Chapter One  Understanding the fear and the future

Firstly, I congratulate you for beginning to read this chapter. By doing so, you've taken an active step towards conquering your condition and towards building a better future for yourself and your loved ones. It is not an easy route out of the struggle you are in at present. You may think that there must be a life-changing drug waiting for you somewhere and that you are simply not 'giving in' by not immediately resorting to taking it. Both those thoughts would be incorrect. There is not a life-changing drug for your condition. There may be one to ease the pain, the daily stress and the sleepless nights. There may well be one to take the edge off the adrenalin rush before a meeting, before work or before school. But there is not a drug that can think for you. There is not a drug that can slip into your mind and 'fix' everything. You must do the thinking. You must cure yourself. You are being strong and determined in not immediately resorting to drugs for relief. But you are have also understood that the best path to take is one in which you can fix yourself with your own tool, your own healing machine; your brain.

A drug, an alcoholic drink or staying at home in the comfort of your bedroom will offer temporary relief from your symptoms. If you are afraid of embarrassing yourself in front of your colleagues, you may think that it would be better, perhaps, for you to stay away from your colleagues. You might think that taking a break and avoiding work, taking it easy at home has 'fixed' the problem. It has fixed the problem. If a child is scared of horses, the child does not go horse-riding. But, what if the child wanted to go horse-riding? What if the child wanted to like horses and not to feel afraid? Do you want to be at work, conversing with colleagues and fulfilling your potential? Therefore, it is important to understand the difference between short-term relief and a 'fixed' problem. Short-term relief, such as avoiding the frightening situation, although seemingly helpful, does nothing to treat the root cause. It does nothing to change the thought pattern, the fear and the anxiety. However, a 'fixed' problem, although not an easy solution, is a much more beneficial situation in the long-term. Overall, avoiding what scares you most is not as good, for your future, as dealing with what scares you most.

Therefore, it is more a question of what you want to do. What do you want to achieve? Who do you want to be? And, of course, how?

To begin with, it's important for you to establish what exactly you are afraid of. You may think this is easy, for example, 'Of course I know what I'm afraid of! I've been scared of vomiting for as long as I can remember!' But, in order to deal with the problem, you have to deal from the bottom to the top. Therefore, you need to delve deeper. You need to understand your fear. Is it a fear of the actual act of regurgitation? Are you afraid of losing control? Is it the fear of illness? Therefore, are you afraid the illness may be fatal? Are you afraid of embarrassing yourself by vomiting? Are you afraid that you may be considered disgusting or unable to control yourself? Is it a case of low self-esteem?

Find a quiet place to sit with a pen and paper. Perhaps it would be helpful for you to have your own notebook to use for your healing process? So as you can hold all your thoughts on the subject in one stable place? This first step is critical. Try to understand your fear. Write down your first memory of your emetophobia. Was it during your very early childhood? What happened exactly? Write down as much as you can possibly remember about the event. If it's difficult for you to pin down a particular event, try to remember when you first realised you had a fear of vomiting. Was it when you yourself were ill? Was it when your sibling was ill? As if writing your autobiography, write about your initial moment of fear. Write about all the things you can remember; the weather, the clothes you were wearing, the music that was playing, the time of year. What were you doing? What were you thinking about at the time? Perhaps you felt embarrassed. Perhaps you felt stressed. Perhaps you felt like it was all out of your control. Perhaps you felt like it was all your fault. Perhaps you remember everyone looking at you. Were people shouting? Were people laughing at you? Write about the event. Write about the moment you were first afraid of vomiting.

Everyone is different in their reasons for having phobias. Therefore, it is important for you to understand your own personal reasons for your intense fear. You might find it easier to talk one-to-one with a therapist, a family member or a good friend in order to help you discover your real fear.

It is vital that you understand that severe emetophobia is irrational. It is not the same as the fear you'd experience during a plane crash. That is a rational fear. A plane crash is a fatal, painful experience which most people want to avoid. But a phobia is more intense; it's irrational. You know it's irrational because...let's say, you're sitting in a restaurant and you can feel your stomach churning and you think 'oh God, oh no! This is it! This means I'm going to be sick! I don't want to be ill!' You look around you at the other 40 people in the restaurant and they're all fine. They're all well and enjoying their meal. No one else is terrified of vomiting. If someone did vomit, it wouldn't matter really to them or anyone else. They wouldn't be afraid. There is no need for you to be afraid of vomiting. It is NOT the end of the world. It does NOT kill you and it's really NOT that bad. Therefore, emetophobia is an irrational fear. It's a protection mechanism that your mind has set up from previous experience. Your memory tells your brain of a scary childhood event involving vomit and your brain says 'well, we'd better avoid that in the future! Let's make sure she's very scared of vomiting so's we can be on guard and alert in case there is any chance of that.' But, we need to change this thought pattern. It's not helpful, it's inconvenient and annoying. But how?

