Emetophobia - Fear of Vomiting w/Dara Lovitz & Dr. David Yusko (Episode 106)

SPEAKER_00 0:02

The mother of um twin daughters and an emetophobe who had suffered for more than three decades before seeking the help of uh Dr. Yusko, who um, through a treatment of ERP with him, I was able to get to the other side of the phobia. But before the internet, so many of us suffered in silence. Nobody around us was emetophobic. We felt ashamed of our fear. We know that it's not rational. You know, we know that there's nothing wrong, we know we're not gonna die, and yet our brain tricks us into thinking that this is a real threat.

SPEAKER_03 0:34

Like you kind of have to spend a little bit of time trying to kind of dig around with what they're truly, truly afraid of. When all roads lead to vomit, um, then you are, oh, this is emetophobia.

SPEAKER_02 0:54

Welcome to Disordered. This is the episode 106 on the topic of emetophobia. Guys, this episode is gonna be sick. I'm Joshua Fletcher, also known as Anxiety Josh. You know who I am.

SPEAKER_01 1:08

I'm a therapist, and I talk about anxiety with my podcast co-host who is Drew Linsolata in New York in the U.S., also a therapist. I ain't gonna go through all this stuff. You know the deal. If you're listening, you're listening. And uh yeah, today we're gonna talk about emetophobia, which is like a really intense fear of vomiting and everything that goes along with that. Sorry, we triggered you right in the beginning. But uh, we have two special guests, Dara Lovitz, a former sufferer, and Dr. David Yusko, who's a emetophobia and anxiety specialist in Philadelphia here in the States. They wrote a book together about Dara's treatment and how she recovered. It's really good. How long we talked to them for maybe 40 minutes, I guess, roughly.

SPEAKER_02 1:45

It's brilliant. Excellent guests um from both sides, from both therapy chairs. We've got a brilliant, a brilliant therapist and an excellent client who's been willing to share their experiences. I think you're gonna love this one.

SPEAKER_01 2:00

Yeah, very good. Let's get to it. Welcome, guys. Today we have, as promised, we have Dr. David Yusko and Dara Lovitz, co-authors of Gag Reflections, which is probably the greatest title of an emetophobia book ever. There's no doubt in my mind. So uh welcome guys. Yeah, thanks for coming by.

SPEAKER_00 2:17

We've been told otherwise. We have been told that it was too triggering for emetophobes and they might be turned off by the title.

SPEAKER_01 2:23

We were talking, Dan and I were talking about that before we hit the record button, like the the triggering nature of the book, but but I really admire the book for being kind of triggering, to be honest with you.

SPEAKER_00 2:32

So I mean, we yeah, our intention obviously is to um target emetophobes and let them know that you can get to the other side of this. And so we're hoping that emetophobes will be drawn to the book. And um, I don't know, in retros in retrospect, I don't know. Should we have chosen a different title to be to be determined? I hope the title alone does not scare them off.

SPEAKER_01 2:52

That was clever. Yeah. So quick um give us the reader's digest version. Darry, you first and then David, just tell us a little bit about yourself.

SPEAKER_00 3:00

About myself or about the book?

SPEAKER_01 3:02

No, about you and the book, whatever you think.

SPEAKER_00 3:04

Okay. Um, I'm a lawyer in the Philadelphia area and a mother of um twin daughters and an emetophobe who had suffered for more than three decades before seeking the help of uh Dr. Yusko, who um through a treatment of ERP with him, I was able to get to the other side of the phobia.

SPEAKER_03 3:24

Cool. Welcome, David. Oh, thank you guys. It's uh great to be with you. Um I'm a clinical psychologist, uh licensed in uh Pennsylvania. Um my training came out of actually uh the the great state of New Jersey at uh Rucker's um a side E program there, uh, where predominantly I was an addictions um person. Uh and then I needed to get a job, and then that job led me into Dr. Edna Foa's lab, where I was initially running a study on uh comorbidity of post-traumatic stress disorder and alcohol dependence using my addictions training. But Edna's lab is an anxiety lab, and I uh uh inadvertently then uh took on this specialty of anxiety, not knowing that uh this is the trajectory I was gonna head down, and mainly OCD, because Edna really did a lot of research studies on um ERP and OCD studies. Um, but if you're gonna be in the world of OCD, you're gonna eventually come across emetophobia, which is kind of like how that how that happened. And once once I met Dara, we basically treated her like OCD. I didn't even think that I was really that focused on emetophobia at the time of of her treatment. And you know, I kind of changed the course of my focus too, having met her and helped her, and and then she came along with this great idea to write this book. Um, and then here we are talking to you guys.

SPEAKER_01 5:02

Very cool. Josh, how much emetophobia do you think is in our audience?

SPEAKER_02 5:07

Oh, it's a big one. It's a big one, and even if you don't struggle with emetophobia, I think the mechanics and the mechanism behind OCD, it it's applicable to many things. You know, everyone thinks that their particular theme or fixation is special. Yeah, well I w I wish I'd have had that instead of that. Emetophobia is particularly in our communities. One of them, you know, I'd rather rather die than throw up. Uh, I had it for a long time. I I luckily did unwarranted ERP. I ate a slimy vegetable once from my fridge and it cured my emetophobia because of the uh ensuing three-day hell that I had. It was brilliant exposure therapy. Uh and that's it. So, yeah, you that's the advice. That's the only advice I'm giving in this. If you want to overcome emetophobia, eat the slimiest vegetable in your fridge. Yeah, and and it's really good to it's good to have you guys on to share this story because we how Drew, how often do we hear this?

