14—–——30 31
When not feeling well18152126283132
While listening to sounds2—-—-—–———–——-——-
While watching a vomit video3—–————-——–————–———
While smelling vomit mixture4916——-——–—–——————
While fake vomiting in a toilet5101722——–—————-———-
While spinning around 6111823—————-———-after spinning – 33
While tasting vomit beans71219242729———-after tasting – 34
While gagging yourself——-132025——-——–———-————

Once you’ve mastered all these, try combining THREE things such as smelling vomit, tasting a vomit-flavoured jellybean all when you’re not feeling well or after a big meal.

Next try doing other things when you’re not feeling well such as going out to a movie or, if you’re not feeling too bad, a restaurant or dinner party. You can put a plastic bag in your pocket or purse so you don’t have to worry about embarrassing yourself in public, but don’t use any other safety behaviors – particularly NO MEDS!


The car can be challenging because most people with emetophobia believe they get carsick. There’s a simple test for this: ask your parents if you vomited in the car when you were a child. If the answer is yes, then you legitimately get carsick. Dramamine in the US or Gravol in Canada is therefore your best friend. If you have Zofran (Ondansetron) note that it is not as effective as Dramamine/Gravol for motion sickness.

But let’s go with you DON’T get carsick, you just get anxious and feel nauseous. The answer to this is to practice riding in the car, preferably as a passenger. You can make a list of all the things you’d rather avoid: riding with a less-known driver, riding in the back, riding with others, riding with kids. Like everything else, make a list or hierarchy and try each thing. For DEEPENED EXTINCTION you want to ride in the car when you’re already feeling nauseous, after you’ve had a meal, while tasting vomit jellybeans, while smelling vomit, etc. By this stage, we’re sure you can figure it out.

Next Step: Imaginal Exercises