Case Study: Resolving Emetophobia - a Typical Journey
After 8 sessions of online therapy from Sense-Ability Hypnotherapy & Coaching Christine transformed her crippling emetophobia and got her life back on track.
TRIGGER WARNING
As this case study is directed at people who suffer from emetophobia I have used a common substitution for potentially triggering words to reduce potential triggers. There’s a glossary at the end of this article but I doubt any emetophobe will need it!
Sense-Ability helps people with emetophobia get back their quality of life (c) unsplash Austin Kehmeier
Resolving a Typical Case of Emetophobia with Sense-Ability
Christine was a typical, straight-forward case of emetophobia.
Emetophobia can be very complex, however Christine’s emetophobia didn’t seem to be linked to earlier trauma, or sensory sensitivity, although she did also have Crohn's disease which may have had been a contributory factor.
Christine, from the East Coast of America, developed her fear of v* began while she was in High School. She was diagnosed with emetophobia 12 years ago. Christine had two young children, Michael** and Mary**, and is married to Steve**. All her therapy took place online.
This is Christine’s story.
Final Outcome
Having suffered with emetophobia, (a fear of v*) for many years, Christine contacted me in June 2021.
When Christine finished her therapy after 8 sessions - spread over a few months - she gave herself a recovery score of 8.5, where 0 is the worst her emetophobia has ever been, and 10 is completely resolved She started with a score of 3 implying she had already developed coping strategies over the years but was now ‘stuck’.
Recovery is defined as comfortable being s* and being able to enjoy normal activities with no ruminating, obsessing, anxiety or fear.
Six months after finishing therapy
Six months after starting therapy, Christine reported being 9 on the scale, where 10 is fully resolved.
Christine felt her emetophobia had continued to improve by itself.
Hypnotic suggestions and natural exposure continues long after therapy has ended so I expect resolution to continue until worst case scenarios are faced and conquered quite naturally over time.
Although Christine had not yet been s* herself, she had experienced one or two blips on her journey. Over the weeks and months following formal therapy, she had faced a number of exposures and challenges that she had handled well. She had increased her resilience and confidence further. Despite a couple of significant blips, her considerable progress was sustained.
How and when did Christine’s emetophobia start?
One of Christine’s brothers suffered from anxiety and he often unpredictably v*ed. Christine was babysitting when her parents went out one evening. Her brother v*ed unexpectedly. Christine, then 14, feeling totally overwhelmed, just couldn’t deal with it and called a neighbour in to help. It was then her anxiety around v*ing became deeply embedded.
Christine’s Symptoms at the start of therapy
Where 0 is the worst the problem is every been, and 10 is resolution, Christine scored her emetophobia issue as a 3 on the scale at the start of therapy.
Stress and Anxiety
Although Christine had made progress over the years, her daily life was still badly profoundly impacted by her emetophobia, causing her a great deal of anxiety and stress.
Variable Symptoms
Christine’s symptoms varied. She was able to manage her general anxiety and her emetophobia reasonably well; unless there was a direct threat of a s* virus or s* bug (trigger).
However, whenever Christine was triggered, she experienced what she described as a ‘stomach drop’ – a physical and instant feeling of intense and overwhelming fear.
Once triggered, Christine could neither eat, nor think clearly, for hours, or often days. At these times she became preoccupied with thoughts about v*in making everyday life very challenging.
How was Christine coping?
Emetophobes are warriors, battling their intense fears every day.
Imagine how stressful it is to be terrified – as if facing a wild animal bearing down on you – with everyone around you treating you as if you are being unreasonable, over-reacting or even crazy?
Every emetophobe knows it is almost impossible to explain to a non-sufferer just how overwhelming the fear is and how hard it is to live with. In effect, it feels like that sabre-toothed tiger is standing outside the door just waiting to pounce.
The primitive mind seems to experience v*ing as truly terrifying, and even life threatening.
Feeling demeaned and ridiculed
Sufferers are perfectly aware that this is irrational, however, their subconscious mind is so powerful it can hijack their reason in a split second. It doesn’t matter how intelligent or generally in control and sensible they are, sufferers are at the mercy of a deeply primitive intense fear response.
Sometimes the fear, overwhelm and phobic responses have been demeaned, even ridiculed, by others. Well-meaning parents have forced children to eat, or made them do other activities linked to the fear, which has added a sense of loss of personal agency or autonomy, shame and guilt into the emotional mix.
Not much empathy!