The next step is to visualize your goal.

Ask yourself the question:

who do I want to become?

Picture yourself in the future (the time scale depends on how quickly you want the process to work. But be realistic, a healing period of 24 hours is not sufficient if you have been suffering for over a year. However, you do not have to picture yourself as an ancient old man  you can be hopeful that things will get better soon). See yourself eating out in a restaurant with friends, completely engaged in lively conversation, not worrying about your health. See yourself on an aeroplane, watching a nice film, on your way to a lovely holiday, not worried about anything at all. See yourself eating seafood and not even considering the possibility of food poisoning. See yourself with a stomach bug and, see yourself vomiting without fear. It's up to you how you see yourself in the future  but be brave and choose what you really, really want.

You must develop a clear picture of who you want to become. If it helps, draw a picture, or write down a scenario. It's important that this picture is very clear and hopeful.

Under your notes or drawing or brainstorm diagram (whatever works for you) write down the following:

I CAN DO THIS. I CAN BEAT MY FEAR OF VOMITING. I CAN BE WHO I WANT TO BE.

Say this aloud to yourself. Repeat. Say it loudly and clearly. Repeat until you absolutely, whole-heartedly, undoubtedly believe the words. This is your mantra. Say it whenever you start to feel sick/worried/afraid. Believe it.

Chapter Two  Preparation





It's important for you to understand that a true cure is never a quick cure. A true cure will take a large amount of time to complete due to the fact that your fear has taken a large amount of control over your life for, quite possibly, a large amount of your life. One of the hardest things to master is perhaps not courage, but determination throughout the healing process. It's quite easy to tell yourself, after three weeks of struggle, 'this isn't working at all! It's best for me to just carry on as I was. I'm an emetophobic and I always will be.' That moment of surrender, that one thought of giving up, is extremely difficult to banish. Therefore, it is useful to have a reminder of your feelings and thoughts when you were feeling more positive about overcoming your fear.





You can remember the positive mindset you were in only a few days earlier. Perhaps you read an article about living life to the full? Perhaps you saw something on TV which lifted your spirits? Perhaps your friend invited you to a fun party in a couple of weeks and you started to look forward to it? You felt excited, strong and hopeful. You thought  'I'm definitely going to live my life to the full. I'm definitely going to go to that party and have a fantastic time.' But, as always, the night before the party, you're starting to feel a little anxious. You're starting to think  'maybe it's not for me, maybe I'll give it a miss. People will drink, won't they? They might vomit? I won't like that. I probably shouldn't go. I can't go. I'm probably coming down with some kind of sickness bug. I won't go.' Does this sound like your thought pattern? If so, you have to take active steps to prevent this pattern from controlling what you want to do.





Remember the clear image you had, in Chapter One, of who you wanted to be? Remember how you felt that there was a light at the end of the tunnel? Remember how you felt positive about your future? Those feelings of positivity and hope are vital to your success in beating your emetophobia. You can't beat it without believing you can. So, when you feel like giving up, you need a way of reminding yourself of that positivity you once felt. It's very difficult, when you're feeling anxious and upset, to simply remember the thoughts you had when you were feeling happier and more hopeful. Your mind, during a blind panic, is scrambled and confused and this makes it almost impossible for you to access those memories. Therefore, it would be good to have the memories outside of your worried mind. It would be useful to store them in a separate place so as you could refer to them easily when you are feeling stressed. A key way to anchor thoughts is to write them down. When you receive the invitation to the party from your friend and you think 'ooh that sounds amazing! I would really like to be able to go to that,' that's when you need to reach for your notebook and pen. Write a letter to yourself in the near future, maybe imagine yourself reading it a few hours before the party. You know what your fears are, you know how you'd be feeling and what you'd be thinking better than any one else in the whole world. In your letter, remind future self of your hope and excitement at this stage. Remind yourself just how much you want to be able to go to this party and enjoy yourself. Remind yourself that you know that it will be a stressful situation for you and you know you'll be wanting to back out at the last minute, but, remind yourself that backing out and giving up will not get you away from this awful emetophobia. You can read your letter during the time of doubt and worry and, hopefully, you'll be able regain at least some of positivity you had previously.





