Starting therapy again

[overthere441]

Hi all,

This is my first post. As a background, I've had emetophobia (full-with panic attacks related to n* and v* since I was about 12. Prior to that, I feared n* and v*, but I don't think I was phobic. Now, I'm 22.

I completed a course of exposure therapy (went up to everything but actually v* myself), and it was very helpful-panic attacks diminishes, thought about v* and n* less frequently, and was more able to deal with n* without panicking.

However, I had a sv* in May, and have had a full return of symptoms. So I am starting treatment again, at a different place. I'd be happy to go into details, and differences in treatment/theory between the two places, with anyone interested - but will not include that here.

Basically, I am very scared and fear that I won't be able to overcome it again. Part of the fear is also probably because engaging in therapy for it is like accepting the fact that I may v* at some point.

I'm hoping for support from others, whether or not you have gone through any type of therapy for it.

I do have a boyfriend who is very supportive, but it is hard to connect regarding the phobia. It would be nice to have a network of people going through similar experiences.

If I used words that shouldn't be used, or said something fear-inducing, please let me know so that I won't do it again. And I apologize!

(I initially posted this in the help & support section-sorry for the overlap)

Thank you!

[KaydeeJayde]

Hey there!

In regards to starting therapy again and your fear that you won't overcome it, think about this, you did it once. You were strong enough to overcome your fears for the most part once, why not do it again. Have faith in yourself. There's nothing stopping you, you know you can do it

It'd certainly be interesting to hear about the differences between the places you've been for treatment, too.

I hope you find what you're looking for here xx

[Sweet Illusion]

I've never tried therapy before, but I did book in for 2 weeks time. I have your same worries that it's not going to help... I know it should but I've always been a biased person against psychologists - I've always just thought they're not going to understand my phobia and my anxiety. I know I shouldn't judge however... so please do tell us how you go I'd love to see another person's experience on it.

[bubblesnz]

I would love to know how you get on too And good luck!!!

Does any one know of help for this in New Zealand?

[sage]

Hi overthere,

Welcome to the site! I hope you don't think of it as "starting over" because you should be able to build on the therapy you had before which was so helpful. I like to tell my clients that treatment is a years-long race to be run, with only the first leg of the race in therapy. You get tools for the journey - how to think differently, how to relax, how to desensitize to the phobia. But then you have to go and live your life. Have some close calls, be near other sick people, get sick yourself perhaps. And continue with the tools. If you just sort of finish therapy, go away and forget it (which I did once as well) then yes, it's likely to rear its ugly head again when your anxiety goes up in general (family crisis, illness, catching something - even moving or having a baby). So think of it as "review!" It shouldn't take as long as before.

Good luck!

[overthere441]

Update

Thank you all for the support! I'm a full time student, and I've been swamped with studying - so I haven't had the time to write, sorry about that!

To bubblenz: I've seen an experimental online (as in a researcher has designed it and is testing it) CBT program for emetophobia, being conducted by researchers at Griffith University in Australia. It looks legitimate, and follows Australian ethical guidelines for psych research, and seems to follow the US APA guidelines as well. The website is emetstudy.org. Since it is an online program, it is available to all people with Internet access.

To Sweet Illusion: While it is true that some therapists/psychologists won't understand your fears/anxieties, there will be others completely capable of working with you, even if they have not directly experienced fear related to v*. I used to think that the only therapist who could help would be one who has experienced emetophobia, but I don't think that is true. Now I think it is more a matter of how well the therapist was trained (and what therapeutic orientation the therapist ascribes to), the ability tone compassionate, and possibly a willingness to learn about the phobia. However, it has taken me a few therapists to find one with whom I clicked, and have a good therapeutic relationship. I did well with the therapist I previously saw, prior to the v* episode in may, and am also doing well with my current therapist.

I'm curious, why are you biased against psychologists?

In my response to KaydeJayde I refer to my previous therapist as my "first therapist" my current/most recent one as my "second therapist." Although I saw other therapists before the one I call my "first therapist" I label her as such because she was the first therapist with whom I had an effective therapeutic relationship and a significantly beneficial outcome.

What does it mean to "book in" - would that be to stay at an inpatient treatment facility?

To KaydeJayde: the first therapist I saw was a student in a clinical psychology program, and she was supervised by the director of the anxiety division of the program, who had a phd in psychology. The orientation of that program was strictly cognitive behavioral, and did not integrate any relaxation training into therapy. The current (second) therapist I am seeing does have a cognitive behavioral orientation, but she also integrates other forms of therapy, such as acceptance commitment therapy (ACT), as well as mindfulness training.