You might imagine that Christine’s husband Steve could not really understand the intensity of Christine’s fear. However, she could rely on Steve to deal with the practical aspects of v* at home or on holiday which was reassuring, but he couldn’t empathise or offer emotional support.
For Christine, there was a clear understanding that her responses were not rational, and there was some shame attached to the issue.
Masking feelings and thoughts
Christine has two young children. In spite of her complex phobia, she was determined to be the best mother she could be. When her husband wasn’t there to offer practical help, she had to deal with her overwhelming symptoms and feelings by herself. She dreaded him going away on business. Whenever one of her children felt unwell or was s*, she paid a huge emotional price.
When fear causes inner conflict
For parents suffering from emetophobia, its hard to live with the conflict between being a great parent, and this over-riding fear.
Christine tried to mask her feelings at home which added to her stress. Sometimes she felt she was interrogating her children, asking questions to reassure herself that they were unlikely to be s*. She suspected they picked up on her anxiety even though she did her best to hide it.
Luckily, Christine had supportive friends she could talk to and seek reassurance from which she found helpful. Sympathy doesn’t resolve a deep-rooted fear, although it does make it a little more bearable.
The Initial Consultation
Anxious to start therapy
“Christine’s vivid and clear vision of a future without emetophobia largely focused on being a better parent and created a strong pull motivation to help her move forward. ”
Christine, in common with most emetophobia clients, was anxious about starting therapy. She didn’t know exactly what might be involved, and she didn’t know me. That’s why the Sense-Ability Initial Consultation is so important.
I explained the neuroscience that underpins anxiety and conditions like emetophobia. I made notes about how the condition affected Christine (benchmark against which to measure progress). We explored Christine’s Best Hopes in detail – what will her life be like once her emetophobia is resolved. Christine’s vivid and clear vision of a future without emetophobia largely focused on being a better parent and created a strong pull motivation to help her move forward.
Free Recordings
After the initial consultation, Christine received two free recordings (one with music and one without, which is purely to give clients a choice. The recordings include:
a short physical relaxation
a guided meditation into a safe space
a metaphorical story focused on change
appropriate crafted suggestions.
Christine was asked to listen to this nightly to ‘empty her stress bucket’, reduce anxiety and to improve sleep.
Session 1 - Best Hopes
Our first session reflected the structure of the recording but was tailored to Christine.
Christine’s Best Hopes for therapy
Our Solution Focused conversation enabled Christine to identify how she would feel once her emetophobia was resolved: She explained: “I’d be a happier individual overall. Emetophobia wouldn’t consume me… I would be more laid back. I’d be more likely to look for activities to do with the children and more excited to do them; things like soft play… I’d be more in the moment even if they are miserable and I would see the enjoyment through their eyes.”
Reframing negative hopes to positive
When people first explore their Best Hopes they usually detail a lot of negatives like: I’d be less stressed out. I’d be less uptight. I would feel less short-fused. However, the primitive mind tends to ignore the negatives and hears and remembers … stressed out, uptight, short-fused embedding those negative states still further! So at this stage I direct clients to frame their Best Hopes in positive terms.
Christine’s Best Hopes Vision is therefore the one she created after being prompted to reframe the negatives into positives. Less of what she doesn’t want; more of what she does want.
We included a suggestion based hypnotherapy script to reduce stress and anxiety, and begin the process of changing Christine’s patterns of thinking and reacting.
The Miracle Question
Christine had already made some progress with her emetophobia since childhood and scored herself as a 3, where 0 is the worst her emetophobia has even been, and 10 is resolved.
We explored what 4 on her scale would look like through what we call the Miracle Question: “If you went to bed tonight, and a miracle happened, what would show you, you were a 4 on the scale?”
The answer to the Miracle Question is called the Preferred Future.
A clear description of a Preferred Future
Christine said: “Maybe if Michael [her son] came downstairs at night, I would ask him how he is? If he said his belly hurts, which he often does, I would think maybe he ate too much... I would be able to lie with him until he fell asleep.”
Christine wanted to respond with the assumption that Michael was going to be okay, and to be able to reassure him. Even if he was going to be s*, she wanted to deal with s* more like her husband whose attitude was more ‘So what, kids get s*. We’ll clear it up but it will be okay.’ She would be able to go downstairs to watch a show or read a book. And she would be feeling nothing. She would feel neutral.
