Overheard neighbour mention something to do with sickness - how do I face this like a normal person?

[BelAnna]

Our French-windows (garden doors) were open as my brother was taking the dog into the garden and I overheard my next door neighbour (who was right next to the hedge in her garden) say something like 'that won't stop me from being sick' to her husband. I have very severe emetophobia (vomit phobia) and contamination OCD and I'm now terrified that my family will contract viral gastroenteritis (a stomach bug) from this as my brother walked close to our neighbour.

Normally stomach bugs are spread by a faecal-oral route so from small amounts of viral particles spreading from people's poo to their hands to someone else's hands and into their mouths. However if she'd just been sick then there's a chance that it could be carried in droplets of spit when speaking, especially as they were speaking loudly. 

I want to recover from my OCD so I'm guessing the best thing is just to ignore this and do nothing! 

Does anyone have any advice/tips to cope with the anxiety?   

[Angst]

Yes just let the thought drift away. Anything else will be a compulsion.

[dksea]

I think you should work on accepting that sickness is a thing that happens. The odds of you going through the rest of your life and never catching something are basically zero. Even with the extreme measures people have had to take with COVID illness can still spread.  So long as you cling to the idea that it’s possible to avoid it all I think you will continue to struggle. 
Is illness unpleasant? Absolutely. But honestly I think the hell OCD puts us through worrying about it is worse than the actual experience, especially given the relative infrequency of illness in our lives compared to how OCD can take over on a daily basis. 
So challenge not just the avoidance but also the very idea itself. 

[gingerbreadgirl]

Hi Belanna

i agree with others here, and I think if you really wanted to tell OCD where to go you could deliberately run your hands over the hedge near where they were standing, breathe it in, tell OCD to take a hike. 

[BelAnna]

7 hours ago, Angst said:

Yes just let the thought drift away. Anything else will be a compulsion.

Thank you! I managed this for once so I'm pleased with myself (I don't often resist compulsions related to this fear).  

7 hours ago, dksea said:

I think you should work on accepting that sickness is a thing that happens. The odds of you going through the rest of your life and never catching something are basically zero. Even with the extreme measures people have had to take with COVID illness can still spread.  So long as you cling to the idea that it’s possible to avoid it all I think you will continue to struggle. 
Is illness unpleasant? Absolutely. But honestly I think the hell OCD puts us through worrying about it is worse than the actual experience, especially given the relative infrequency of illness in our lives compared to how OCD can take over on a daily basis. 
So challenge not just the avoidance but also the very idea itself. 

Thanks Dksea, that's something I need to work on. I find it very difficult (almost unbearable) to cope with the idea of contracting a stomach virus again (I've not had one for over a decade) but this fear has such a huge impact on my life. I particularly struggle with a fear of being stuck in the house with someone else who is sick (throwing up) with a virus and knowing that everything is contaminated and that I might be next. 

7 hours ago, gingerbreadgirl said:

Hi Belanna

i agree with others here, and I think if you really wanted to tell OCD where to go you could deliberately run your hands over the hedge near where they were standing, breathe it in, tell OCD to take a hike. 

Thank you Gingerbreadgirl, I'm not quite there yet but I did manage to avoid showering (immediately afterwards as a compulsion) and to avoid any other cleaning compulsions in this instance. 

[dksea]

On 08/04/2021 at 08:10, BelAnna said:

Thanks Dksea, that's something I need to work on. I find it very difficult (almost unbearable) to cope with the idea of contracting a stomach virus again (I've not had one for over a decade) but this fear has such a huge impact on my life. I particularly struggle with a fear of being stuck in the house with someone else who is sick (throwing up) with a virus and knowing that everything is contaminated and that I might be next. 

I can understand, emetophobia was my first major OCD fear too.  Its definitely not fun, and a tough fear too.  But I think its good you realize its something to work on.  Even this post highlights the disparity between the fear and the actual event.  You haven't had a stomach virus in over a decade!  

And yeah, being around someone who is sick is also not fun (there's a reason I'm not a doctor! well a few actually :D) but I'm guessing your estimation of "contamination" far far FAR outweighs the actual risk, not to mention what that fear does to you versus the occasional illness.  It helps me to keep in mind that OCD makes my risk estimation skills pretty bad   Knowing its a lot of false alarms has helped me temper my responses to fear.