SPEAKER_01 6:12

Uh a lot of them. I I suspect that if you had a hundred thousand people that listen to this podcast, I bet at least 25 to 30,000 of them would say, I didn't know I there was such a thing. We hear that all the time. Like, wow, that has a name. I thought it was just me. And many of them are dealing with like, you know, associated conditions like panic disorder, agoraphobia, or OCD, and then that exposure thing becomes a torture merry-go-round. Because when I get anxious, my tummy gets upset. And then it triggers that core thing of like, but I can't possibly allow that to happen. And I think what makes it particularly insidious in our sort of like audience here is you know, the person who fears a rapid heartbreak heartbeat because they fear they're having a heart attack logically understands they're not. There is an insight there. Whereas the emetophobe, and Darry, you can chime in here, will say, no, no, no, no. There's no insight to be had here. That is objectively the worst fate any living human being can possibly face. So don't tell me that it's an irrational fear, because it should never, ever, ever happen. And it digs itself in. So we have these multiple layers of people trying to dig through these like triggers, but the emetophobia is that silent foundation that just keeps them stuck. So I don't know, Darrell, did you find any of that?

SPEAKER_00 7:21

Yeah, I mean, we say that emetophobia is probably the most common disorder that no one talks about. So many of us emetophobes have lived. And now with the internet, everything's different, and with social media, everything's different because we found communities in across the world. But before the internet, so many of us suffered in silence. Nobody around us was emetophobic. We felt ashamed of our fear. Everybody around us seemed fine with vomit. And um, and also I will say with regard to irrationality, we know that it's not rational. You know, we know that there's nothing wrong, we know we're not gonna die, and yet our brain tricks us into thinking that this is a real threat, and we have to, and our heart has to, our heartbeat has to race and we have to lose our breath and lose consciousness, and we it's created like a real threat in our brain for some reason, but on a logical level, yeah, we know it's okay. So when people tell us, oh, it's vomiting's not scary, it's not gonna hurt you, like we know, you know, we know that's no one likes vomiting, but you know, no one likes being sick, yeah.

SPEAKER_02 8:17

Yeah, that's what you hear all the time, isn't it? It's like all the time. My threat relations.

SPEAKER_01 8:23

Yeah. So how uh David, when you encounter emetophobes now, where do you start?

SPEAKER_03 8:29

First, a lot of it is just trying to figure out what it what what it is they're coming in for, because like Daris says, some of them, some folks are aware, like they've they've done their research and they're like, I am emetophobic, and you know, this is the help that I need. And it's like, oh, this is pretty straightforward. Let me just make sure there's not like some other kind of sneaky things going on that are operating in the background, or you know, what what what else could be happening? For some folks, it's um it's a puzzle. Um, and they really, really look like they could be generalized anxiety or panic disorder or health anxiety or OCD. Like you kind of have to spend a little bit of time trying to kind of dig around um with what they're truly, truly afraid of. And then once you kind of oh, all when all roads lead to vomit, um then you are, oh, this is a metaphobia, despite seeing all the washing and the cleaning and the obsessing about germs or heart racing. Like once you kind of clear the deck and it gets back to every time throwing up, uh, then we can start conceptualizing and explaining what's going on and put a nice rationale out there and you know, just start getting people ready uh for you know what I would like to do with them is going to be an exposure-based treatment.

SPEAKER_00 9:46

I feel like for a lot of us, uh for a lot of us emetophobes, I'll just say it is um obvious that it's the main thing for us. It's the main because we are, I I'm I don't mean to speak for every emetophobe, but a lot of us are very obsessed with it and we're con vomit is always on the brain. You know, you see a stain on the sidewalk, you think someone must have gotten sick, or the there's a car stopped on the side of the road, and you think, oh, someone's car sick, and they pulled over because someone's car sick. Like vomit is um, it's like sprinkled everywhere. Everything that happens in the world, you're constantly fair scared of this thing that's around the corner. So it's you're almost obsessed with it, it's everywhere. Um, so for me, emetophobia, and I have other like little anxious things, separation, anxiety, and fear of heights, and all of that is kind of muted. The emetophobia is the loudest voice in in the head for me. And I think a lot of emetophobes feel that way. They're always thinking about it. And I can tell through these emetophobia groups online, the social media groups, people are obsessed. And I remember being like that.

SPEAKER_01 10:40

Well, yeah, which kind of speaks to that, you know, the the link. It it sure looks like OCD, treat it like OCD because yeah, there's that obsession there. I I always find that like when you ask, you know, I ask my emetophobic clients, like, well, where does it show up in your life? Initially, sometimes it's like, well, you know, food prep and the usual stuff. But then when you really get into the conversations, oh, it shows up everywhere. Because no matter where I am, it's always like kind of lurking there, and I'm always looking around just to see if there's any signs or like possible triggers and that sort of stuff. So insidious though. Just gets everywhere.

SPEAKER_00 11:16

It's everywhere.

SPEAKER_02 11:17

I mean, anyway, compulsions are really insidious.

SPEAKER_01 11:20

Go ahead, Josh. You're you're in a little bit of a delay.