Grasping the Solution Focused approach
“Christine was using her right-sided creative brain to explore new and better solutions and possibilities; and I know that her agitated, fearful primitive mind would be listening. ”
Now strictly speaking this ‘preferred future’ description sounded more like a 6 or a 7 than a 4 along the scale. However, this positive description demonstrated that Christine had grasped the Solution Focused approach, and could envisage a better future. Christine was using her right-sided creative brain to explore new and better solutions and possibilities; and I know that her agitated, fearful primitive mind would be listening.
This is how we begin to lay down new and more helpful patterns of thinking and to forge new neural connections, and ultimately change patterns of thinking.
Session 2 - becoming Solution Focused
Christine had 8 paid sessions spread over 5 months. We started with two consecutive sessions. First came Rewind Trauma Therapy.
Most phobias respond well to one session of Phobia Rewind Therapy, and one session of reframing (imagining a better scenario than the phobia response in detail) along with hypnotherapy.
Emetophobia - a unique phobia
Emetophobia, however, is a unique phobia. It is complex. It is enduring. It is deeply embedded.
By the second therapy session, Christine was already a 5 on her scale. That is a good leap so early in the process. She reported that the recordings helped her stay calmer overall and although there were moments of panic, things were already a little better. However, there had been no direct triggers, so it could have been a false dawn! We followed the same format in his session:
Solution Focused conversation
What was good and better; challenging but you handled it better?
Exploring Christine’s strengths and resources; how did she cope when challenged?
Scaling (0 to 10 where are you now where 10 is you don’t have emetophobia)
Eliciting the preferred future through the miracle question*
Suggestion based hypnotherapy
Tailored suggestions that reflected the preferred future description
Session 3 - a leap forward
Christine reported that she had leapt to 7 on her scale. She hadn’t experienced any panic. Again there had been no direct triggers but she wasn’t ruminating and obsessing much. She felt she had experienced a bit of a shift.
She had continued to listen to her recording. She explored what 8 on her scale would feel like. This included: “I’d cope better. Maybe I would just be rolling with it and deal with it as it is. My husband would see that I was more relaxed when there was a trigger; that I seemed un-phased by what was happening. I would be playing and engaging with my children more.”
Week 4 – A bit of a set back
Christine reported that she was a 6 on her scale. There had been a slip back which is to be expected at some point in the process; especially when there have been no direct triggers in previous weeks. Although there seemed to be no obvious progress, Christine hadn’t returned to earlier negative thinking and behaviour patterns, despite the set-back.
An anxious week
It had been an anxious week overall. Michael’s stomach had hurt and Christine had felt that old familiar moment of panic. However, she was able to pull her thoughts out of negative spiralling, and he had been fine. There was still some general anxiety but it wasn’t as bad. Ruminating had reduced. She was able to move on with her day and sit with a friend and snap out of her anxiety.
When Michael later went away to Summer camp she found she was not worrying about him, or the germs he might be picking up, as she usually did. This was unusual and gave Christine confidence she was progressing.
Envisaging the next step forward
This week, Christine’s preferred future focused on what 8 looks like. Her ability to describe these small steps really helped her progress. She is telling her subconscious mind what she wants, and helping to create new neural connections.
She envisaged, “Rolling with it. Not getting worked up at all. If there was a real trigger, then she might feel her stomach turn, but the initial anxiety feelings would not last long… My first reaction to Michael saying his stomach hurts would not be the stomach flip, but saying something like: ‘Do you feel like you need to go to the bathroom? Are you hungry?’.” She detailed a full and vivid picture of life as an 8 on the scale.
Session 5 – the challenge of a holiday
Christine’s next session was three weeks later. She had been away on holiday.
Anxious about travelling
Christine was a 7 on her scale.
Equipped with breathing exercises, and the five senses mindfulness exercise, Christine was able to ‘surf’ challenging emotions.
“During this time, Christine had taken her children to an amusement park which was a big challenge but she managed her fears well and her children were able to enjoy the day.”
Christine was anxious about travelling as it was a long car trip. However, she enjoyed the holiday more than usual, without too much anxiety or stress. One day she had felt anxious but box breathing helped her move through the feelings and calm down quickly. During this time, Christine had taken her children to an amusement park which was a big challenge but she managed her fears well and her children were able to enjoy the day.
Next steps
Christine explored what 8 would look like. This focused on dealing with hearing about children who had been sick positively. She had learnt many facts about being s* by now and would be able to reassure herself that being s* is@
the body’s first line of defence
it’s natural, it soon passes
it strengthens the immune system
people feel much better after being s*
a flood of endorphins actually make us feel very good
…and so on
In short Christine was better able to stay in her rational logical mind.
