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Ryan LCSW
Ryan LCSW, Mental Health
Category: Mental Health
Satisfied Customers: 872
Experience:  Individual and Family Therapist
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Hi, I have a phobia of vomiting (emetophobia). I have suffered

Resolved Question:

Hi, I have a phobia of vomiting (emetophobia). I have suffered from it for ~20 years and have been actively seeking treatment for it for the last 5 years. I have gone to counselors using classic CBT therapy and EMDR. I have experienced very little in the way of positive results. As I am now trying to find a new counselor, what should I be looking for? What is your professional opinion on the efficacy of CBT, EMDR, Brainspotting? Is there another therapy I should try?
Submitted: 1 year ago.
Category: Mental Health
Expert:  Patience replied 1 year ago.

Patience :

Hello and welcome! I am sorry you have come to a stuck place. Are you available to chat now? Maybe we can get you strted on further options.

Customer:

Sure, thanks for your help.

Customer:

Is there some more background info I can give you?

Patience :

Of course. So it seems you engaged with CBT for awhile? It is said to be helpful with emetophobia, but it is a difficult problem. What do you think was happening with treatment?

Customer:

Well the latest therapy I have been using is EMDR. I really haven't noticed any difference, but by her own admission, my therapist doesn't use it often. So, I'm not sure that she's well versed in it. I have used CBT with previous therapists. Although it has helped my ability to keep my external anxiety less apparent, I still feel the same amount of panic about my phobia.

Patience :

And how is your life and health otherwise?

Customer:

well I have GI issues, which of course affect my phobia. But other than that I am healthy and well adjusted.

Customer:

I have been speaking to another therapist about starting brainspotting/EMDR. But I have reservations about how effective it will be.

Patience :

What type of work or school do you do?

Customer:

I am a biologist. I work in biotech.

Patience :

And are you on any kind of medication?

Customer:

I have been on fluoxetine for many years. I does help any overall anxiety. But is ineffective when it comes to my phobia. I take xanax prn (when I have a phobia induced panic attack)

Patience :

Ok. Do you have support people who are there for you?

Patience :

What's your name, by the way?

Customer:

well I currently live on the other side of the country from my family, but I have a very strong relationship with my mother.

Customer:

its Jayd

Patience :

What a pretty name!

Customer:

thanks!

Patience :

You are welcome! So this has been something that has been with you since childhood?

Customer:

yes, I had an incident that occurred when I was ~7 years old. I have been terrified of nausea and vomiting ever since.

Customer:

I have done a good bit of research to try to help myself, but I am at a loss as to what to do now.

Patience :

What made you quit your last therapist and how long were you with him or her, Jayd?

Customer:

I only stopped going recently. I had been with her for a year. I just felt that after several months of EMDR I didn't feel as though we were making any progress. Our discussions were circular and I felt like we were getting no where.

Customer:

Do you know if there is some better type of therapy for phobias that I should be looking at?

Patience :

I see. So tell me more about how this condition manifests for you, if that's ok.

Customer:

Sure. I feel queasy at the sight of watching someone vomit, like anyone. But the difference is I obsess about vomiting, how my stomach feels, and if I'm becoming ill. It keeps me from going out, from eating certain things, from being around people I suspect may be ill and contagious. Any time my stomach hurts (which is frequently) I become panicked. I often have very bad panic attacks that require to leave work or wherever I am and go home.

Patience :

What about your G/I complaints? Do you have a specific diagnosis on that? Is it under treatment? Do you suffer with bouts often?

Customer:

Yes, I have had GI problems since early childhood as well. My current diagnosis is IBS, but I have had stomach ulcers, etc. They are being treated by a gastroenterologist. I feel certain that my anxiety about nausea most likely contributes to the severity of my GI symptoms, though they have been around longer than my phobia.

Patience :

You poor thing! I know it is very difficult to have to deal with stromach/digestive stuff and with mental health issues. You are very brave to keep on trying.

Patience :

As for the EMDR, etc. I have not looked into that much. If it has not worked for you recently, you might want to put it on the back burner. Your best bet would probably be to find someone who specializees in phobias. Do you live in a small or large town and in whjat area of the country?

Customer:

I live in a large city in California. I have looked for a therapist that specializes in phobias with very limited results.

Customer:

My only way forward at this point is to look into specific therapies to see what would be most helpful and then find a practitioner.

Patience :

I still think that CBT is the way to go on this with maybe a support group as well. DBT is good for a support group but that mioght not be available in your area.

Customer:

DBT?

Patience :

It is a subset of CBT that help people get over there stuck places. One part of it that would be good for you is doing mindfulness meditation, to help you relax an also to help you observe yourself and your world a little better.

Customer:

ok.

