What It Took to Finally Stand Up to My Biggest Fear
I was in the emergency room in the spring of 2021 when I decided something had to change. I had driven to the hospital so many times in the past few years that I knew the directions to the emergency room and the intake questions by heart. I don’t have a life-threatening condition, as you might imagine. I have a pathological fear of vomiting, also called emetophobia, and over the years, I have tried everything to try to prevent it.
I have broken out my rosary to pray when I felt the slightest bit nauseous, chugged Mylanta or ginger ale like it’s beer at a college party, worn nausea relief bands, and taken prescription medications typically given to cancer patients. This trip to the ER was just the latest of many, taken at the onset of queasiness to get powerful anti-emetics delivered intravenously. I had spent so much time and energy trying to control my nausea, but that day in the ER, I finally realized the one thing I could control about this anxiety disorder was whether I chose to get help or not. My fear had always seemed too big to tackle, but that was before both of my parents died one right after the other. Surviving the deaths of my parents was harder than I could have ever fathomed. Still, there I was, alive but in the emergency room. I finally decided to give cognitive behavioral therapy and hypnotherapy a try. I had been afraid of being sick for so long—finally, I was sick of my fear.
My pathological fear of vomiting began with a nasty bout of food poisoning when I was in kindergarten. I began throwing up uncontrollably, faster than my maternal grandmother could wash the sweet-sour stench of fresh vomit out of my hair and place me in a new set of clean clothes. In the background, I could hear my parents fighting: my mother worried I was dehydrated or worse, wanted to rush me to the hospital; my father, more concerned about the hospital bill, wanted to keep me home. Meanwhile, I remember feeling a sense of dread and embarrassment, like I was at fault for causing my parents to argue.
The emetophobia got worse in my adolescence, leading to a scary diagnosis of anorexia. At 13, I became afraid of food because of a vomiting episode and the onset of non-ulcer dyspepsia. If food could conceivably make me nauseated, it was scary. Every subsequent wave of nausea caused me to restrict my food intake to the point where the only foods I considered “safe” were baked potatoes, wheat toast with grape jelly, and bananas.
My weight plummeted to 60 pounds, and I was hospitalized at an eating disorder facility for nearly a year, most of that time with a nasogastric tube—a tube that passed from my nose to my stomach—to help me gain the weight I had dropped. All the while, I avoided conversations with some bulimic patients in the ward, several of whom romanticized their binge-and-purge episodes. Any mention of the word puke would cause me to run out of group therapy sessions. Though I recovered from my dangerously low weight, for two decades after that, I treated the symptoms of my phobia but not the debilitating fear itself.
I got very good at avoidance. Trying to dodge turbulence that might make me queasy, it took me years to fly at all and then longer to graduate to long-distance flights. But the journey my phobia has most limited is the one toward my future. Even though I yearn to get married and have children, I’ve, perhaps subconsciously, chosen romantic partners who’ve been ambivalent about that kind of long-term commitment. If they’re not willing to take the next step, it takes some of the pressure off me to worry about morning sickness.
When a person has a phobia, what is happening on a neurological level is that the amygdala—the part of the brain responsible for processing emotions and memories associated with fear—is trying to keep us safe. In doing so, it registers phobias as something dangerous. For example, in my case, if my brain sees vomiting as hazardous, then food also becomes dangerous since it can lead to throwing up. Those of us with persistent, debilitating phobias are moved to control the trigger (eating certain foods, eating out), but in doing so, we stay stuck in the fear. Instead, I’m learning that controlling the actual phobia instead is where the power lies, and where the fear can ultimately lose its grip on us.
For some, a phobia is rooted in a traumatic event. During this past year with my new therapist, Sara, I’ve realized that trauma is part of my phobia. My fear of being ill commingled with my late father’s tendency to be emotionally distant and sometimes physically abusive in the name of “discipline.” I realized that being sick or otherwise standing out could make me a target for my dad’s anger and disappointment. Dad’s spankings and diminishing comments led me to associate my vomiting fear to the corporal punishments I experienced. Vomiting wasn’t just asking for punishment—it was a punishment within me I could not stop.