SPEAKER_02 11:23

Sorry, my sign my signal is so shit. I'm not being rude. Um saying something really profound, and then I'm talking just directly over you. I'm like, oh no, can't believe it. Um yes, uh um sorry, Drew, for the editing. It's okay. Uhetophobia is so um insidious in the sense that I remember I would go to a restaurant and I'd erase spices from my life, even though I loved spices. Uh, I would have to eat a certain amount of food before getting into a car because eating too less into a car getting into a car might make me feel sick. Eating too much might make me feel sick. Uh, I would avoid sitting backwards on trains and transport. I would I would research, uh I'd go around with the magic bag just in case I did throw up and humiliate myself. I had about four bags on me. Yeah, and all these I didn't realize at the time I thought I was, you know, doing it, and these little micro compulsions. Uh, and looking back, it's like, wow, yeah, that was absolutely nuts. But it felt so real. Like Dara said, when you're in it, it feels so real, and it feels like that's the logical thing to do to abate to uh uh appease the fear, but now, yeah, now I realize, particularly with the obsessive compulsive component to it, what I was doing. I was just reinforcing the fear continuously.

SPEAKER_00 12:52

Yeah, those we call them safety behaviors in my treatment with Dr. Yusko, and those safety behaviors completely reinforce it, and you don't realize they're so small, it's like, and they're um they're so innocent seeming. You know, I'll carry some mints in my purse, I'll drink ginger ale, I'll have the bag with me. Um, and then we we um David and I, Dr. Yusko and I run these emetophobia institute workshops, and so we meet a lot of emetophobes, and we met one who was similar to you, Josh, who was really careful about what she ate, and she had a lot of like restrictive eating patterns, and food just scared her. The intake of food scared her, and she was losing weight. And so we've met a lot of different emetophobes and they all have different safety behaviors. And on the surface, some of them seem logical and fine. And like you said, they really reinforce this negative feeling that that vomit is something to be scared of and to have to protect yourself against. And um, and I'll say that in my recovery, it was easier for me to do the exposures than to limit the safety behaviors, or I'll say than to eliminate the safety behaviors. Maybe some amount of limiting was tolerable, but safety behavior elimination came much towards the end of my recovery uh journey than in the beginning. That was really the hardest to get rid of those compulsions and just the way of living that you can really the problem is again, they're so tiny that they seem justifiable. Of course I'll sit at the end of the aisle. It just makes sense. I'm closer to the bathroom. You know, it's you can talk yourself into anything. And we emetophobes are really good at talking ourselves into um justifying certain behaviors.

SPEAKER_01 14:20

I that's such a good point. And David, I'd be curious to hear your your take on this. That's that whole like I'm going to do the acceptance part, you know, that we that we do when we do ERP, but I'm also gonna try and marry it to control. So like I'm gonna accept, but I'm also still gonna try and control and manage with the mints and the sit on the end of the thing. And you're right, they seem so, but in my experience, it tends to lead to that like 85% recovered until there's something that overwhelms the control strategies, and then the house of cards comes tumbling down again. So I don't know, Dave, you want to speak to that a little bit? How do you how do you get to that point where like, no, we gotta go all the way, all the way?

SPEAKER_03 15:08

You know, I think people are super smart and uh they got to figure stuff out for themselves. And I can tell them, I've told folks, you know, over and over and over my rationale, right? Like if we kind of keep responding to stimuli with certain behaviors that don't match what we're actually dealing with in reality, we're gonna create, you know, something that's not true. And therefore, we're gonna have to live according to this life that's not accurate, that's not reflective of reality. But folks want to try and figure it out, they're hopeful that maybe I can get away with just a couple of these behaviors. They're they're just super important or valuable or helpful to me. And so they've got to learn for themselves the cost of maintaining some of those behaviors. I I certainly try to, you know, give them enough education, but usually it's because they learn uh themselves that I actually have to get rid of those things. Like I won't be able to get better the way that I want to unless I actually do the thing that sucks, which is get rid of all of these safety behaviors and really commit. When you talk about acceptance, right? There's probably degrees of. We're talking about fully accepting the idea that you could vomit and throw up, and somehow being okay or tolerant of that. Um, getting somebody there just takes time and practice and and and work and patience and not getting frustrated with folks when um they're doing things that make total sense to them at times. I think about I came from addictions, right? So whenever people relapse, I always got confused why people would get punished in treatment for the behavior they came to treatment for. So they demonstrate the thing that they've come to get help for, and then they get punished for that. In my mind, emetophobes they do safety behaviors, so they're gonna keep doing safety behaviors until we kind of figure this out together. Um, so being patient with them and talking them through it and figuring it out is usually uh my best strategy for them.

SPEAKER_02 17:19

Yeah. I like that compassion there as well. It's it's so important, isn't it? I I think it's shocking that sometimes it's you you you've come to help with an addiction. So when you do the addiction, you get disciplined. I mean, like that no, the comp we bang on about compassion for all anxiety and anxiety disorders on here. I think it's it's integral. We often forget that we're our own friend. And when it comes to emetophobia, I think it's no different there. So it's uh it's refreshing to hear that. Um, Dave, thank you.

SPEAKER_01 17:48

Or the per the the client's opinion that they have failed because they had a bit of a lapse or a relapse. Oh, I failed, I blew it, I didn't do it right. Darek, you ever beat yourself up for that stuff?

