The following is a ‘cure your emetophobia and thrive’ book update from March 2014.

The update comes from the final chapter, and the ‘common mistakes people make’ section.

Common Mistakes People Make

Let’s have a look at where you might go wrong…

Persistent and continuous effort (PACE)

You want to spend the next six weeks or so re-training yourself: changing your limiting beliefs and unhelpful thinking styles and developing new skills.  You need to put in some work every single day.  You are building up momentum and you want that momentum to become so big and powerful that it becomes habitual.  At that point, you can more or less stop putting any effort in. Imagine you are creating a big snowball and you are starting to push that snowball down a hill… it is only when it becomes big enough, and the momentum sufficient, that you can stop pushing it, and it will continue on down the hill under it’s own steam.  Stop pushing too early and the snowball will grind to a halt. Then you have to start pushing all over again.

Another metaphor could be push-starting a car. When you have owned crappy cars, like some of the ones I’ve owned in the past, you’ll get this straight away… When push starting a car, you need to first get the car moving, then keep it moving whilst the driver engages a gear and waits for the engine to splutter into life. Only once the engine has taken over completely, can you stop pushing.  Stop too early and you have to start the whole bloody thing over again. In fact, push starting a car is a great metaphor for overcoming emetophobia for another reason. It needs a really REALLY good push to get moving in the first place. You aren’t going to get a car moving without putting all your bodyweight and effort behind it.  Once it’s moving, you can stop pushing quite so hard, but you MUST keep up the momentum until the engine takes over. This is exactly what you need to do in order to overcome you emetophobia.

If you throw yourself into this programme and put in loads of (the right) effort for a few days, you will start to feel better. If you stop for a day, or have a big blip (see below) your snowball or car will come to a grinding halt, and you will need to start all over again.  This is fine – if you can put up with stop/start, stop/start, and you can manage all the emotions that you will create in the process. But you will find the whole process smoother and easier if you apply persistent and continuous effort!

Have a look at the diagram below:

pace graph

This diagram shows the effects of someone starting then stopping, starting then stopping putting in effort. Position (1) is at the end of the first week. The emetophobe has done really well and is starting to feel better, so eases off the effort. They then experience a decline.  This goes on for the next couple of weeks. Position (2) – at the end of the third week – shows a big blip. The person went really downhill because they stopped putting in the effort, but manages to pull it back again over a few days. Position (3) is where the person is really putting in persistent and continuous effort. He or she has finally got control of the whole thing, knows how minimise blips, and is well on the way to recovering completely – albeit a few weeks late.

This diagram shows someone always recovering… Even though this person kept creating setbacks initially, they maintained their belief in the process and kept getting back on track.  Though you don’t really want any big setbacks at all, this diagram shows why Thrive is successful where other treatments fail. The person in this diagram kept on ‘getting back into the saddle’ and not giving up, because they understood WHY the blip had happened, and WHERE they had gone wrong.  Because this programme is understandable and predictable, people can recover even though they sometimes go through some shitty times.

When you bear in mind that many other treatments for emetophobia aren’t believable, understandable and predictable, it isn’t surprising that Veale and Lambrou (2006, p. 139) reported “clinicians generally regard it [emetophobia] as challenging to treat because of high drop out or a poor response to treatment.” If you have thoroughly studied this book and completed all the exercises, you will really understand exactly how you have been creating your emetophobia and how to un-create it! Now it is just a matter of putting in the effort and practising your new beliefs and skills until they become habitual. Even when you have the odd blip you will understand exactly how to get back on track.

Blips

By putting in persistent and continuous effort you will minimise blips. It is, however, important to remember that everybody has blips from time to time. Even people who are completely thriving have bad days. It’s managing your reaction to them that is important. You want to minimise the impact of a small wobble and not make it into something bigger than it really is.

So, remember that you are going to create good days and not-so-good days in the forthcoming weeks. You are going to feel that you are getting somewhere but then create a bad day. Tolerate it. Put up with it. It’s par for the course. Early on, in putting this programme into action, you aren’t going to be able to catch and change every single unhelpful thought or belief that you have. Some – probably many in fact – are going to slip through your net. This means, that in the near future at least, you are still going to have some anxiety about sickness.

If you have a difficult day, calm yourself down, reassure yourself, and take the actions you deem necessary in order to get over it and move on.  Don’t focus on that ‘bad day’, don’t wallow, don’t think ‘it’s not working’. Remember, there is no ‘it’ – YOU are doing this to yourself – and focus upon the fact that you are gradually making progress. Every time you create a blip, remind yourself that you are learning something else about your thinking and beliefs that will ultimately help you to overcome your fear.

The thinking style most often associated with a big blip is the perfectionist style. Perfectionists are hypervigilant about their perceived imperfections, mistakes and flaws. Add in some of the other thinking styles and a ‘minor blip’ can easily become ‘I’ve ruined everything, I’m so stupid, I’m never going to get better’.  ‘Beating yourself up’ is enough in itself to maintain your emetophobia, because it drags in all your limiting beliefs and thinking styles. So stop it. Stop beating yourself up, it serves no purpose at all, other than ensuring you stay emetophobic.  Give yourself a break, be nice to yourself and tolerate the blips. Remember the blip drawing in the perfectionist thinking style section (page 129)? If not go back and look at it again now. When you create a minor blip, you can go one of two ways… You can either get back on track quickly, or you can blow the whole thing out of proportion, beating yourself up and wallowing in misery for several days.

Desire for control

Your desire for control, as we’ve already discussed, is something that you need to reduce.  You believe that your sense of control over things is helpful but in fact it does nothing other than make you feel powerless much of the time. You want to remember that the things you do in order to feel more in control are the exact opposite of what you need to do to get over your phobia. You must stop thinking ‘I’ve got to control this’, and instead think ‘I’m going to get over this’ because it is an entirely different attitude. Instead of thinking ‘how can I put this fire out?’, start to think ‘how can I stop building fires?’ Instead of thinking ‘how can I totally and completely avoid being sick for the rest of my life?’, put effort into thinking ‘I don’t have a fear of being sick, I have a fear of being out of control, that I am going to slowly and safely overcome.’

If you keep reverting to safety-seeking and controlling behaviours, you are undermining the good work that you are doing in other areas. Maintaining your desire for control, whilst at the same time attempting to overcome your phobia, has the effect of holding you back. Worse than that, because you are putting in loads of the right sort of effort (as well as loads of the wrong sort of effort), you will not progress very quickly. You are then likely to think that ‘it’s not working’, something that you would typically react to by trying to be more in control… I’m not suggesting you suddenly throw away your defences and lay yourself bare, rather that you slowly reduce your safety-seeking and controlling behaviours, as you build up your sense of secondary control and your need for these defences slowly subsides.  In other words, slowly and gently lower your barriers as you slowly and gently get better.  If you hold on too tight, your progress will look a little like the continuous line in the drawing below:

DFC graph
The dotted line shows the progress you want to achieve – gradually getting better and better each week – whilst the dotted line shows the typical progress of someone holding on too hard to their desire for control.  Hold firmly onto your desire for control and you’ll find it – amongst other things – harder to challenge your beliefs, harder to tolerate uncomfortable feelings, harder to expose yourself to experiences you deem ‘outside your control’, harder to be nicer to yourself… and much more.