Similarities between the two: both included a hierarchy of fears for the exposure component, and the goal of habituation and desensitization to each specific fear. Both included cognitive components (such saying to myself "I can handle v*" when I felt anxious or n*, instead of saying to myself "please don't puke, I can't puke"). Related to the hierarchy of fears, both included a behavioral component, with the goal of me changing my behaviors in relation to v* and n* (ie: not engaging in avoidance behaviors, like willing myself not to puke, or seeking reassurance from others that I wouldn't puke, or taking medication to prevent myself from puking). It was important for both that i see the anxiety rise and come down on its own, without engaging in avoidance behaviors. Both therapists were very supportive and encouraging.

First therapist only: considered relaxation techniques, such as deep breathing, during exposures/times of anxiety as counter-productive to the therapy. The goal was to see my anxiety rise, and come down on it's own without me doing anything to lower it (avoidance behaviors), and she considered relaxation techniques as avoidance behaviors, she said they would prevent from getting the full benefit of exposures.

Second Therapist only: Considers relaxation techniques, when used appropriately, as a helpful adjunct to CBT. She thinks that if deep breathing helps me to "ride the wave" of anxiety, or to "ride the wave" of n*, then they are okay. She sees them as coping mechanisms, not avoidance behaviors. I like this outlook much more, I find it more helpful. I asked my previous therapist if we could incorporate them, but she was not willing to do so - I am very happy that this new therapist is willing to do so. She also incorporates ACT into our sessions. So far, ACT seems to be about acknowledging ones values and personal commitments, and trying to live by those (or use them as motivation, perhaps). Additionally, it encourages an acceptance of one's feelings, whatever they may be - and that includes accepting my anxiety when I am feeling n* or anxious about p*. Interestingly, this therapist acknowledged that part of why I "relapsed" after the p* episode was because, as I said, "it was exactly as bad as I thought it would be-it felt awful." My first therapist had the outlook that p* wouldn't be as bad as I thought it would be, which could have set me up, in a way, to have the fear come back full force once I actually p*, realizing that it really was as bad as I thought it would be. I know some people who have recovered from emet say that p* wasn't as bad as they thought it would be, that the anxiety leading up to it is what was the worst-so I guess it is a very subjective feeling. This therapist acknowledges that p* feels awful for most people, that my phobic reaction is out of proportion to the experience (which is what my first therapist focused on), but that it is important for me to accept (even focus on) the awful feelings that come with n* and p*, bad as they may feel, to "experience them as they are, rather than what I wish they were." ACT is a form of CBT, but relatively new, and it is hard for me to describe how they go together because in a way they may seem contradictory - but the incorporation of ACT is really helpful for me.

She views ACT strategies, relaxation techniques, and more traditional CBT strategies all as tools that can be used together, or individually - all depending on the situation.

However - my second therapist is also a supervisor for people with relatively new PhDs or PsyDs, called "fellows," and I have agreed to work with one of them. We had our first appointment last week, and I was a bit disheartened as she seems to have more of a strict cognitive behavioral orientation. I've explained that I find the relaxation techniques helpful as coping mechanisms, and want to include ACT, and she said she would try to honor that - but I feel like it will be more like it was with my first therapist. I have one more appointment my second therapist to see how things are going with my third therapist (the fellow). If after the next few sessions with my third therapist aren't going in a direction I'm comfortable with, I will see if I can switch back to the second therapist - and will hope it won't be too awkward.

To Sage: everything you said about therapy and life has been 100% true in my experience. Thank you for the support in being vigilant in applying the tools to my life even after therapy ends - I think that is one of the hardest things to do.

To all: I'm already experiencing an improvement in my symptoms. I am able to handle n* and d* better, to accept those feelings more than I previously had - I've stopped taking benadryl as a way to avoid n* and p,* and anxiety (not that it worked - I don't encourage this as a way of coping - certainly not healthy).

Hope this post wasn't confusing or rambling!

[overthere441]

Forgot to add- it is certainly possible that I described CBT, ACT, or any of their components incorrectly. If anyone notices an incorrect description, feel free to correct it - misinformation is never helpful.

[mhartse]

Do they really make you vomit??? I go to my first session Tuesday and I am afraid I'm gonna go somewhere uncomfortable.

[overthere441]

I was never made to vomit, and I can't imagine any decent therapist making you do anything you are not willing to do. The vomiting episode I had was not due to therapy - I had a stomach virus. Which led me to start therapy again. if I gave the impression that I was made to vomit, I am so sorry!

However, it has been my (tentative) goal in past therapy, and current therapy, to be able to vomit, and to possibly incorporate the actual act into therapy, once/if I feel ready to. I feel that the best way to show myself that I can do it is to do it, but that is certainly a distant goal. I've never heard of any therapist saying that it is necessary to vomit to get over the phobia; my goal has been to get to the point where if I need to vomit, and my body is going to do it no matter what my mind wants, I can do so with less panic than I currrently experience. An equal goal is to be able to live without the constant fear of it happening, with everything being viewed as something that could lead to it.

[overthere441]

I forgot to add, congrats on getting to the point of wanting to start therapy!