SPEAKER_00 17:58

100%. And I think I don't know if this is particular to emetophobes, but we tend to be okay, I'll say it again. I'm not speaking for every emetophobe, but I am a black and white thinker. So if I'm not succeeding, then I'm failing. And I've definitely had setbacks in my um in my exposures. You know, sometimes my reaction would be too panicky, and I would feel like, well, this isn't working. And I'm so quick to turn in the towel, to throw in the towel, also because honestly, exposure therapy is pretty unpleasant at times, and I don't want to be doing it. Um, and so if I mess up or if I feel like I've had a setback, I for me it's easy to say, well, this isn't working. And there are a couple of times I've come into Dr. Yusko's office during treatment and said, this was my reaction. I over, you know, I'm obviously not getting over this and it's not working. And he would have to sort of gently nudge me back into the exposures. Uh, it's so easy to think of a little setback as a complete failure. But what's important, and Dr. Yusko was really good at reminding me, is to look back and see how far you've come. And um, you're not a failure if you're doing this. And each little act of exposure and each little feeling of discomfort and then doing it anyway is growth. And a trajectory isn't a straight line up. There are gonna be little dips along the way, and that's normal because life isn't always easy and things get harder, and sometimes you have less ability to cope and less strength to handle difficult moments, and that's all okay. And it doesn't mean that the therapy isn't working, and it doesn't mean you're not gonna get better. It just means that day you had a bad day and it didn't go as planned, and that's okay. And so moving forward and just, you know, keeping your eye on the on the end goal is really important. And it's really important not to let, and I think a lot of emetophobes feel we already feel shame, you know, we already feel bad about who we are and the way we think and how it's inhibiting the other people around us. We already feel bad about that. So the last and we already feel you know, we feel bad about ourselves and we don't want to feel worse about ourselves. So it's really easy to see a setback as like, oh, just another failure in my life, you know. So it's really important to just sort of trudge ahead and realize that these little setbacks are not indicative of failure at all. They are absolutely normal, they're to be expected. And it would be nice to know that when people go to recovery, they have little setbacks along the way, and that's part of recovery. That setbacks are part of recovery. I think that needs to be more um, you know, repeated in in the world.

SPEAKER_01 20:16

Yeah, at the risk of sounding like a cheesy like high school football coach, I always try and tell people we're either winning or learning. Like we're never, you know, we're never really losing here. Like, what can we take out of the experience where maybe you reverted back to those like avoidant behaviors? But okay, well, what can we learn from that? It's okay. And you know, I think it's so important to recognize too that like you're doing something that scares you. Like, why would you not be scared? And sometimes really scared, like that's just human. You're allowed to be a person. So I appreciate you sharing that, definitely.

SPEAKER_00 20:45

I love that.

SPEAKER_01 20:48

No, no, we're we're mediocre at best, but I'm gonna come with the cliches anyway.

SPEAKER_02 20:55

Yeah, yeah, for sure. Um, that was that was so good, Dara. You're right. And that's the one of the biggest blocks I I see with my clients and people in our community. It's um black and white thinkers or perfectionists and and and people who who are very judgmental on themselves uh themselves as well. It's like if they don't see instant results, it means they're not doing something right, or they have to go back to the drawing board. But actually, I love that. No, failure is not failure in air quotes, is part of the upwards trajectory, and it also helps you learn that even when you have an off day or a sensitized day, um, you can bounce back quickly, which is ultimately uh what I imagine. I mean, I I don't have emetophobia anymore. Um, my hobby is to actually walk down the street and vomit in front of people for joy, uh for pleasure. Uh but um but it actually I did a TED talk the other day. It's being uploaded this week, my first TED talk, and on the uh minute four, I say I'm having intrusive thoughts now. My omega. Stiller is firing off. And I my intrusive thoughts are about throwing up on the first front row. And then afterwards, so many emetophobes came up saying, when you said that word, it it kind of triggered me. But I sat with it and actually I felt okay with it. And you're so right, there's so many emetophobes out there. And Dar is so right. A lot of people don't really how do you bring it up in conversation? And um, yeah, I just find that that that's really interesting. And but yeah, the compassion side of things and and talking about it more and realizing there's probably someone else in the room that has exactly the same fear as you, and that's that's completely okay. You're both in a tricky situation, so let's kind of work on our exposures and our compassion to get out of it.

SPEAKER_01 22:45

Yeah, David, let's talk about the exposures a little bit. And Dara, I want to talk about your your like uh experience on when people gather to support each other, but it becomes it goes off the rails. So you you wrote about that in the book. Like, well, hey, the giant emetophobia group that was just a lot of hand-wringing or co-rumination versus the one that you made. But David, let's go to exposures really at first. And as I'm reading through the book, I'm like, clearly, this is a Dark Christ who does this because I have my Rolodex of vomit scenes from movies and TV shows, like we're such an odd bunch that you know. Let's talk about that. What is exposure? And then Dara, chime in too. Like, how do you introduce that? Because I find a lot of people who understand, like, oh, it I I hear you, exposure is the gold standard treatment for emetophobia, but uh, do I have to get sick? Is the first thing I get asked. Do I have to vomit? It's the very first thing, or are you gonna make me vomit? Can you address that?