Session 6 - a major trigger
Again, there was a couple of weeks’ gap because Christine was making excellent progress. Generally things had been positive and her quality of life remained good.
Dealing with a trigger
Her son Michael did have an issue that week. He had a choking incident and was a little s*. She reports: “I don’t know how but I was not overly panicked. I did spiral for a bit but was able to breathe through it and tell myself that everything was fine. I was able to get over quite quickly. I dealt with the event much better than expected. Michael had to go to the emergency room but I stayed calm.”
Coping strategies
“ Last weekend my son Michael* was not himself. In the past I would have ruminated but I didn’t. I thought: ‘It is what it is. Whatever is going to happen is going to happen.’ My husband noticed I was much more level headed.”
However, having handled things well, Christine found the next day difficult: “I was more panicked the next day than on the actual day but I played a game with a friend, and over the next hour was able to calm down and the anxiety didn’t come back.”
Dealing with an incident in real time, and panicking the next day seems to be quite common around half way through the process. In the moment, with adrenaline running high, ‘love trumped fear’.
The old unhelpful programmes and patterns are still running but Christine is coping with them better, and recovering from the more quickly.
The power of affirmations
By this stage, well crafted affirmations were also helping Christine. Phrases like ‘I am strong; I can cope; this too will pass’ are more effective than reassurances such as, ‘it’s okay, nothing will happen’.
The truth is you can’t control an autonomic function and you can’t predict when it will happen. The more you avoid the issue, the worse your emetophobia gets so Christine is now ‘urge surfing’ and has the strength and resources to cope with more challenging situations.
The Sense-Ability Timeline Inner Child Script
Throughout the process, the hypnotherapy sessions are highly tailored and include suggestions such as floating back in time to support herself as a child when she first experienced traumatic experiences related to v*, affirmations and general suggestions, and a relevant metaphorical story. Christine stays fully relaxed when potentially challenging scenarios are described while she is in a light to medium trance state.
Michael’s choking incident, while most alarming for him and mum, was excellent exposure for Christine. She learnt that she could face the fear, deal with the outcome,and recover. This is the basis for lasting recovery.
Session 7 - a month later
A month later Christine has sustained her progress and remains around an 8 or 8.5 on her scale. She now describes her life. “I wake up and don’t have a pit in my stomach. Last weekend my son Michael was not himself. In the past I would have ruminated but I didn’t. I thought: ‘It is what it is. Whatever is going to happen is going to happen.’ My husband noticed I was much more level headed.”
Session 8 - coping with a real trigger
Christine has sustained her progress and reported herself as an 8.5 on the scale.
Since our last session, Christine had faced problems one of her worst case scenarios.
Michael had had an upset stomach during this time and there had been ‘a moment’ but it was short-lived. Christine kept him home, didn’t ruminate and didn’t think about it. She played Lego with him and thought of other things. She was able to move on quickly, and that night, she was able to go back to bed and go to sleep.
Imagining 9.5 on the scale
Christine imagined what 9.5 would be like on the scale. “I imagine I wouldn’t feel that initial ‘drop’ at all… I would have even more control... When husband is travelling, normally I feel anxious if he is leaving, but this time I wouldn’t have that concern at all.”
We revised Christine’s affirmations and what she would say to herself if any anxiety arises. She described that she would feel happier and knows that if she or anyone else is ill, they will feel better soon. And believe it.
Ready to finish therapy
Christine felt ready to leave therapy, but knew that I was there in her ‘emergency back up team’ if there were any set backs, or major triggers that set her back.
Six Months Later
When I followed up with Christine six months later she reported having had a much better quality of life overall and feeling mostly resolved. She thought her emetophobia largely resolved and she had few of her earlier symptoms.
A significant blip and a quick recovery
Christine still had occasional bouts of anxiety and the week before our follow-up session she had experienced a significant blip. She thought this was related to ‘unexplained heightened anxiety’ which seems to have come to her without warning and without real cause. This can happen to any of us of course, so I was interested to hear about the blip and how she had recovered from it.
One of the reasons she thought she had experienced this spike in anxiety is that she had come off Prozac for the first time in 3 years. A good sign in general as it showed she felt on top of general anxiety and her emetophobia.
