How can therapy help with emetophobia?

Emetophobia (the fear of vomiting or seeing others being sick) is expected to affect approximately 8% of the population in the UK. Individuals with emetophobia often report feeling nauseous or unwell more frequently than the general population, which may be linked to heightened anxiety, hypervigilance to bodily sensations, and misinterpretation of normal physical cues as signs of impending vomiting. Often misdiagnosed, it can have a devastating, long-lasting impact on a person's daily life. Emetophobia also appears to be highly comorbid with other anxiety conditions, including OCD and panic. Whilst anyone can be affected, it often begins in childhood. 

Sufferers might find themselves avoiding certain places, people or situations in an attempt to avoid becoming ill and risking the chance of throwing up. If you find yourself obsessively checking food labels, refusing to touch door handles, being hypervigilant with cleaning or seeking reassurance from others about whether you are ill, you may be struggling with emetophobia. 

So, how can therapy help?

Here are the five steps I take with clients who want to work on their fear of being sick.

1. Understand your story

Where and when did this fear develop? What has it been like for you? What is your goal for this work? I may ask clients to share with me their early experiences of being unwell, or seeing others unwell and identify any links to this and their fear. Then, in a more holistic view, what other life events or experiences may be keeping this phobia going?

2. Psychoeducation: Understanding the body’s response

Did you know that our bodies vomit when they need to protect us, to expel poison? This is why poison is so effective on rats, as rats cannot vomit. Therapy will help you to explore how and why we vomit, to better understand our body's response.

3. Reducing safety-seeking behaviours

What behaviours are you demonstrating in an attempt to avoid being sick, i.e. not eating out, refusing to go on an aeroplane, obsessively cleaning certain items, avoiding being near children or in medical establishments, overly checking if the people you are planning to meet/work with have recently been ill? And why are these actually making your fear worse?

4. Reshaping your belief system

We can change/alter our belief system and lose beliefs that are no longer serving us. Looking at the parts of us and how the anxious part isn't always the part to listen to. Here, I may introduce a CBT tool - 'Theory A versus Theory B' to help you consider an alternative way of viewing things. With emetophobia, Theory A is like thinking, “If I feel sick, I’m definitely going to vomit, and it’ll be absolutely awful – I won’t be able to cope.” It’s all about the worst possible outcome feeling guaranteed. Theory B is more like, “I’m feeling sick, and I’m worried I might vomit – but that doesn’t mean it’s definitely going to happen or that I couldn’t handle it if it did.” It’s more about anxiety and uncertainty than a full-blown disaster.

5. Gradual exposure

Facing the challenge head-on. Testing out those scary things bit by bit. This will help you gain confidence and reduce anxiety levels. This usually looks like dropping the safety-seeking behaviours, but also working through sick-related material, i.e. pictures, sounds and videos to acclimatise you to vomit.

Many clients have tried lots of things to overcome emetophobia. Everyone is different, and it is important to state that this isn't a one-size-fits-all approach. Cognitive behavioural therapy (CBT) and hypnotherapy are also effective ways to manage the phobia. If the emetophobia was triggered by a traumatic experience, EMDR (eye movement desensitisation and reprocessing) can be really helpful too. 

This phobia is detrimental to the quality of life for some, stopping young people from attending school, stopping some from enjoying holidays or meals out with loved ones. Care-givers, family, and loved ones of the sufferer also experience huge distress as they really want to help but don't know where to start. It can feel more complex to overcome than other phobias, due to the nature of the fear, as it isn't something you experience on a daily basis, like a fear of animals or objects, for example.

Often, others cannot understand the phobia, and sufferers are told to get over it or just not think about it. But there is help out there, and your experience is valid. Make sure you find support from someone you trust, someone you feel safe talking to, and with time and effort, things can be improved.