If writing does not work particularly well for you personally, then perhaps you could explore other media? Perhaps painting a picture to remind yourself would be better? Perhaps reading your letter aloud and recording it for you to listen to on your iPod would be easier? Whatever you choose, you need to anchor your positivity in some material form in order to remind yourself during a period of anxiety. It's too much to expect your troubled, tired mind to hunt around for memories when you're in a state of panic. Therefore, help yourself out by providing a hard copy of your positive memories to access when you need them most, when you're feeling your lowest, when you feel like you're about to give up.





The next step requires quite a substantial amount of thought. You need to set yourself a series of 'mini-goals' in order to accomplish your main goal, overcoming your emetophobia. These mini-goals are challenging tasks which you feel you could achieve. In order to fight this fear, you have to keep facing the fear directly and feeling the fear.

If sitting in a theatre makes you feel worried about vomiting, then you need to go to the theatre, sit there, and feel the fear. You need to feel the panic, the dread, the adrenalin rush and you need to accept it. You need to learn to accept it for what it is  nothing more than stupid, pathetic, powerless anxiety. The fear will start to diminish the longer you sit there and stare at it in the face. The longer you sit there and feel every awful moment of panic, the weaker your emetophobia will become. Therefore, you need to set yourself a clear set of mini-goals for you to complete  a clear set of times in which you can walk right into your fear and fight it.





There can be as many 'mini-goals' as you would like. For example, you could have as many as one hundred to as little as five  it's completely up to you as it is a very personal agenda. A 'mini-goal' is something small, but significant, which you feel you can achieve with a view to conquering your emetophobia. It all depends on your personal situation. If, for example, you are struggling to leave your home, then a mini-goal of heading abroad for a holiday in the next few days is not realistic at all. Instead, a good mini-goal would be to 'go to the supermarket tomorrow morning for half an hour' or 'walk down to the end of the road and back.' It does not matter in the least how small or insignificant the mini-goals may look to someone else. One might scoff at the idea that you see going to a restaurant with friends as a challenging event  but they are not the ones experiencing the level of fear that you have to face and, therefore, they will not enjoy the sense of accomplishment and happiness that you will feel after the meal when you return home. You must ignore the negative comments from other people  they are only beneficial in that they spur you on to overcome your fear. If ever you hear an insult or a joke about your anxiety, you must simply use it as fuel to the fire which you use to fight this emetophobia.





In your notebook, write down your mini-goals for this week. Perhaps you feel you could achieve two mini-goals a day? Or perhaps just three throughout the week? It's completely up to you and what you feel you can personally achieve. The more challenging you find the mini-goal and the more anxious you feel about attempting it, the more intense the accomplishment will be once you have completed it. You can start off as gently as you like, but, understand that the process will take longer if you take it slowly.





Let's say you write down ten mini-goals for this week? The first one could be 'going to the cinema with a friend?' or 'going out to town for a cup of coffee?' Choose things that worry you and you feel would challenge you. Choose things that you want to be able to do. For example, you don't have to try to achieve 'going to a football match' if you find football boring. Instead, you could try 'going shopping' or 'going out for dinner.' The overall idea is: you have to keep facing the fear head on. You have to repeatedly put yourself in situations which you find difficult and stressful in order to diminish the emetophobia.

It may sound daunting and difficult, but imagine what it would feel like to be free of your emetophobia? Find the clear image you had of you want to be, find the positive thoughts you wrote down in your letter  use these to remind yourself of how much you want this fear to go away.





After writing down your mini-goals, remember to say your mantra:





I CAN DO THIS. I CAN BEAT MY FEAR OF VOMITING. I CAN BE WHO I WANT TO BE.





Chapter Three  Bravery





You have your goal. You know who you want to be. You understand your fear. You have your positive thoughts written down clearly. You have your mini-goals set out for this week. So, how do you actually start to fight the fear?





There is only one way to fight a fear. It's the same way you'd fight a lion. You have to walk straight towards it, with all the strength you have, and attack it. You could run away. But then you'd have left it to grow stronger, more frightening and more controlling. If you truly want to overcome your emetophobia, you need fight it head on. You need to see it for the manipulative, cruel beast that it is and you need to face it.





It's extremely difficult to fight your fear. You know it is. You know you'll feel sick and anxious when you try to achieve one of your mini-goals. You know that you won't want to go to the restaurant, or the cinema, or the shops, or the party. You know the worried thoughts that will be going through your head. It would be easier for you to run away, not to bother with the challenge, to stay at home in your room on your own. But, truly, is that what you want? At the point when you're considering giving up, you need to find your letter that your wrote to yourself when you were feeling more positive. You need to remind yourself just how much you want to be free from this emetophobia. There is freedom for you and you can beat this emetophobia. The only thing stopping you from living the life you want to lead, is you.