[BelAnna]

5 hours ago, dksea said:

I can understand, emetophobia was my first major OCD fear too.  Its definitely not fun, and a tough fear too.  But I think its good you realize its something to work on.  Even this post highlights the disparity between the fear and the actual event.  You haven't had a stomach virus in over a decade!  

And yeah, being around someone who is sick is also not fun (there's a reason I'm not a doctor! well a few actually :D) but I'm guessing your estimation of "contamination" far far FAR outweighs the actual risk, not to mention what that fear does to you versus the occasional illness.  It helps me to keep in mind that OCD makes my risk estimation skills pretty bad   Knowing its a lot of false alarms has helped me temper my responses to fear.

Thanks Dksea!

Yeah, I've not been able to shake the Emetophobia x Contamination OCD combination, despite a lot of therapy. I managed to get the 'end' of the standard emetophobia-CBT tasks (e.g. working up the hierarchy from looking at the word 'vomit' to looking at a vomit-like concoction in a loo (vegetable soup in a toilet bowl) to watching clips of people vomiting but it really made no positive difference and if anything seemed to sensitize me more (for example one of the clips showed someone vomiting through a car window, with the car stopped so now every time I pass a stationary car I panic that someone has stopped their car to vomit!!). 

I know that I spend 365 days a year panicking about seeing vomit/being sick/other people being sick and most years I don't even vomit once but like you say OCD's risk assessment is highly inaccurate! (and I think my limbic system's reaction overrides my thinking and reasoning most of the time with this anyway!).

Edited April 9, 2021 by BelAnna

[dksea]

@BelAnna I’m sure it must be frustrating to go through all that and still find yourself struggling

My amateur psychologist guess is what’s keeping you stuck is that you are still fighting the idea that you might get sick someday, that you are still treating that possibility as unacceptable and that you have to fight it at all costs. We tend to focus a lot on the B in CBT but the C is just as important. We have to change not just our behavior (ie reduce/eliminate compulsions) but also our cognition. We have to be willing to accept that we can’t be certain, that even unpleasant things are possible (if perhaps not necessarily likely). 
If this is the case you can work on responding to the intrusive thought by saying something along the lines of “ok, I probably won’t get sick just because my neighbor is, but it might happen and if it does I’ll deal with it”.  Accepting the possibility of something we don’t want happening is hard, we reflexively fight against it, but it can be done and it does work.  I had to do it too. Like when I was on the bus I had to say to myself “you probably aren’t going to get sick, but it sometimes happens to people, and life goes on”. I had to do it for other fears too, like when I was afraid I’d suddenly “lose control” and hurt myself.  I had to sit there with a knife in my hand preparing dinner and say to myself “there’s no reason to believe your going to hurt yourself, but if you do, you do”. Let me tell you, accepting THAT possibility was probably one of the hardest things I’ve ever done in OCD recovery. But it turns out to be incredibly freeing. It’s like that feeling when you finally get a task done you’ve been putting off over and over. When it’s done you say to yourself “why the heck didn’t I take care of that sooner, now I don’t have to worry about it!”   You can feel the same with OCD.  

[BelAnna]

19 minutes ago, dksea said:

@BelAnna I’m sure it must be frustrating to go through all that and still find yourself struggling

My amateur psychologist guess is what’s keeping you stuck is that you are still fighting the idea that you might get sick someday, that you are still treating that possibility as unacceptable and that you have to fight it at all costs. We tend to focus a lot on the B in CBT but the C is just as important. We have to change not just our behavior (ie reduce/eliminate compulsions) but also our cognition. We have to be willing to accept that we can’t be certain, that even unpleasant things are possible (if perhaps not necessarily likely). 
If this is the case you can work on responding to the intrusive thought by saying something along the lines of “ok, I probably won’t get sick just because my neighbor is, but it might happen and if it does I’ll deal with it”.  Accepting the possibility of something we don’t want happening is hard, we reflexively fight against it, but it can be done and it does work.  I had to do it too. Like when I was on the bus I had to say to myself “you probably aren’t going to get sick, but it sometimes happens to people, and life goes on”. I had to do it for other fears too, like when I was afraid I’d suddenly “lose control” and hurt myself.  I had to sit there with a knife in my hand preparing dinner and say to myself “there’s no reason to believe your going to hurt yourself, but if you do, you do”. Let me tell you, accepting THAT possibility was probably one of the hardest things I’ve ever done in OCD recovery. But it turns out to be incredibly freeing. It’s like that feeling when you finally get a task done you’ve been putting off over and over. When it’s done you say to yourself “why the heck didn’t I take care of that sooner, now I don’t have to worry about it!”   You can feel the same with OCD.  

