What Kind of Help is Available?

I think I will start with the end goal. The treatment target is for the person with the phobia to believe the object of their fear is no longer threatening and the corresponding biological alarm is no longer distressing. (One important thing to know is that the wrong treatment target is to reduce the anxiety. That is a goal but not the treatment target. I will explain later.) People with anxiety disorders have two ways of thinking that are part of the problem. First, they think the likelihood of being harmed is very high. Second, they think that what happens will be extremely bad.[1] I wish it was as simple as presenting the logical and rational reasons that vo**ting isn’t harmful or won't be so bad if it happens. If you have an anxious child, you have probably tried every reasonable explanation to try to convince your child to not be afraid. It just doesn’t work when the fear is at the level of a phobia.

One reason that a straightforward explanation might not be working is because there are different kinds of knowledge. For example, there is something called a priori which is knowledge that someone can have without needing to experience it. This is what we typically describe as reasoning. For example, you could understand that a bicycle can be ridden. You can read about it and possibly watch a video of how to learn to ride a bike. But you still don’t really understand what it is to ride one.

Another type of knowledge is called a posteriori. This is knowledge gained from having an experience and then using reason to make sense if it. For example, to understand how to ride a bike would take the experience of getting on it and rolling down the street. It is a different way to understand something.[2]

Treatment for anxiety is designed to experientially prove (a posteriori) that something terrible isn’t likely to happen and if it does, that they have the ability to handle it. This treatment is called exposure and response prevention (ERP). Exposure is basically doing something that causes the fear in order to discover that the fear is mistaken. You do this, not for self-inflicted torture, but to get the experiential knowledge that will provide the proof needed to overcome the fear. 

ERP is a subset of a more general treatment called Cognitive Behavioral Therapy. The hope is that once you revise your thinking (cognitive) and behavior that whatever symptoms you have would either be gone or greatly reduced.

Exposure is the act of deliberately facing or experiencing the "something" that triggers your anxiety and then learning to tolerate the anxiety. I heard it described as “changing your relationship to the fear.” Instead of trying to avoid you intentionally step toward it.

Response Prevention is simply preventing yourself from responding to the trigger in your previous manner. I prefer the term, safety behaviors, because that is a better description of the purpose one has for that behavior. 

Here is an example. Let's say someone has a phobia of chickens. It is called Alektorophobia. I know, there are a lot of jokes coming to mind. Anyway, the exposure could be to look at a picture of a chicken. Here is one my daughter drew. You will keep looking and repeat looking until the picture was not longer difficult. The response prevention would be to NOT avoid looking or trying to make it safer in some way. 

The treatment that I believe is most effective is exposure and response prevention. Sometimes good clinicians use aspects of learning to breathe and/or relax as part of the exposure process. Some clinicians may also employ other treatments such as acceptance and commitment therapy or meta-cognitive therapy. Biofeedback is also used with some success. Of course, there are medications that are effective but that is often a catch-22 for this phobia because often a possible side effect is nausea. There are likely other helpful treatments that I am not going to take the time to list or review here.

It is my opinion that most talk therapies when used without ERP are not very effective with emetophobia. Most “coping” strategies end up becoming safety behaviors. Of course, talk therapy is effective with a multitude of other issues. 

The bottom line is that to overcome this phobia, the patient will need to systematically face various triggers that will cause anxiety and some physical distress. Each trigger will need repeating until the level of distress decreases or the level of confidence it can be tolerated increases.

I hear often that people cannot find clinicians who are familiar with ERP. If they are, they often don’t have experience with emetophobia. There are a few self-help resources available. First is the premier website for information and the actual steps listed. This website was developed and maintained by Anna Christie, BCACC. She was a former sufferer and is now a leading clinician in treating this phobia. Her website link is here.  She has a list of books and articles on her website about this as well. https://emetophobiahelp.org/books-articles/

Additionally, (this part is a bit self-promoting, sorry) there is an anxiety program for kids called Turnaround: Turning Fear Into Freedom and a special supplement for emetophobia. This was developed by a colleague and myself to help kids with anxiety disorders. We got so many requests for additional help with emetophobia that we developed a supplement to the program for that.

I have also written an interactive book for kids on emetophobia. It is a bit hard to describe but your child would read and interact with it on a device. The necessary information and then the steps are included. There is an adult companion guide with it as well. It is currently only available on apple books for use on apple devices. Here is a link to it.

Go to this page to see a more complete list of books and resources. I frequently include links to another website that was created by Anna Christie and me. 

[1] Abramowitz, J. S. (2013) The Practice of Exposure Therapy: Relevance of Cognitive-Behavioral Theory and Extinction Theory. Behavior Therapy. 44. 548. https://doi.org/10.1016/j.beth.2013.03.003

[2] https://blog.udemy.com/types-of-knowledge/