Patience :

Also, can you tell me, how are you going about your search for a therapist?

Customer:

I have gone through several associations as well as the apa.

Patience :

And what happened/ they just could not give you any leads?

Customer:

There are just very few people who specialize in phobias. And the ones that do don't specialize in complicated ones.

Patience :

Does that mean they are not willing to take you on?

Customer:

Well I had one specifically tell me that mine was not concidered a simple phobia and couldn't be treated by normal methods.

Patience :

Well, that was not very encouraging, was it? But you have to pick yourself up and dust yourself off and keep interviewing therapists. ok? The person does not have to be expert in the subject, the person just has to be willing to try and someone with whom you can feel comfortable and confident.

Patience :

Also, look for a support group. Try mindfulness-based meditation; try yoga if it interests you.

Patience :

Additionally you might want to pursue some wholistic health stuff for your IBS. Naturopaths are good with that, but there are other health providers who can help you with it as well.

Patience :

what do you thik?

Customer:

Well, I have definitely tried some of that, I'm just really looking for some evidence based therapy.

Customer:

I will just continue to look.

Customer:

thanks for your time.

Customer: replied 1 year ago.
Relist: Answer quality.
Very nice Expert, but did not seem to have the expertise to answer my question.
Expert:  Patience replied 1 year ago.

Hello Jayd- I would encourage you to not give up so easily. i would also encourage you to please remove the poor service rating, as it will count against me. I was just in the midst of writing that I would be happy to do some resarch for you in some of the journals to which I have access to get you the evidence based medicine info. I am requesting that you take some breaths and let me continue to work with you. Also, I want to ask what you think of the following link: http://www.emetophobia-clinic.com/emetophobia_f-a-q.html

If nothing else, you could just relist without downgrading the time I spent getting to know what was needed, ok? please consider leaving at least an OK service rating.

 

Best regards, XXXXX XXXXX

Customer: replied 1 year ago.

I really appreciate your help, I just need to speak with someone who has a bit more background in this area. I've read that website as well as a few others like it. They are mostly scams unfortunately and I have been advised against them by other therapists.


Expert:  Ryan LCSW replied 1 year ago.
Thanks for your question,

I'm sorry that you've been advised that this website is a scam. There are certainly many qualified professionals here with proven track records of helping people out. While I certainly understand your frustration in being unable to overcome your phobia, I do think it is important to point out that the most proven method for conquering any phobia is a combination of CBT and exposure therapy. All phobias, no matter how complex, are generally treated similarly because they all stem from irrational fears. Because of that, your phobia may be more complex due to the severity and length of time you've been suffering from it, but the solution remains the same.

Generally the problem in exposure therapy is that people give up on it long before it works because it is a long and difficult process. However, if you are looking for proven methodologies, this is it. If you think about the basic concept of overcoming your fears, it logically makes sense, and people who stick to it have success. While the quality of your therapist may certainly help, exposure therapy is something that you must also do on your own on a regular basis. Unless you are consistently working on this problem in your own time and doing your exposures, then there's a good chance that you'll continue to shuffle through therapists, since the bulk of the work depends on yourself.

I do understand your frustration with finding a good therapist. That can obviously make a big difference. However, since all phobias similarly, I would recommend you pursue a therapist who has experience using the most proven methodologies for phobias, which is CBT and exposure therapy. I definitely wish you the best with all of this, and if there is anything else I can do to help just let me know.

Ryan
Customer: replied 1 year ago.

Thanks for your answer. Just a little clarification. I have "completed" a CBT therapy course with little results. I have been pursuing EMDR as a treatment. Do you know anything about the efficacy of it in comparison to CBT?

Expert:  Ryan LCSW replied 1 year ago.

EMDR is typically used to treat people whose problems are the result of a traumatic experience. While it is a method that has been adapted to treat people with phobias, people generally do not have as much success with it for those specific types of problems. I have attached a link herewith more information about that, and some studies that you may find interesting regarding EMDR and it's effectiveness in treating phobias. Of course different things work for different people, and what works well for one person may not necessary work for the next. If you find that the EMDR is working, then I would certainly not deter you from sticking with it.


Considering this problem has been going on for 20 years, it is not surprising that it would be persistent through one course of CBT. Problems that have been around for a long time take a long time to unwind. It is also possible that you didn't connect well with your therapist, or didn't have time to go through enough of the exposures to make a significant difference. People with longstanding phobias like this often require more persistence and treatment of longer duration. However, when it comes to phobias, CBT and exposure therapy generally is the most effective means of conquering it. All the best,

Ryan
Ryan LCSW, Mental Health
Category: Mental Health
Satisfied Customers: 872
Experience: Individual and Family Therapist
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