Thanks so much Dksea, your reply has really helped me!

 I think that I used to cope better with the uncertainty over getting ill when I lived alone for a couple of years. There is something about living in a household with other people and knowing that if they get ill then I'm very likely to get ill too but not knowing when or how bad it will be, which really terrifies me.

I think you're onto something though because a few days before Christmas 2019 I was eating in a restaurant and overheard the waitress telling another customer that she had been up with her son all night as he was sick. I immediately panicked but then realising that I had already eaten, so that if I was going to catch the virus and throw-up, it would inevitably happen and that there was nothing I could do about it, took a lot of the anxiety away. The uncertainty really feeds my fear and feeling like I can and should do something to prevent it actually adds to the anxiety.  

I also have some similar fears to yours and I need to accept the doubt there too! 

 

[snowbear]

38 minutes ago, BelAnna said:

 I think that I used to cope better with the uncertainty over getting ill when I lived alone for a couple of years. There is something about living in a household with other people and knowing that if they get ill then I'm very likely to get ill too but not knowing when or how bad it will be, which really terrifies me.

I think we tell ourselves things like this to explain the increased fear, but in reality the fear has increased because you've been focused on avoiding it rather than because you now live with other people. The explanations we give ourselves can sound very convincing! It's helpful if every time you come up with a reason why you're doing compulsions/ why your OCD is as bad as it is always think to yourself 'or it might just be me trying to rationalise my OCD to save my blushes.'

Dksea was saying about the cognitive part of CBT and this is another aspect of that, accepting there is more than one possible explanation for things rather than rigidly believing the one that feels most comfortable/ best fit for how we feel about it.

43 minutes ago, BelAnna said:

The uncertainty really feeds my fear and feeling like I can and should do something to prevent it actually adds to the anxiety.  

I completely get this. So keep working on the idea you don't need to take action to prevent everything you want to avoid. Get into the mindset, 'If it happens I'm capable of dealing with it, so there's no need to worry.'

[BelAnna]

3 hours ago, snowbear said:

I think we tell ourselves things like this to explain the increased fear, but in reality the fear has increased because you've been focused on avoiding it rather than because you now live with other people. The explanations we give ourselves can sound very convincing! It's helpful if every time you come up with a reason why you're doing compulsions/ why your OCD is as bad as it is always think to yourself 'or it might just be me trying to rationalise my OCD to save my blushes.'

Dksea was saying about the cognitive part of CBT and this is another aspect of that, accepting there is more than one possible explanation for things rather than rigidly believing the one that feels most comfortable/ best fit for how we feel about it.

 

Thanks Snowbear!

I understand but I do remember when I lived alone that even though I was still completing compulsions (and other aspects of my OCD were definitely just as bad as they are just now!); I was less afraid of catching stomach viruses (e.g. Norovirus) because although I was worried about falling sick; my fear of being in a house full of other people who are sick (where I might catch it from them) is much greater than the fear of being the first/only person to fall ill. I think this is because of the uncertainty regarding when I might fall ill and how ill I might be.

I've also lived with flatmates (and faced all of the same situations that I did when living alone) and I had a much more difficult time (despite my avoidance levels not being any higher at that point) because my fear of being in a house full of sickies is/was so great. 

I guess you could say that living alone with Emetophobia is a form of avoidance though- living with no-one, means never having to share a household with someone who is sick. Also perhaps one of the reasons that other people being sick first is so difficult for me is the fact that I then feel compelled to complete compulsions / safety behaviours to keep myself safe. Also in that context I find it difficult to determine which behaviours are safety behaviours/compulsions and which are reasonable, preventative measure to avoid the spread of contagious illness in a household.