SPEAKER_03 23:34

I'm pretty sure Dara asked that in our first session. Yeah. Um, so you're spot on, Drew. Like that, I can't, you know, that's gotta be from a client's perspective when they're assessing whether to do this or not. That's number one. If I have to do this and you're gonna say that I have to do this, um, I'm out. Um and so far, yeah, I've I have not had an amenophobic throw-up um as uh on a as a purposeful, intentional exposure uh practice. Um, so I've I've never done that with someone um as part of their recovery. Um, is it possible that someone could need that to get better? Sure. Um, you know, I I do think that there are some folks out there to until they prove to themselves that they can, you know, throw up and be okay in the presence of that, like that's the ultimate kind of like exposure for them. Um, but Darrell didn't need to do that. Uh, you know, any number of other emetophobics have um, you know, confronted the things in their life that they're concerned might make them throw up has been enough, meaning learning that the world, it's actually a little bit harder to throw up than than people think it is. Um, and when you are living fairly normally, um vomit is pretty far from from your your everyday life, um, surprisingly enough. And that's a shocker to a lot of emetophobes. Um, and then I think just the last thing I would like to highlight is whenever, because this happens all the time, you're as an exposure therapist, you're gonna make me do something. Um, and so I will address that right away because I just that mindset is something that I want to challenge because I'm not gonna make anybody do anything ever. Um, that is never uh my goal here. My goal is to collaboratively work together to where you're gonna choose to do the things that we talk about, but I'm never gonna make you. We're gonna give you opportunities and we're gonna decide whether or not you're gonna take these opportunities to learn something. Uh, but no one's gonna make you do anything. Um, and I think it's really important to put that out there, even if it's not being said like I fully believe that, but the the mindset behind it, I want to shift the mindset of one that you're gonna be more owning those choices and being responsible for kind of confronting those triggers. Um, I would like that to be a collaborative process, best as possible.

SPEAKER_01 26:09

I think even the person who like you know exercises their right to autonomy and opts out of an exposure, or like, no, I don't want that part of the fear ladder. Like, that's totally okay. All I would usually ask is at least when you're making the choice to opt out, let's try to make it mindfully and and with it with a recognition of like, well, what is it that makes you not want to do that? I'm not gonna try and talk you into doing it, but what is it that makes you believe that you can or shouldn't do that? So sometimes just that gentle exploration, the person may still say, No, I don't want to do that. Okay, no problem, we'll work around it. Or, oh yeah, I guess you're right. Maybe I will challenge that. And they may revisit it in a couple of weeks when they they're feeling more clear, or maybe they have a few more winds under their belt. So, yeah, really important.

SPEAKER_03 26:47

Exactly, right? Like somebody's digging their feet in for a reason, like yes, something's going on there. So if we can understand what that reluctance is, chances are we can also come up with another strategy or intervention to work around that to eventually get to that part later. But if you just push someone, especially when they're afraid, this is generally gonna backfire on you.

SPEAKER_01 27:11

Yeah, 100%. Darrell, did you find moments where you were like, nope, I'm out, like I'm hitting the eject button and that well, I'm not ever coming back. Last session, sorry, dude. Did you ever hit that?

SPEAKER_00 27:20

I mean, there were times when I really did think that it wasn't working, and it would be, you know, a certain exposure. I'd see some kind of video, and I instead of being at a discomfort level, a suds level, if you discuss that subjective units of distress, of maybe six, I would be up at a nine and my heart would be racing and I think, well, this isn't working. And I'd, you know, I'd stop the exposures because it's uncomfortable. And then again, Dr. Yuska would sort of talk me back into it and say, well, maybe we need to slow down. Maybe we need to titrate. And instead of watching the the video with volume, turn the volume off first, then watch it. And once you can do that calmly, then you can put the video uh the volume back up, or do the opposite, you know, don't watch it, but listen to it and then whatever. So titrating was also a good way to get people back on the horse, so to speak. Just sort of slow it down. Sometimes we bite off more than we can chew. And it's really easy to think that because we didn't react well in that moment, that it's not working, and that's not the case. So it's really important to go at to change to be flexible um in the goals, right? Is there someone getting arrested in one of our homes? They found him.

SPEAKER_01 28:24

Yeah, that's it. They're coming for us.

SPEAKER_02 28:27

I have a fear of sirens. So what do you suggest I'd do now?

SPEAKER_01 28:33

Clearly, David is in sirens. Yeah, exactly. So funny.

SPEAKER_00 28:39

But I think I think I think flexibility is key. You know, they say man laugh man plans and God laughs. Like to have a set plan and to be so fixated on this one hierarchy that you've created, it's unrealistic and you need to be flexible. And some things might take two weeks rather than one week, and um, just that flexibility. And again, it's like life can throw you challenges that make doing exposures harder. And so it's really important to be, as Josh likes one to say, self-compassionate and to um allow oneself to take their time with things, even if they think they should be going quick more quickly. It's okay to slow it down um to make it more tolerable. I I'm fine. I mean, I was lucky in that in four months I really had achieved a lot and I was just really diligent. I was able to get through the exposures pretty consistently. I know people who have been in ERP therapy for years, um, and they are making progress and they're getting better and they are really proud of themselves. And I think that's great. I think everybody goes at a different pace. Everybody's emetophobia manifests differently. So one hierarchy for one emetophobe is not going to work for another emetophobe. And what you may think of as um, like if you're, you know, you're suggesting something and then the client pushes back and says, no, I'll never do that, or absolutely not. You could also introduce the word yet, you know, okay, you're not ready for that yet.

SPEAKER_02 29:55

Let's love the word yeah, right?

SPEAKER_00 29:58

Yeah, the power of yet. It's it's we're we're not ready for it yet. And look, they may never be ready for it, and that's okay too. And it's important to introduce the idea of yet, maybe this was in the wrong place in your hierarchy. Maybe it's not time for you to do this yet. We'll do something else instead, and then you know, maybe save that challenging exercise for later, later down the road.

