And I’ve done it. I’ve finally compiled enough information and facts on helping you understand Cognitive Behavioral Therapy (CBT) and exactly how it helps emetophobia sufferers cope. This was one of the most requested blog posts from the lovely people in my support group (which lives here) and I’m so glad that I can finally put it out there for all to read. I also apologize in advance for the length, but honestly there was not a good way to explain this in lesser words.
When I started counseling back in 2011, I had just found out my fear had a name, I was still in the process of learning how not to cry when I told people about it, and I still wasn’t sure if this whole phobia was all in my head. To just go ahead and skip to the good part: no I don’t still cry when I tell people about it. I do talk too much about it though…like way too much.
So, when I arrived at the counseling office, I gave my therapist the history of me. My family dynamic, the name of the phobia, the symptoms I was exhibiting, the thought processes, the little trademark emetophobic quirks… In fact the first two sessions consisted of me just babbling and her jotting down notes. By the end of the second session she said, “Well, based on what I’ve heard I think we’re going to start working on Cognitive Behavioral Therapy. It will incorporate several suggestions I give you, as well as use coping tools you may already be doing – just better.” Okay, she didn’t say “just better.” But the rest of it is true.
So what is CBT? By itself, it’s just a “form of psychotherapy that emphasizes the important role of thinking in how we feel and what we do.”
It’s okay if that sounded like a bunch of scientific mumbo jumbo. It doesn’t make sense to me that way either.
So if you want the Chelsie version of the definition, here’s what I say it is: CBT was a time in my life where I had to evaluate what I was thinking and learn to restructure my thoughts in a way that was less negative or catastrophic so that I could better cope with the phobia, anxiety and panic that came with living my life.
For me, it’s the easiest way to explain CBT. If the smart people don’t like it, well, I’m sorry.
I found a great site that basically sums up what comes from CBT-like sessions, so I’m going to sum up the summed up webpage for you (that’s a lot of sums):
- Our thoughts cause our emotions, not people. Anyone who suffers from anxiety or phobia probably can recognize that it was a learned behavior, some how. You may not be able to pin point the exact moment, but something happened and then bam – phobia. What this is trying to tell you is that if you learned these behaviors, you can unlearn them. Our brain makes us stay up all night staring at the ceiling, counting down the minutes until we feel the threat has subsided. The only thing we have to overcome is ourself. This means we can learn to change our behaviors, even if the situation does not change around us. The only thing that makes it different is how we perceive it.
- CBT doesn’t take as much time as other therapy methods – but still takes a while. CBT is not an overnight fix. It takes hard work, dedication, pushing your limits, and learning to tie concrete blocks on your ankles when your flight response beats out the fight. So this site says that the average number of sessions that someone using a CBT-esque method is 16. That’s four months. And honestly, that might seem like overnight, but it’s still a long time. If you see a counselor once a week for 16 weeks, that’s great. But of course, the magic word is “average.” This means it could takes you 18 sessions, or 13 sessions, but as long as it sticks you can learn to maintain.
**My personal experience with CBT was a 2 year stint, going once a week every week. Therapy times are dependent on many factors! Just because average CBT therapy can take 16 weeks doesn’t mean it’ll fix the issue that fast. Be patient, be persistent and go back for as long as you need to get the help you need!**
- CBT thrives on a good patient-provider relationship. I’m kind of combining two points here, because they both relate to each other. Anyone can go to a counselor and just babble till the cows come home. Of course, you can do that to anyone – like your cat or your reflection. I wouldn’t say you need to be BFF’s with your counselor (because that’s probably a conflict of interest), but being able to trust that they are doing what’s best for you is so, so important. If you are willing to take that plunge with them and begin to stretch your comfort zone and push your anxieties, you will make strides in the right direction. And you don’t have to like them all the time, because let me tell you there were times I did not like my counselor. Not one bit. She would push me to a point that I didn’t think I could achieve, and it sucked… but more on that later. It’s their job to help you achieve your goals, but not just phobia wise – life wise too – and it’s your job to take what they teach you and apply it. Without trust and a common respect for each other, CBT can’t work.
- You’ll unlearn unwanted behavior. So this goes back to something I said before, but if your phobia is a series of learned behaviors, you can, in fact, unlearn them. Thankfully, behaviors aren’t like other learned things. Like riding a bike or tying you shoes. You actually can unlearn them. All it takes is learning to restructure your thoughts and finding other ways to deal with the anxiety and situations that cause you stress. The site actually says “when people understand how and why they are doing well, they know what to do to continue doing well.” It’s true, even if it means you’ll be uncomfortable at some points.
- There will be homework. Every week I had a homework assignment from my counselor. They weren’t necessarily big or groundbreaking assignments, but it always pushed the limits I had set in regards to my phobia. Which meant it wasn’t always comfortable, and it sometimes caused me anxiety or panic, but I always had something to work on when I left my therapist’s office. And you better believe that when I came in and didn’t do what she had asked I got a “look” – but there was never any negativity. Except from me. She always just wanted to talk out what went wrong, and why I hadn’t completed the assignment. Then, she’d send me on my way with the previous week’s assignment and one for this week. That always sucked. But just as you can’t learn your times tables by osmosis, you can’t train your brain to think differently unless you push yourself to your limit.