I think that if I was constructing an exposure hierarchy for my emetophobia 'staying in the house when someone is being sick with a virus' would be at the very top; but obviously it's not something that I could/would expose myself to intentionally! I think that some people sometimes assume that because the CBT hasn't worked for me, I must not have completed it but I have completed the standard Emetophobia CBT treatment protocol twice now and it hasn't improved things. 

The CBT that I had at Bethlem Hospital for my Emetophobia did focus on certain cognitive aspects such as challenging my belief that I would be unable to cope in the event of illness. The only problem is that I have had sickness bugs since my first attempt at CBT (in my teens) and although it's theoretically helpful to reframe things; When I'm actually ill I find it so deeply unpleasant that afterwards I resort to doing everything that I can to avoid it happening again. It is like I then have evidence that vomiting really is as terrible as I thought it was and that I really do feel as overwhelmed and unable to cope as I thought I would... I'm  not sure what to do about that?

I've just realised I'm rambling because it's past midnight and that I'm not making a huge amount of sense either! 

Edited April 9, 2021 by BelAnna

[BelAnna]

Just realised I've contradicted myself several times in that post!! 

So: 

- I struggle to cope with both sickness and uncertainty surrounding sickness. 

- I can cope somewhat better with the prospect of being the first/only person to be sick because 1. there is less anticipation/fear if I'm alone, 2. I find being around people who are sick completely overwhelming/traumatic. 

- Phrases like 'If it happens, I'll deal with it/ cope with it' seem (so far) to work for me in certain situations but for some reason my fear response prevents me from believing this in other situations. For example with the neighbour situation, it is remote enough for me to just about cope with telling myself that 'I might get ill but I'll cope with' (because it's fairly unlikely) but in others where I truly believe it might happen (for example if a family member is ill) I still find it fairly impossible to accept. 

I'm not sure whether Emetophobic contamination fears differ from standard contamination OCD in that respect? Part of CBT for standard contamination OCD is surely is testing out your feared situations and seeing that there is nothing to be afraid of; whereas with Emetophobic contamination fears- if you truly test out the fear then it is pretty much inevitable that at some point you will throw-up or be around someone who is being sick.

Again this doesn't make sense. Bedtime! 

Edited April 10, 2021 by BelAnna

[Caramoole]

10 hours ago, BelAnna said:

Again this doesn't make sense. Bedtime! 

No, it doesn't really

 

10 hours ago, BelAnna said:

For example with the neighbour situation, it is remote enough for me to just about cope with telling myself that 'I might get ill but I'll cope with' (because it's fairly unlikely) but in others where I truly believe it might happen (for example if a family member is ill) I still find it fairly impossible to accept. 

Although you say that you've applied the cognitive techniques, it does seem that you're paying lip service to the situation rather than believing your assessment of it.  Above you say "If you're remote enough......t's fairly unlikely etc" You're building caveats into the statements that sort of neutralise the belief.

 

10 hours ago, BelAnna said:

I'm not sure whether Emetophobic contamination fears differ from standard contamination OCD in that respect? Part of CBT for standard contamination OCD is surely is testing out your feared situations and seeing that there is nothing to be afraid of; whereas with Emetophobic contamination fears- if you truly test out the fear then it is pretty much inevitable that at some point you will throw-up or be around someone who is being sick.

I'm sure it probably does, or should.  You have a phobia and you have OCD.....or you use compulsions to deal with the anxiety created by the phobia.  I think it's impossible and unhelpful to try and put separate labels on these things, as all of these psychological, anxiety conditions overlap & interconnect.  What you really need to find is a therapist that can help you address this subtle difference in approach.

One thing that does seem to underpin your phobia is that you still seem to be unable to accept anything but the certainty that you won't be sick.  Until you can change this rigid, core fear, it's going to dominate your situation.  It is an inflated & disproportionate response to a situation that is very unpleasant but perfectly survival.  It is something you can, and have survived.  The Hell of your day to day living is far more catastrophic.  In many of your posts you seem to indicate that you can't get over this because Emetophobia is more complicated, more difficult to treat. It is different, in so much as it "could" actually occur.  Yes it could......but you have an over-inflated reaction & fear to the experience of vomiting, something that the rest of the population also live with, deal with when/if it occurs and move beyond usually within 48 hours.  I think you need to work with someone who can help you in this area first.  Not necessarily about how unlikely it is to happen but at your inability to accept that this would be an unpleasant illness but perfectly survivable, something you can and have coped with.