SPEAKER_01 30:24

Yeah. Oh, we have like the all hell is breaking loose, you know, like my boss is killing me and the kids are sick, and like I'm having problems with money, and like the car broke down and the dog is, you know, sick. Like, yeah, well, you're not gonna be terribly flexible right now. So, like things might get a little bit harder for the next week. That's normal. That's supposed to happen. So let's you know, circle back again when things start to calm down in your life. Because you're not just like Darry, you're you are an attorney, right? You said like were you you were were you practicing? Like it's not like your full-time job was just watching South Park episodes, like vomit scenes in South Park. Like you're also living a life at the same time.

SPEAKER_00 30:58

Yeah, well, so I because I wanted to make this something that I didn't forget to do or really talk myself out of doing, I did it during like my lunch. You know, I would close the door of my office and from 12 to 1220 every day, it's just something that I did. Weekends were a little harder because my schedule was not my own, you know, having kids. Um, so weekends it was usually like a nighttime exercise, which I don't recommend watching videos of people vomiting before you go to sleep. Um I always had to have like a Oh, there goes my Monday night.

SPEAKER_01 31:27

Oh, forget it.

SPEAKER_00 31:31

If I was doing a nighttime exposure, I'd have to do like a chaser of a Gilmore girls episode or something to get my brain in a better place before before going to sleep. Um, but I was just pretty diligent about making sure this was part of my day, and it was like something that I couldn't talk myself out of or schedule a meeting over. And I was just, this is something I had to do, kind of like I, it's the way I treat exercise, it's the way I treat eating meals, and it's the way I treat picking up my kids from whatever activity. Like these are things that you have to do. And once I shifted my brain and thought, I have to do this. Also, I was paying Dr. Yusko for his sessions, and I want to be paying forever. So I really wanted to make this an efficient process where um was respectfully, where I didn't want to be paying for the rest of my life to be seeing a therapist. So it was like something I just really I scheduled it. I put it in the schedule, and it's about time management and getting it done. It wasn't pleasant, and I knew that it was only for me, it was 20 minutes a day. That was my homework. And I think Dr. Yusko recommends that as like the bare minimum. And that sounds just right to me. So um, and I just figured like 20 minutes, it's gonna be unpleasant. I can handle 20 minutes of unpleasantness. There will be an end where I'm at minute 21 and I get to go back to my life and enjoy it.

SPEAKER_01 32:41

Guys, uh, the three of us, and Darrell, I appreciate you being like the client in the room with the three therapists here and being so open. Show of hands, who was surprised at the number of times you hear the words Gilmore girls in your practice? They need to be our next guests. Not what I thought what I was getting into when I got into this field, but like the Gilmore girls are a miracle. They are literally like everybody's coping mechanism. I don't understand where that comes from, but like I we need them on very common. Yeah, so I don't know what that is. And that and the golden girls, the Gilmore girls and the golden girls. So those are the scene to be the go-to from my people. So yeah. Anyway, um, Josh, let's what about the social media aspect of things? Like, Josh, in our community, I mean, I know I'm starting to rail against the word community, but like we Josh and I talk all the time. We go on these little mini rants about like this sort of co-rumination space and the content that gets the most what's the word I'm looking for, attention is that like hand either you're overpromising an instant fix to people who really want one, or you're just kind of hand-wringing together, and that that hit that gets the like button really fast. What are your thoughts on that in the UK over there? I mean, I want to I'm trying to set up a little mini rant while he's sitting in his for me, yeah.

SPEAKER_02 33:52

Oh yeah, there's loads, there's actually um this I'll call him out. It's our podcast, I don't care. There's loads of things like non-evidence-based coaching programs for emetophobia. There's one over here called Thrive, uh, run by some sociopaths who uh just expose people with uh emetophobia, uh, and they just treat with absolute nonsense. Uh any listeners of our podcast don't, I mean, you know what this podcast is about, you know. Uh, but yeah, you see it, uh, particularly in the UK, because we're not regulated here. Anyone can be a therapist, um, which is frightening. Um, but in general, um, yeah, that's that emetophobia because it's so such an isolated to be honest, OCD is a very isolating thing, and then you take things like emetophobia, which is even more niche, and when you haven't got direct act uh resources for it, you end up with these cowboys that are like, you know, you have to do this thing or this magic technique to get rid of your special emetophobia, you know. And if that's anyone listening and you fall into that, no, it's okay, you know, emetophobia is horrible, but as Drew and I often say on disordered, it's it's it's specific, but it's not special. And you know, you if you we always recommend the ERP, exposure response prevention, some form of that, uh, and do it properly and try not to fall for those people. Uh I don't think that was a rant, Drew. Is that okay? No, that was pretty good. That was a mini rant.

SPEAKER_01 35:25

It's fine. But Darrell, did you ever get sucked into any of that stuff? You know, the whole yeah, yeah.