- BONUS FACT: You’ll learn it’s okay to feel things. This one was not on the website, but it’s something I think is extremely important that I learned during my CBT sessions. For the longest time I believed that any negative emotion, especially anxiety and panic was bad and I shouldn’t feel it. My counselor had to constantly repeat to me, “Feeling anxiety and panic is normal. We all feel it at some point. It’s just how you handle the anxiety that needs working on.” And it’s true. I have felt anxious hundreds of times over a test, a swim meet, a piano recital, waiting for my sister to get out of surgery… But I didn’t necessarily think that the emotion was an unreasonable feeling like I did with my phobia. Having feelings isn’t a bad thing and it makes you human. It’s how you react to those feelings and how you let it manifest that creates the issues.
So now that we’ve learned what CBT is, let me explain to you how a standard therapy session would go for me.
Basically, my counseling sessions were once a week for one hour. We’d discuss my homework assignments, talk about what went wrong, what went right, any random events that happened during the week that seemed worthy of a discussion and we’d also focus on one of the biggest aspects of CBT: restructuring.
For example, I’d say something like, “I’m really upset that I couldn’t eat all my dinner. I froze up and I kept getting looks from the waiter and my boyfriend. I just feel like I’m not going anywhere with my phobia.” My counselor then would reply, “But how much did you eat?” And when I explained it was 2/3 of my food she’d reply back happily, “Well that’s wonderful! That’s so much better than you were doing! I’d call that an achievement.” It’s all about restructuring, and it would always make me go, “Oh yeah, I guess you’re right. That is pretty awesome.”
Many of my restructures were around setbacks or things I felt I didn’t do well enough. However, the other big part of the therapy was figuring out how to not be as anxious about the phobia in general. It was sometimes as simple as this:
“Someone coughed today in the Bakery at school and it really got me anxious. I couldn’t sit still.”
“Why did it make you anxious? They just needed to cough, they probably had a cold.”
“Well I know, but what if they had gotten sick?”
“So what if they get sick? What’s the worst that could happen? You get sick too, but remember it’s not that bad and it’s out of your control.”
And like clockwork, I’d look down at my hands, fidget a bit and go, “Yeah, you’re right.”
Eventually after weeks of saying the same things, and hearing the same things back, I learned that just because someone coughs it doesn’t mean that they are going to get sick.
Finally, at the end of each session, she’d send me out with a homework assignment. These assignments varied from week to week, but I’ll list a few for you so you know what I did. Each person is different, each situation is different, so assignments would of course vary from person to person:
- An emetophobia log – I’d write down anytime I felt anxious, used hand sanitizer (my security blanket at the time), didn’t finish a meal, opted out of a meal all together, and really anything else that was phobia related.
- Don’t use an entire mini bottle of hand sanitizer in a day – And eventually phase them out completely.
- Stress and anxiety management – We would occasionally talk about what I do to release stress. I told her I liked to sit outside, listen to music or play video games. So one week, she told me to make it a goal to spend a certain amount of time sitting outside just absorbing nature. Or spend a certain amount of time listening to music while I was stressed.
- Having a lunch date – Find a friend, make a lunch date, actually show up to lunch date, eat my meal, and live to tell the tale.
- Go out to a new restaurant I’d never been before…and not bring home leftovers – This meant I actually had to eat what was on my plate. At the restaurant. In a reasonable amount of time.
- Travel in a car as a passenger with friends – Go out somewhere with a group of people and be a passenger instead of the driver.
There were others, but those were the big ones. Honestly for me, the emetophobia log was the biggest eye opener. You don’t realize sometimes how crazy your life has become until you write down every moment you don’t feel safe in your own skin. Maybe I’ll share it with you sometime… that is if I can find it.
Overall, CBT was what helped pave the way for me to live a normal life. I spent most of the first year in counseling learning and striving to be more than I was before, and by the end of that first year I had done things I never thought I would. I had eaten at a Chinese buffet, gone to one of those Brazilian steak houses that gives you unlimited meat, ate a salad or two, and survived my husband having a stomach bug.
By the end of that first year, I learned I really, really, REALLY loved food. I liked being around people, and people liked being around me. I made friends. I tried new restaurants. I traveled. I shared a drink with a close friend and didn’t fret about if they had been sick – or if I got sick.
I also cried, a lot. I panicked, a lot. I would take two steps forward, three steps back. I didn’t always come out feeling like I had actually accomplished anything in a therapy session.
But overall, I’d call the CBT successful. I spent the next year, 2012-2013, practicing what I had learned and applying it so that I could continue to excel in conquering my phobia.
I try to tell people, if they can find a therapist that can help them with their phobia they most definitely should take advantage of it. I was very lucky that I had free therapy available to me at my university, but I know not everyone has the ability to find a therapist or has the expendable income to do so.
I know that therapy is not out of the question for me, even now. Eventually I want to start a family, but I know it will resurface my anxieties ten fold. It’s already a conversation my husband and I have had, and when we decide we want to start trying for a family, I will start talking with someone again.
So, I hope this answers all your questions you have about CBT, but if you have any other questions that you want me to answer about either my experience with CBT or CBT in general that I didn’t touch on, feel free to email me or comment below!
Until next time, Internet.
If you would like to email me, you can send any questions, concerns, comments or suggestions to firstname.lastname@example.org. I will do my best to respond to you within 48 hours, but if for some reason I cannot get back to you in that time frame, I promise I will always respond as soon as possible. You can also find me on Facebook, Twitter, Pinterest and Instagram!
Lastly, I run an Emetophobia Support Group on Facebook. Emetophobia is the intense and irrational fear of throwing up, and it is one struggle I am passionately engaged in. The group is a closed, by request only group to help facilitate sharing and support by all members. It is also private, meaning that the posts you and others make will not show up publicly in your newsfeed.