[dksea]

11 hours ago, BelAnna said:

I'm not sure whether Emetophobic contamination fears differ from standard contamination OCD in that respect? Part of CBT for standard contamination OCD is surely is testing out your feared situations and seeing that there is nothing to be afraid of; whereas with Emetophobic contamination fears- if you truly test out the fear then it is pretty much inevitable that at some point you will throw-up or be around someone who is being sick.

I don’t think how we handle/are affected by OCD really differs by fear so much as it differs by person. 
In other words I think you would handle various different fears similarly but you and I might handle the same fear differently. 
 

As for CBT it’s true SOMETIMES part of the process involves directly encountering the feared outcome, but that’s not always possible and there are many ways to confront the fear.  For example a person whose afraid of hurting themselves or others would NEVER be asked to actually do so, that would be unethical.  And what if your fear is that not doing certain things will cause a bad thing to happen, like say, a plane crash. You can’t actually cause a plane crash. (Well I mean you COULD if you were a pilot but that’s different). Imaginary exposures are one option. Putting yourself in a situation where you have to be close to but not actually sick yourself might be another. If you wanted to go really extreme there are ways to make someone vomit though that gets iffy on ethical grounds again. 
 

But I can assure you it’s absolutely possible to move past a fear without experiencing it directly. I did with my emetophobia. I’m not saying I handle it as well as any old random person might, I still very much don’t like the idea. But it doesn’t dominate my life. I can do things like ride public transportation, be around sick people, hear the words  throw up, vomit, etc. even see it on TV with only mild discomfort.  You can too.  

[Angst]

Some years ago there was a documentary on BBC 4 about the work CADAT was doing with young adults it shows  exposure work with people who have a harm theme OCD. It is possible to reproduce the contextual scenario of situations where a person has such a theme. So when gingerbread girl says you should have touched the boundary hedge - the situational context of what caused your spike - would not this have been the exposure to have undertaken? It did not automatically mean that you would vomit.  In gingerbreadgirl’s example there is, of course, no need to construct a scenario as an actual situation presented itself.

Edited April 10, 2021 by Angst

[BelAnna]

6 hours ago, Caramoole said:

No, it doesn't really

Haha, thanks for being honest Caramoole and for your helpful reply. I realise that my post was full of contradictions and that it might have seemed that I didn't understand Dksea's post about accepting the uncertainty but I was just trying to say that I do find it very difficult to cope with the idea of it in some contexts, which I guess you all already knew!

6 hours ago, Caramoole said:

Although you say that you've applied the cognitive techniques, it does seem that you're paying lip service to the situation rather than believing your assessment of it.  Above you say "If you're remote enough......t's fairly unlikely etc" You're building caveats into the statements that sort of neutralise the belief.

That might be true! 

6 hours ago, Caramoole said:

One thing that does seem to underpin your phobia is that you still seem to be unable to accept anything but the certainty that you won't be sick.  Until you can change this rigid, core fear, it's going to dominate your situation.  It is an inflated & disproportionate response to a situation that is very unpleasant but perfectly survival.  It is something you can, and have survived.  The Hell of your day to day living is far more catastrophic.  In many of your posts you seem to indicate that you can't get over this because Emetophobia is more complicated, more difficult to treat. 

I think I read recently that in general Emetophobia does tend to be slightly more tricky to treat but then there's such variation in different people's OCD/phobias that some cases of Emetophobia are probably easier to treat than some OCD cases and vice versa. I think that the way that my Emetophobia and contamination OCD interact (whereas some people just have more straightforward Emetophobia without the contamination fears) makes it harder to tackle in some respects.

I realise that this sounds as though I am making excuses but I have in the past overcome other (completely unrelated) aspects/ 'themes' of my OCD quite successfully, whereas I have had Emetophobia since the age of 7 and it has impacted on my life for over 20 years. 