Let's say your first mini-goal is to go to town and have a cup of coffee with a friend. When you spoke to your friend about meeting up, you wanted to see him and you were looking forward to spending time with him. But now, a week later, when the event is in a couple of hours, you're starting to feel nervous. You're thinking, 'should I even bother going? I feel really ill. I feel like I might be coming down with something. I don't think I will go.' Before you think any more negative thoughts, you need to read your letter that you wrote to yourself earlier. You need to make every possible effort to remind your body of the positivity you felt previously about going to have coffee with your friend. You need to remind yourself just how much you want to do this. It would be a shift in the right direction to conquering your emetophobia.





The next step is to actually walk out of the door and get into the car. This part may be the hardest part for you. It's the part where you actually have to jump over the threshold and make the choice to challenge your fear. Don't think about the 'what ifs.' Don't worry about a single moment in the future. It is right now that matters. Now. This very moment. All you have to do is walk out the front door. Don't think about where you're going, or what is going to happen next, or what you'll feel like in a minute. Think only of the present and your immediate task. After you've stepped outside, all you have to do is close the door behind you. You can do that. You've done it a hundred times before. You don't need to think about what you'll do after you've closed the door. Just close the door. Break the goal down into tiny, tiny steps. For example, after you've closed the door, you just have to sit in the car. Following that, you just have to drive up your road. Think only of the present moment. Think only of what is happening right now.





Each time you have an anxious thought creep into your head; face it. If you're sitting in the caf é and you can feel yourself getting in a panic, starting to feel sick. Excuse yourself and go somewhere quiet and calm where you can be alone, like the bathroom. Stare at yourself in the mirror. You're in town with your friend. You are out in town. You could vomit at any minute. You could actually vomit at any minute. So what? Would it really, really matter? What would happen? What you people say? The world would keep spinning, the Sun would keep shining and your heart would still be beating. Nothing would happen. Nothing would happen at all. Ask yourself aloud: Does it really matter if I vomit right now? It may seem absolutely terrifying to think these thoughts whilst you are at your most vulnerable, out in a public place. But this is actually the best time to think them. This is the time when your emetophobia is at its weakest and you can fight it head on.





It will do you know real good to reassure yourself that you will not be sick. It will do you no good to tell yourself things like 'I don't have an illness, I will not be sick now.' Although those statements will be true for the majority of your lifetime, they are not actually fighting the phobia. Reassuring yourself about the unlikelihood of your having food poisoning will not conquer your fear of vomiting. Instead of reassuring statements, it's better to be saying 'It doesn't matter if I vomit. It really doesn't matter. I won't die. I won't choke. It won't change me in any way. It doesn't matter.' By saying statements like that, you're facing the emetophobia. You're fighting it directly. You're exposing it for what it really is; pathetic. It's absolutely pathetic and it has no right to control your life.





If you feel the fear taking hold and you deicide to give up on the mini-goal, to run away from the lion. Don't punish yourself with sadness, disappointment or guilt. Forget about it immediately. Tomorrow is, and always will be, a brand new day for you to start again. I remember the days my Dad drove me to school every morning. I was terrified. I could feel myself getting sicker and sicker. Dad would be encouraging me and trying to make me feel more positive. Eventually, when we would arrive at school, I would refuse to go in. I would feel too worried, too sick and too angry. As soon as Dad turned the car around, he didn't say a single thing about it. He didn't shout. He didn't try to persuade me. He didn't tell me what I should have done instead and where I went wrong. He just didn't talk about it. When I asked why he wasn't disappointed like I was, he just said 'we can try again tomorrow.' He was right. You can always try again tomorrow. Don't think about where you went wrong. You don't deserve it. It's your life  therefore, it's up to you how slowly you take this healing process.





Make sure you write in your notebook how far you got with each mini-goal. Write down how you felt. Did you feel sick? Did you feel tired? Angry? Happy? If you write down your emotions, your thoughts and your feelings, you'll find it easier to understand your fears. When you've completed a mini-goal (or at least given it your very best shot), remember to treat yourself. Take a bath, do something you find enjoy, read a book. You can be proud of your achievements, your bravery and your strength. You can be hopeful for the future. You have taken a big step in beating your emetophobia.