When phobias are linked to trauma, sufferers will avoid certain people, things, or circumstances if they equate it to something traumatic that happened in their lives, explains Thea Gallagher, a clinical psychologist and assistant professor at NYU Langone Health with 17 years of experience treating phobias. But a phobia is just as likely to persist without trauma as with it. Either way the amygdala is triggered when we are fearful or perceive a threat, activating our fight-or-flight response, she adds. I understood this all too well. The thought of retching makes my blood pressure rise, my skin turn clammy, and my heart beat so fast that it feels as though I just ran a 5K.
Exposure therapy works to a break down a person's resistance to the fear, Gallagher explained. With emetophobia, the core fear might be losing control, or embarrassing yourself in front of others, or feeling like you won’t be able to breathe. For someone with emetophobia, Gallagher will have the person fake gag in public (if their biggest fear about vomiting is related to embarrassment, for example). She’ll also have the person being treated create fake vomit and simulate throwing up. Eventually, the person moves up to using a toothbrush to gag themselves. The key is while the person is undergoing exposure therapy, they cannot engage in any ritual safety behavior (for example, avoiding food trucks, or overmedicating on anti-nausea pills).
“I like to normalize and let people know what you’re feeling is very real and painful,” Gallagher says. “But the more we face something, the easier it gets over time. Exposure therapy is uncomfortable, but it works.” She says it can take up to 20 sessions for this form of therapy to achieve results, but the person being treated must actively work at it (for example, they need to keep exposing themselves to their fear).
“The goal is not for people to be completely unafraid,” Gallagher says. “The goal is to still have some fear but to do it anyway.”
I adopted my dog, Jack, in September 2021, six months after I started treatment. In his first week with me, he started throwing up after eating a brand of food that irritated his stomach. I called my ex, crying and begging him to drive a half hour to my house to pick up the mess for me. About a month ago, Jack had another vomiting episode. This time it was much worse: He threw up four times in two days. Instead of asking my ex-boyfriend to help me, I grabbed a ton of paper towels and cleaning solution and cleaned it up myself. It took me more than an hour each time. I was shaking from fear but simultaneously fighting my fear and my gag reflex. Ultimately, I did it all on my own.
Later, I thought about my progress. Though it may be slow, every small improvement has felt like a miracle.
SCARE TACTICS
These expert-approved techniques for managing fear mean you have nothing to fear—not even fear itself.
To De-fang Fear
Rebrand the feeling
Instead of letting fear paralyze you, turn it into adrenaline to motivate you. If you’re nervous about taking action—whether it’s giving a presentation or meeting a blind date—find somewhere to do a few jumping jacks, suggests sociologist Margee Kerr, author of the book Scream: Chilling Adventures in the Science of Fear. “As you’re jumping, repeat, ‘I’m so excited right now!’ ” Kerr says. “It will help rechannel your feelings. And the more often you do that, the more readily you’ll experience nervous tension as excitement, not fear, in the future.”
Find a friend
“A social support person—a partner, best friend, even your dog—can really help counteract fear,” says Vanessa LoBue, PhD, associate professor of psychology and director of the Child Study Center at Rutgers University.
“I participated in a study in which women were shown a symbol that meant that they were going to receive a mild electric shock in a few seconds; the ones who were holding their husband’s hand showed a completely dampened-down stress response in their brain. When a stranger held their hand, that didn’t help.”
Take Fear’s Advice
Speaking of friends, Barry Moniak, a consultant who focuses on fear in the workplace, suggests you start thinking of the emotion as one of your BFFs— the honest, on-top-of-it one who will tell you there’s spinach in your teeth. “Ask what the fear is saying,” says Moniak. “It’s often that you don’t have an adequate skill set to do what you’re trying to, and if you got a little more knowledgeable, you’d have nothing to be afraid of.” Once you’ve identified the fear (taking on a leadership role at work, say), you can develop your skills (reading books or taking classes about managing a team successfully and getting to know the people you’ll be leading) enough to gain confidence and get moving.