 

6 hours ago, Caramoole said:

One thing that does seem to underpin your phobia is that you still seem to be unable to accept anything but the certainty that you won't be sick.  Until you can change this rigid, core fear, it's going to dominate your situation.  It is an inflated & disproportionate response to a situation that is very unpleasant but perfectly survival.  It is something you can, and have survived.  Not necessarily about how unlikely it is to happen but at your inability to accept that this would be an unpleasant illness but perfectly survivable, something you can and have coped with.

Yes, I agree. On a theoretical level I do know that puking is survivable and that other people really don't find it unbearable but I cannot seem to override the fear (flight) response in situations where I am presented with someone who is being sick. I can watch clips of people throwing up, make myself feel nauseous (e.g. one of the CBT tasks was to spin around until nauseated), clean up dog's vomit and my baby niece's reflux/spit-up but presented with a stomach virus type situation and I feel as though the only way to cope is to run away! It's definitely something I need to work on.

 

5 hours ago, dksea said:

As for CBT it’s true SOMETIMES part of the process involves directly encountering the feared outcome, but that’s not always possible and there are many ways to confront the fear.  For example a person whose afraid of hurting themselves or others would NEVER be asked to actually do so, that would be unethical.  And what if your fear is that not doing certain things will cause a bad thing to happen, like say, a plane crash. You can’t actually cause a plane crash. (Well I mean you COULD if you were a pilot but that’s different). Imaginary exposures are one option. Putting yourself in a situation where you have to be close to but not actually sick yourself might be another. If you wanted to go really extreme there are ways to make someone vomit though that gets iffy on ethical grounds again. 
 

But I can assure you it’s absolutely possible to move past a fear without experiencing it directly. I did with my emetophobia. I’m not saying I handle it as well as any old random person might, I still very much don’t like the idea. But it doesn’t dominate my life. I can do things like ride public transportation, be around sick people, hear the words  throw up, vomit, etc. even see it on TV with only mild discomfort.  You can too.  

Thank you Dksea! I might try some imaginary exposures- that sounds like a good idea. Also thanks, I do find it really helpful to hear that you recovered from this phobia. I can write 'vomit' etc, clear up dog's puke/baby regurgitant puke, watch people puking on TV etc., it's just the constant fear of gastroenteritis / stomach bugs (viruses or food poisoning) that leads to extensive avoidance (e.g. anything that looks like puke on the ground (as it may contain Norovirus), anyone who has been ill within the past month, any situation where someone may suddenly vomit due to gastroenteritis etc., anything that anyone has touched [which may be contaminated with viral particles] etc. that's the main problem really. I maybe need to imagine being in the house when someone is ill and coping okay with it!

 

4 hours ago, Angst said:

Some years ago there was a documentary on BBC 4 about the work CADAT was doing with young adults it shows  exposure work with people who have a harm theme OCD. It is possible to reproduce the contextual scenario of situations where a person has such a theme. So when gingerbread girl says you should have touched the boundary hedge - the situational context of what caused your spike - would not this have been the exposure to have undertaken? It did not automatically mean that you would vomit.  In gingerbreadgirl’s example there is, of course, no need to construct a scenario as an actual situation presented itself.

Thanks Angst- that's true the deliberately touching the hedge would have made a good exposure task if I'd been able to face it.

[snowbear]

18 hours ago, BelAnna said:

I understand but I do remember when I lived alone that even though I was still completing compulsions (and other aspects of my OCD were definitely just as bad as they are just now!); I was less afraid of catching stomach viruses (e.g. Norovirus) because although I was worried about falling sick; my fear of being in a house full of other people who are sick (where I might catch it from them) is much greater than the fear of being the first/only person to fall ill. I think this is because of the uncertainty regarding when I might fall ill and how ill I might be.

I'm not disagreeing with you here, BelAnna.   I'm just trying to show you there's an alternative (more helpful) way to explain why it's harder living with other people.

When you lived alone you felt less threatened, so you spent less time thinking about avoiding sickness. Now you live with other people you spend more time thinking about avoiding sickness.

It's not the living with other people that's the problem, it's the consequence - that you spend more time thinking about avoiding sickness.

The point I'm making is a very subtle one, but an important distinction that really helps once you get your head around it.