SPEAKER_00 35:30

I I thankfully didn't discover emetophobia social media groups until after recovery. So I was able to recognize what the bad ones were. And there are a lot out there, and they are um panic-inducing, reassurance-seeking, um, and it just keeps everybody who's in there in the phobia. What it does that's good, the one good thing is that it's validating, right? These people are no longer feeling alone, and they totally get other people's panic. The problem is everything else about these groups. Um, you'll see a piece of raw chicken as the image posted, and they'll say, Is this safe to eat? Oh my god, I just ate this. Am I gonna get sick? Am I gonna uh asterisk T U? You know, there's tons of censorship. They're always censoring their words. And am I gonna V? Um, or you know, oh my God, the stomach bug is going around my kids' preschool. Should I keep them home? And people are telling the poster, yes, keep them home. I wouldn't send them back and bathe in rubbing alcohol. And, you know, it's it's people keeping each other in the phobia, and it's really upsetting to witness. So I've had to remove myself from those groups because I feel so bad for these people. And there have been times when I've commented and sort of tried to talk them out of doing the safety behavior and the reassurance seeking and explaining why those are keeping you in the phobia and they don't want to hear it. It's almost like they want to be in that setting. Um, there is one emetophobia group of which I'm a moderator, so I'm a little biased, but it's the emetophobia no panic resource group. And in that we have rules, and I'm a moderator, so I have to enforce the rules. The rules are no censoring of words. If you're gonna say the word vomit, don't write V, write the word vomit. Um, no panic posts, no reassurance seeking, um, no safety behavior talk, you know, no, no encouraging the use of safety behaviors. So we have these rules that we just, it's really for people who want to be better and who want to get over the phobia. That's what this social media group does. So that's the only one I feel comfortable being a part of because we are there to help each other and support each other through recovery. We don't want to keep each keep each other, you know, um, buried in this mindset of vomit is so scary and it's awful. And um, so anyway, yeah, social media can be a real curse for emetophobes. It can really make them worse. And that's a shame. And I feel really sad about that, that there are these emetophobes out there and they don't realize they're just making their phobia worse and they're not living their best lives, and it's it's like upsetting to see.

SPEAKER_01 37:50

Yeah, it's tough. I I kind of find that it like in emetophobia, you know, and the other sort of anxiety I know emetophobia is not officially an anxiety disorder, but I mean we're gonna look at it as it is, but like in the other disorders, there's an equal match of like, you know, co-ruminating and co-hand-wringing content and quick fix. Here's the five things you must do today to banish anxiety forever. But I find that in emetophobia, there it I don't see a lot of the quick fix stuff. It's just the whole like, oh, no one understands how horrible this is, which is true, but it never goes beyond that. So, Josh, the thing that makes me laugh about Dara's Dara's group is she has snipers on the rooftops, brother. Like he always he always picked up me from my old Facebook group was like the snipers on the rooftops anxiety support group, because we have the same exact rules. It's an inactive group at this point, but so I can appreciate what you did there. You went and made your own group, which is really awesome.

SPEAKER_02 38:40

Yeah, you don't want to facilitate those compulsions. Sorry, Darren.

SPEAKER_00 38:44

Like, oh yeah, no, I was just gonna say there people even dispute us, you know, we decline to post, we give feedback like sorry, this is reassurance seeking. So then people try to manipulate and they'll send a post that says, I'm not seeking reassurance. I'm just asking if you know they're really trying to people try to get around the rules, and no, we we don't let it happen. And it's and I think people appreciate that ultimately because they know that our place is uh one of recovery. You know, we are really trying to get people better. And I think the emetophobes in there who are serious about recovery and treatment, uh, they appreciate our hard work in that respect.

SPEAKER_01 39:18

David, along along those lines, the like uh the rephrase, I hear you, I get you on this, the rephrasing of the question. It's one of the reasons why my group is inactive now. But what do you, David, the person who comes in and says, but you don't understand, I'm just the kind of person that does better when, and insert the end of the sentence there. I just know, I just like to know, I just I'm just curious. You know, how do you steal a client that, like, okay, maybe you are a naturally curious person, but at the moment we may have to abandon that for a little while. Was it you that wrote, like, emetophobia isn't like regular, so we can't treat it with regular things. Like, it's extreme, but we have to be extreme too. How do you deal with that whole like I'm I just do better if I know? And they just keep asking the same questions again and again. How do you respond to that?

SPEAKER_03 40:00

I mean, I I I'm gonna try to I I try hard to not, yeah, but people, but I often fail, and then I have to catch myself. Um, and then I'm I'm really trying hard to stay out of a conversation where we're both giving ideas and then we're both saying, yeah, but and then and then I come back and I say, yeah, but that's like totally unhelpful to making some progress. So I'm gonna take them at their word and um like believe them, and then like get them to tell me more about how that's working towards the goals that they came here for help with. Because if that strategy was working, the chances that they wouldn't be in my office um at that point. And it's not for me to tell them that, it's for me to really be, I don't know if you guys are old enough to remember Columbo as a character of a TV show. Um, but Columbo presents just like a great genuine confusion, and in his confusion, he gets people to commit admit to their crime, so to speak, right? And so if I can present genuine confusion, which is it's not um help me understand how all the amount of information you've gathered over this over the course of your lifetime, and if we could just have one more piece of information, that's gonna solve it. That's I think that's what you're telling me. And I'm trying really hard to not change their words, to reflect them back accurately to them, but then also pose the dilemma or the discrepancy um that's inherent um in their argument or in their words, because that conflict that's theirs to wrestle with, they've got to figure that out. I'm there to help them, you know, slog through it, but if I'm there to just tell them answers, it's just not gonna work. Um, so I like to take people seriously, I like to take them at their word, and then I like to create discrepancies for them to have to solve. Um, because if this were true, I really believe they would be better by now. They wouldn't be in my office. So what's the deal? And that's usually the conversation we're having is um somehow I'm not sold that this idea is gonna is gonna work the way that you think it will. Help me understand that. And that's usually what I'm what I'm going at there. Not direct challenging, but curiosity, I think, is a better response in that moment. It's pretty good.