Overall, when it comes to achieving each of your mini-goals, it is simply a case of bravery. As I said before, there is no other way to fight your phobia other than to fight it directly. To fight it directly, you need to be brave. You need to find enormous strength within yourself to step over the threshold and face your fear. You'll find it extremely difficult. If it was easy, you'd have done it years ago and you wouldn't be suffering with your emetophobia. There is no other answer to overcoming your fear: you must have courage. Picture who you want to be. Read your positive letters, your thoughts and your messages to yourself. Find the strength within yourself. Repeat your mantra:





I CAN DO THIS. I CAN BEAT MY FEAR OF VOMITING. I CAN BE WHO I WANT TO BE.









Chapter Four  A few things...





On the International Emetophobia Society website, many sufferers continually ask about the possibility of food poisoning, of catching a stomach virus or of motion sickness. It's irrational and unhelpful to worry about these things constantly. But, of course, they are real things to be aware of and, in general, people do take care to avoid sickness. So, what is realistic? What is rational?





Food poisoning

- This occurs from consuming contaminated food or drink. A contaminated food product will have pathogenic bacteria on it or in it e.g. Salmonella, E . coli. Typically, symptoms will begin shortly after consuming the contaminated food product. Symptoms are likely to include vomiting, fever and diarrhoea.

- It is realistic to follow 'use-by' dates on products and the guidelines for storage written on the packaging.

- It is realistic to discard food which smells bad, looks bad or has mould growing on it.

- It is realistic to discard cooked food, dairy products or meat products which have been left out of the refrigerator for more than two hours.

- It is not realistic to worry intensely about contracting food poisoning at a reasonably expensive, respectable restaurant. A restaurant with an excellent reputation will do everything possible to uphold its good name and a case of food poisoning would be devastating. Therefore, it is highly likely that they'd take great care with every meal.

- However, it is realistic to worry about food poisoning from a restaurant which does not have a good reputation. If you feel that the establishment is dirty, smelly or too cheap, it's probably best to give it a miss.

Illness

- Stomach illnesses are contagious. They can be caught from breathing in airborne bacteria, ingesting bacteria on hands or from rubbing bacteria into eyes or nose.

- But! Fear not! For you, as a healthy human being, have a perfectly functioning immune system making every effort to defend your body against illness. Therefore, it is unrealistic to panic about contracting an illness simply because someone you've been close to recently has had an illness. Trust your immune system. Your body could be successfully destroying a bug as you read this.

- It is realistic to wash your hands before a meal.

- It is realistic to wash your hands more than usual if someone close to you is unwell.

- It is realistic to avoid sucking your fingers, rubbing your eyes or picking your nose if you have unclean hands.

- Vomiting and diarrhoea are not the only symptoms. If you're ill you'll feel feverish, tired and, just generally, very sick. It's different to anxiety.









In order to have the strength to fight the fear, you need to feel healthy.





Make sure you're getting enough sleep at night. Tiredness can make you feel physically and emotionally weak. Tiredness can also make you feel nauseous  therefore, working through your mini-goals will be much more challenging.

Eat healthily. It may sound obvious, but a good diet can make you feel amazing. Certain foods are excellent for your immune system, for example; Chinese white tea, tomatoes, broccoli, spinach, cabbage, citrus fruits and seeds. Aim to have 3 small, healthy meals a day at regular times. Don't let emetophobia interfere with your eating patterns. Remember: all you have to do is think of the present. Think of going to the fridge to get the food. Think of preparing it step by step. Sit the food in front of you. Sit at the table. Take one bite at a time. Take as much as you feel you can. One step at a time. Take it slowly. Make sure the food is tasty and healthy, with lots of vegetables. It is important to drink water as well, to help you digest your food.

Exercise! I can't stress it enough! It did wonders for fighting my emetophobia. I went for a run every day, followed by an hour of aerobics. You can't worry and focus on exercise at the same  jogging clears your head and burns up adrenalin. Set up a regular routine so you know what's happening every day. I guarantee that, after just one work-out, you'll feel relaxed and healthy. Exercise is good for the immune system too!

Meditation is incredible for cutting down the intensity of the anxiety. Buy some relaxation music (whale songs, Chopin, Tibetan monk chanting, Spanish guitar etc.) and meditate for at least an hour a day. Meditation is not sleeping. Meditation is thinking of nothing. Switch off your mind, follow your breathing and take yourself to a beautiful, calming place. It may take you a little while to relax into it, but, I can assure, it's worthwhile!





I've given you all the information I can give you. To sum it up:

Understand your fear  what exactly are you afraid of?

Visualise yourself without your fear  see a clear goal

Write down your positive thoughts for times when you're feeling blue

Set out a clear list of mini-goals at the beginning of each week

Attempt each mini-goal. BE BRAVE.

Make sure you sleep and eat well, exercise and meditate for at least an hour each day.