It's not the circumstances but your reaction to those circumstances that makes your OCD worse. In other words, it's exactly what you already know - the more time you spend doing compulsions (trying to avoid sickness) the more threatening getting sick feels, so you do more avoidance compulsions and the threat feels greater... spiralling upwards.

Why does this matter?

If you say to yourself, 'I'm worse now because I live with my family' that's a circumstance you can't immediately change, so you're condemned to suffer every compulsion that comes your way for as long as your external circumstances stay the same.

If instead you accept, 'My circumstances aren't the problem, it's how I'm thinking about those circumstances and what I do as a reaction to them' ... well, we're free to change our thinking and behaviour at any moment throughout life. So you're able to make changes now in spite of continuing to live with your family. You have the power to change the internal, even when you can't change the external. 

Make sense?

 

18 hours ago, BelAnna said:

I think that some people sometimes assume that because the CBT hasn't worked for me, I must not have completed it but I have completed the standard Emetophobia CBT treatment protocol twice now and it hasn't improved things. 

My special interest is people who are 'stuck' over one particular aspect or theme of their OCD. (Including me, which is why I'm so interested!)

I've spent decades improving and overcoming multiple aspects of my OCD using CBT techniques I've learned, with one exception. That exception keeps me stuck. There are complex reasons why, but in short I'm emotionally not ready to accept my phobia/disgust is excessive and unnecessary, or to give up the OCD safety behaviours I do in response.

So I describe myself as 'living with OCD'. I accept that no matter how much progress I make in every other aspect of it I'm not fully recovered. And I will never be completely free of OCD until I decide to let go of the tangled web of emotionally-charged history that keeps me stuck.

I think you're in the same boat. Whether consciously (like me) or unconsciously (like most people who are stuck) you have decided that whatever it is you're avoiding is worth the pain and misery of a life crippled by OCD.

To overcome your emetophobia you have to make the decision that the scales have tipped in favour of a more normal life and that you're willing to give up your safety behaviours.

 

7 hours ago, Caramoole said:

Although you say that you've applied the cognitive techniques, it does seem that you're paying lip service to the situation rather than believing your assessment of it.

Caramoole is 100% right. We're willing to apply the CBT techniques to OCD thoughts and beliefs in general, but not to our phobia/ exception.

So what you need to be discussing with a therapist is how you can change your belief that avoiding sickness is more important than life itself (or certainly more important than living life free of OCD.) It's a slightly different application of cognitive techniques, but nothing a bog-standard CBT trained therapist can't explore with you.

The behavioural changes will only come after you've accepted your phobia is open to changing the way you think about it. Until that happens you'll find yourself resisting CBT and keep coming away from it saying 'CBT doesn't work for me.' (A belief I held for years until I understood I hadn't done the right type of cognitive work!)

 

18 hours ago, BelAnna said:

The CBT that I had at Bethlem Hospital for my Emetophobia did focus on certain cognitive aspects such as challenging my belief that I would be unable to cope in the event of illness. The only problem is that I have had sickness bugs since my first attempt at CBT (in my teens) and although it's theoretically helpful to reframe things; When I'm actually ill I find it so deeply unpleasant that afterwards I resort to doing everything that I can to avoid it happening again. It is like I then have evidence that vomiting really is as terrible as I thought it was and that I really do feel as overwhelmed and unable to cope as I thought I would... I'm  not sure what to do about that?

Here's a perfect example of what I'm talking about.

For most people it's as straightforward as challenging the belief you wouldn't cope/ would die. ERP is geared towards proving 'Oh look, I did cope, I didn't die, whoopee-do-dah, no more anxiety!' And it doesn't work for those of us who are stuck because the fear isn't that you won't cope. You know you'd find a way to cope (throw up, clean up and avoid even more excessively in future!) and that's exactly how you've reacted in the past.

Simply reframing things isn't tackling the emotions you've attached to the experience when you were 7.

There's nothing rocket-sciencey about this. You look at your emotional reactions, see they were appropriate at the time, accept that applying the same emotional response in the present isn't appropriate, and decide you will change how you react.

Then you do the behavioural part of CBT, working on changing your emotional response instead of focusing on changing your thinking response or not reacting at all.