Invite Jitters
A long-term approach to becoming less fearful, says Kerr, is to “engage with that stress response but in more enjoyable scenarios—trying different foods, going to new places.” She points out, “Older people especially sometimes restrict activity and narrow their lives out of fear. Encouraging yourself to be adventurous and curious, and pushing yourself in terms of entertainment or scholarship or activities, is a way to increase your resilience and sense of competency”—both excellent attributes to have the next time you find yourself in a scary situation.
To Deflate Worry
Be Specific
“If you’re nervous something bad will happen, narrow it down specifically to who, what, when, where, why,” says clinical psychologist Ellen Hendriksen, PhD—that way you can either figure out how to face the issue or realize it’s not as threatening as you once thought. For example, Hendriksen says, “people with social anxiety will often think, Everybody is going to hate me. But when I ask them to get specific, they realize the concern is actually, ‘Oh, Darla and Jolene are going to be judgmental of my outfit.’ That’s very different, and when it’s expressed, then we can deal with it.”
Hope for the Best, Plan for the Worst
When you’re anxious about something going wrong, Hendriksen advises asking—and answering—the question, what if? “This might mean, If Sam and I break up, I’ll go on a long trip. Or, to take a personal example, when I was worried I might get Covid-19 and have to self-quarantine, I decided that if I did, I’d stay in the study. It has a glass door, so I’d be able to see my kids even if I couldn’t be in the same room. ” Whatever the circumstance, having a plan reduces the vague uncertainty that makes worry so stressful.
Manage your Expectations
One thing that can make you panic is the fear of disappointing yourself. “If you’re anxious about going to a party because you imagine everyone expects you to be funny and cool and not leave any gaps in conversation, say to yourself, I don’t have to perform. I just have to show up and listen and be interested in other people, and that’s enough,” says Hendriksen. “Modifying your own standards away from perfectionism is very important in reducing anxiety.”
To Disarm Trauma
Look Past It
In eye movement desensitization and reprocessing (EMDR), a therapeutic treatment that has gained traction in the past 30 years, the therapist has a client describe a past trauma, “recalling the images, thoughts, feelings, sensations, and what remains disturbing about it,” says Deany Laliotis, a licensed independent social worker and director of training at the EMDR Institute in Watsonville, California. The client is then guided through a series of eye movements, following the therapist’s fingers as they move back and forth, almost as if watching a tennis match, while recalling the trauma. This allows her to “notice what comes to mind about that memory while at the same time maintaining an awareness that it’s not happening now,” says Laliotis. As she reexperiences the trauma while focusing on the eye movement, “the emotional and physical distress and confusion is processed out, and eventually it’s over permanently because the way the memory is encoded in the brain has changed,” says Laliotis. “It no longer has an emotional charge with a corresponding body sensation, so the recalled experience and other memories like it are effectively neutralized. The past is in the past rather than the present”—a potentially life-changing development for sufferers of PTSD, and a reminder that just because something once scared you doesn’t mean you have to be frightened forever.
Expose Yourself
Specific phobias are often treated with exposure therapy, confronting the dreaded object in increasingly intense ways: An arachnophobe might start looking at a picture of a spider, then a spider stuffed animal, and ultimately engage with a real arachnid. It’s very effective—60 to 90 percent of patients who stick with the protocols see improvement—but it can be difficult to keep confronting your deepest fear. Kerr and a colleague are currently experimenting with flipping the script, starting with the most terrifying but amusing over-the-top version of a fear and scaling down. For example, says Kerr, “we took a subway car, which is a common exposure for people with social anxiety, and, using virtual reality techniques, filled it not only with people but with zombies and other scary-but-fun figures.” Preliminary findings show that starting with the outlandishly worst-case scenario that works its way down to an everyday fear makes that phobia seem, says Kerr, “like no big deal.” It’s new research that bears out an old truth: Fear loses its power once we face it.
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