Feelings that pass
During the blip of anxiety the week before, there had been one night that sent Christine ‘into a tailspin’. During this spike in anxiety, Mary had been ill. Christine found that she just shut down, just sat there and couldn’t even pick up a book. However, these feelings did later pass and she was able to return back to her new normal the next day without ruminating on the previous day.
Dealing with a v* bug
In the past six months Christine had handled a v* bug at Mary’s school. The bug had been going right though the school for days. But she was able to feel okay and it didn’t debilitate her. She was as concerned as other parents of course but had managed her emotions really well.
We can see how in the six months following therapy, Christine continued to face challenges, to overcome them and become more resilient, confidence and calm. She has developed more strength and resilience, recovers quickly from setbacks, and is less frequently triggered. She doesn’t think about v* on a day to day basis and is getting on with her life.
Overall a 9 on the scale
Overall, despite the anxiety blip, Christine reported herself as being 9 on the scale. She hasn’t yet been s* herself but now feels much more confident that, should it happen, she can and will deal with it, recover from it and continue to move on with her life.
Christine accepts that life is full of ups and downs, but she feels she can move through her anxiety, and she uses some of the skills and strategies she acquired through the Sense-Ability Emetophobia Recovery Programme to help her manage occasional periods of anxiety.
Why didn’t Christine finish on a 10?
Christine had suffered from emetophobia for over 20 years. In that time she had repeated to herself what I call anti-affirmations: statements that v* is something frightening, dangerous and something to be avoided at all costs. She has, in effect, hypnotised herself, and conditioned herself to be terrified of her own autonomic bodily function.
Complex phobias rooted in terror
Complex phobias are not limiting beliefs, or unwanted emotions. They are rooted in deep terror. It takes time to firstly remove traumas from the past, and then to reprogramme the mind, creating new neural pathways and connections, and to imagine, develop and embed healthier ways of thinking, acting and reacting.
Strength, resilience and skills
Deeply rooted complex phobias can be resolved. It takes several sessions, often spread over months to be resolved. For Christine, the new version of herself is learning to navigate the world again. She has adjusted to the realisation that emetophobia is not part of her personality. Her history is not her future. She continues to face exposure to v* and sb* and to face still unknown challenges now knowing she has the strength, resilience and skills to overcome them.
What does recovery mean?
Perhaps Christine will remain a 9 and that’s far better than the 3 where she began. We won’t know until she is ill herself. Recovery, therefore, is a relative term and each client determines where that will be and how much work, time and money they can put into resolution, and inevitably recovery continues long after therapy is over.
Reflections
It’s possible to find freedom from emetophobia.
Developing a phobia of your own natural autonomous nervous system function is the worst possible complex phobia to experience.
Overwhelming agoraphobia, claustrophobia, social phobias and OCD are also debilitating and deeply embedded as in effect we are frightened of the space around us, and everything associated with our fear in that space; or we are frightened of social connections, which are hard to avoid.
If you are frightened of snakes, in the U.K. you can avoid them. If you frightened of frogs, or spiders, or buttons… you can avoid these much of the time.
“I am delighted Christine has got her quality of life back and I wish her the best of luck with her richer and happier life. ”
But you cannot avoid your own bodily functions; you cannot avoid the space around you and you cannot avoid meeting other people (unless you are a hermit in a cave or a Buddhist monk up a mountain in which case good luck to you). These complex phobias are like fear of fear itself.
What does the recovery process include?
Christine’s recovery process included breathing exercises and some other management strategies designed to make life easier from day one. Often I include Rewind Trauma or Phobia Rewind Therapy but in this case, it wasn’t necessary.
For Christine, the Sense-Ability Solution Focused Emetophobia Recovery Programme helped her recover from a lifelong issue over a few months. Her recovery continues to embed.
I am delighted Christine has got her quality of life back and I wish her the best of luck with her richer and happier life.
Emetophobia Glossary*
v = vomit, vomiting or vomits
s = sick
sb = sickness bug
** Steve, Mary and Michael are not real names. My client is called Christine but wishes to remain anonymous so all identifiers have been removed from the article.
If you would like to discuss whether the Sense-Ability Emetophobia Recovery Programme is for you, I’d be delighted to talk it through with you.
Jane Pendry
BA Hons (London), PGCE (Cantab), DSFH, HPD, AfSFH, ABNLP, ABH, CNCH, IARTT
Sense-Ability Hypnotherapy & Coaching
jane@sense-ability.co.uk
07843 813883
www.sense-ability.co.uk
Wheatley, Oxford, United Kingdom Online across the U.K. and Europe