I suggest you discuss it further with a therapist as I'm not qualified to give therapy and can only share what I've learned through personal experience.

 

[BelAnna]

1 hour ago, snowbear said:

I'm not disagreeing with you here, BelAnna.   I'm just trying to show you there's an alternative (more helpful) way to explain why it's harder living with other people.

When you lived alone you felt less threatened, so you spent less time thinking about avoiding sickness. Now you live with other people you spend more time thinking about avoiding sickness.

It's not the living with other people that's the problem, it's the consequence - that you spend more time thinking about avoiding sickness.

The point I'm making is a very subtle one, but an important distinction that really helps once you get your head around it.

It's not the circumstances but your reaction to those circumstances that makes your OCD worse. In other words, it's exactly what you already know - the more time you spend doing compulsions (trying to avoid sickness) the more threatening getting sick feels, so you do more avoidance compulsions and the threat feels greater... spiralling upwards.

Why does this matter?

If you say to yourself, 'I'm worse now because I live with my family' that's a circumstance you can't immediately change, so you're condemned to suffer every compulsion that comes your way for as long as your external circumstances stay the same.

If instead you accept, 'My circumstances aren't the problem, it's how I'm thinking about those circumstances and what I do as a reaction to them' ... well, we're free to change our thinking and behaviour at any moment throughout life. So you're able to make changes now in spite of continuing to live with your family. You have the power to change the internal, even when you can't change the external. 

Make sense?

Thank you Snowbear! That makes total sense and I can see how thinking 'Everything would be okay, if only I was living alone' is deeply unhelpful! 

 

1 hour ago, snowbear said:

My special interest is people who are 'stuck' over one particular aspect or theme of their OCD. (Including me, which is why I'm so interested!)

I've spent decades improving and overcoming multiple aspects of my OCD using CBT techniques I've learned, with one exception. That exception keeps me stuck. There are complex reasons why, but in short I'm emotionally not ready to accept my phobia/disgust is excessive and unnecessary, or to give up the OCD safety behaviours I do in response.

I think you're in the same boat. Whether consciously (like me) or unconsciously (like most people who are stuck) you have decided that whatever it is you're avoiding is worth the pain and misery of a life crippled by OCD.

To overcome your emetophobia you have to make the decision that the scales have tipped in favour of a more normal life and that you're willing to give up your safety behaviours.

Yes, I think you've hit the nail on the head. Something within me needs to say 'Yes, this is a horrid experience but it's transient and I don't need to waste my life preventing it from happening in the future'. I think that my past experiences with family members vomiting/choking have definitely had a big impact on this fear but talking about this ad nauseam (haha!) with several different therapists hasn't really helped. 

 

1 hour ago, snowbear said:

Here's a perfect example of what I'm talking about.

For most people it's as straightforward as challenging the belief you wouldn't cope/ would die. ERP is geared towards proving 'Oh look, I did cope, I didn't die, whoopee-do-dah, no more anxiety!' And it doesn't work for those of us who are stuck because the fear isn't that you won't cope. You know you'd find a way to cope (throw up, clean up and avoid even more excessively in future!) and that's exactly how you've reacted in the past.

Simply reframing things isn't tackling the emotions you've attached to the experience when you were 7.

Yes, this exactly! 

 

1 hour ago, snowbear said:

There's nothing rocket-sciencey about this. You look at your emotional reactions, see they were appropriate at the time, accept that applying the same emotional response in the present isn't appropriate, and decide you will change how you react.

Then you do the behavioural part of CBT, working on changing your emotional response instead of focusing on changing your thinking response or not reacting at all.

I suggest you discuss it further with a therapist as I'm not qualified to give therapy and can only share what I've learned through personal experience.

Thanks Snowbear, I've just started with a new Psychologist (after a decade of CMHT treatment) and will explore this with them. I'm aware that the response to vomiting that I developed at 7 (namely 'run and hide') isn't appropriate or logical these days and maybe I just need to learn to sit with and cope with the anxiety then I'll only need to cope with the perceived 'awfulness' of vomiting and not the 'awfulness' of compulsions and fear surrounding vomiting or the true dreadfulness of a life consumed by OCD. 

I hope you can overcome your last OCD hurdle too!

Edited April 10, 2021 by BelAnna