SPEAKER_01 42:34

You learned something. Very good. Thank you. Josh, you got anything you want to add in before we start to wrap it up? These two fine people probably need to be on their way.

SPEAKER_02 42:46

I just think it's uh a real um privilege to have you on. I love how we have the you know, the psychologist and someone who's been through metaphobia. I think it's so lovely, and I really appreciate you sharing those words. Um it's encouraging as well. A lot of why people tune into this podcast is you're talking to people that have been through it, come out the other side, and I think just the fact that you guys are sharing that is is encouraging for people with a metaphobia or not. I think as well, some people can take inspiration from just doing a scary thing as well, whether yours is emetophobia or whether it's doing some kind of exposure that you've been put off, uh, that you've put off for a while. Uh, and just today, even if you feel like oh, I can't do it, you know. I love that what Dara said. Well, maybe you can't do it yet. But keep going, you can find your way through.

SPEAKER_01 43:40

Very good. Anything you guys want to add to kind of put a cap on this?

SPEAKER_00 43:44

I I just want to say that it there's a the point of writing the book and the point of getting together with trying to convince Dr. Yusko to write it with me is that we really wanted to educate emetophobes out there and therapists out there who might have to treat emetophobes. And I just wanted to metaphobe. Folks know they're not alone and they can get better. Going to going into recovery was just life-changing for me. And everything changed after that. And it's, I just didn't want to deny anyone else that opportunity because it's available to them. And I went for years not knowing that it was available to me. So I just wanted everyone to know that. And something else that's important about the book is I do talk about post-recovery maintenance. How do you maintain because no matter what, we're still, we still have a metaphobe brains, right? And and Drew, you said something in an episode um a while back that I still think about a lot. You said something to the effect of, I might not quote you perfectly, but it's like your recovery is in shortening the distance between oh my God and oh well. And I think about that constantly ever since I heard that episode. And that is really post-recovery maintenance. For me, I do a lot of act. I I read the Russ Harris book, The Happiness Trap, which is really helpful in recovery and in just maintaining recovery. So I recommend that to people if they're if they feel like they're on the other side of emetophobia. I really do recommend looking into um acceptance and commitment therapy as like a mechanism to help continue um their journey and to help maintain. But we are um, David, Dr. Yusko and I run these emetophobia institute workshops, and we have the book, and we're just out here trying to let emetophobes know that recovery is absolutely possible. And um then we're just here to help. So please do reach out.

SPEAKER_01 45:24

I suspect there are many people listening that are super grateful to hear you say that. So thank you guys. I I appreciate that. You're welcome here anytime. Maybe we'll do it again at some point. If if you guys have questions, and Josh and I'll come back and sort of wrap it up, but like if you go to disorder.fm slash 106, I'll make sure all the links, you guys send me all your links, and I'll put them there so you can find the book and the workshops and all that stuff. But uh otherwise, it's really great. Thank you so much.

SPEAKER_00 45:48

Thank you. It's been a huge honor. Yeah, thank you so much. We really I appreciate all the work you're doing, um, all the episodes you do, they're really amazing. And also with the Anxious Truth Podcast. So you guys are doing great work, and I'm I'm so glad you're out there. Thank you. And thank you for having us.

SPEAKER_01 46:02

All right, we'll be back next time. Thanks, guys. Okay, as promised, we're back to sort of wrap that up. I really enjoyed that. What do you think?

SPEAKER_02 46:08

It was brilliant. Um, and it's it's gonna be an episode that I'm gonna refer to other um therapists, particularly here in the UK. Um, emetophobia is one of those things. Uh, and I think uh I'm gonna also check out that, but you started reading their book, haven't you?

SPEAKER_01 46:22

Yeah, gag reflections. In fact, if you go if you go to disorder.fmfm slash 106, I'll make sure I have all the links there, including the book and stuff. But it's really good.

SPEAKER_02 46:30

Yeah, I'm gonna get that. That's gonna be one for my shelf. You know, I have a special shelf with all the books that I used to refer to. Yeah, and um, that's definitely gonna take a place up there. So yeah, um if you're a meth phobia, go check it out.

SPEAKER_01 46:43

Yeah, for sure. And it's really cool because it's written from the point of view, the shared point of view of the client and the therapist. So they alternated chapters, and then at some points, like Darrow was writing, and then like David sort of chimes in with a like his little narrative and what's going on is really good. And as a therapist, I actually learned a few tricks from that book, so it was it's great. I love it. But we're not trying to sell their book for them, we don't make any money, but like it's pretty good if you want to check it out.

SPEAKER_02 47:04

And it's pretty low to go on this podcast and start plugging books. Who does that?

SPEAKER_01 47:09

Nobody does. We know we never plug anybody's book, do we, Josh? Never. Anyway um, yeah, so go over to disorder.fm slash 106. We'll have all of Dara and Dr. uh Yusko's links and everything, and you can learn more about emetophobia and how to treat it and all that stuff. And if you have questions for them, we were talking after we stopped the recording, like they'll come back. So if you go to disorder.fm and send us a voicemail with the blue button or an email. Um, if you want to talk about emetophobia or ask them questions, if we compile enough of them, we'll have them come back and they'll do like a little QA with us. So that'd be really cool.

SPEAKER_02 47:44

So that's it. Yeah, sounds good. Thank you, Drew. Always good. I'm looking forward to the next episode where we can listen to more community wins and did it anyways. And um, yeah, catch you soon, man.

SPEAKER_01 47:55

Very good. We'll see you next week. We're out of the way.