Overcoming a Phobia, Creatively…And Kind of Sexually

Years ago, I treated a woman in her mid-20’s whom I’ll call Tara. Tara suffered from a specific phobia: vomiting. The very idea of it caused her intense anxiety, and she had managed to avoid doing it her entire life. This isn’t an easy feat: by sheer luck she had never caught a stomach bug or flu or had gotten any type of food poisoning, nor had she ever thrown up in college from drinking too much alcohol.

Never threw up in college, I thought as she relayed this information to me. That’s practically a rite of passage! It should be a required, one-credit course for graduation.

Now some might argue against the notion that a fear of vomiting isn’t actually a problem. If it’s never happened and perhaps never will, so be it. It just means she’ll never get too drunk. And because no one actually enjoys vomiting, this point is granted.* However, as with all phobias, Tara was engaging in unnecessary avoidance behaviors. She was highly selective about her food choices, discriminately eliminating any ethnic foods for no truly justifiable reason. She avoided roller coasters despite the adrenaline rush she craved from them. She was invariably the Designated Driver when she went out with her friends and wouldn’t consume even a drop of champagne at a celebration for fear of what could happen. And because she was terrified of tripping her gag reflex, she wouldn’t eat things like lollipops and fudgecicles, even though she very much enjoyed the taste. As an added source of frustration, her fear of gagging lead to sexual difficulties as well (insert your own joke here, you pervert).

Most importantly, however, Tara needed to have a medical test completed that required a tube be inserted into her throat. For weeks she avoided having this done, to the point that her doctor called and offered her Valium to help take off the edge. No deal. So after some prodding by her family, she decided to seek help.

Tara had a few options for overcoming this problem. She could have simply downed a bottle of Ipicac and waited for the oral avalanche. This would ideally have allowed her to be done with the whole enterprise after recognizing that while unpleasant, throwing your guts up isn’t the end of the world. Some refer to this type of intervention as Flooding. Just mentioning this idea, however, nearly prompted her to leave the office and never return. As an alternative I offered her a form of Systematic Desensitization, where we would gradually take steps to induce the process of hitting the gag reflex as she learned relaxation procedures. She was more amenable to this idea.

The plan was for Tara to bring in a long spoon, ones they might use at a bar to stir drinks in very tall glasses. Over a few weeks, Tara was going to put the spoon into her mouth and slowly and methodically push it further and further into her throat, ultimately making herself gag and perhaps even dry heave. This would simulate the medical procedure that she needed to have done and would ideally get her to truly experience the innocuous nature of the aversive act.

To help slow down her heart rate and induce physiological relaxation, I taught her Diaphragmatic Breathing. This at least somewhat calmed her. We also used what are known as Coping Cards, which consist of self-soothing statements written on index cards that help calm the mind. Now many people erroneously create cards that consist of pithy or cliché statements which pack no therapeutic punch. These are to be avoided. So when Tara wrote, it will be fine I asked her to write a more factually accurate, comprehensive statement that tapped into the very nature of what was going to happen. We ultimately, then, changed the wording on the card to the act of gagging or even vomiting is definitely unpleasant, but it certainly won’t kill me. People do it all the time and pull through. I’ll work my way through it for the sake of my health first, and when my mind truly recognizes that the experience isn’t catastrophic, I’ll then work on other areas of my life so I’m not so restricted because of this kind of gross, yet basically danger-free moment.

This Coping Card helped because it really fleshed out the truth about what this would be like. It wasn’t “fine,” far from it. But it wasn’t apocalyptic either, and Tara needed to recognize that.

Between sessions, Tara practiced her breathing techniques and read the Coping Card many times. Ultimately she felt at least somewhat prepared to work with the spoon. And when she arrived to session, she had not one, but two spoons in hand. “You’re going to do this with me, right?” she asked.

I’m not against working through an experience with a client in such a direct manner. In graduate school I had a client who had a fear of seeing his physical therapist. The idea of simply laying on a mat while his ankle was being manipulated terrified him. So he and I would simply lie on the floor together and work through the experience in our minds. If you had walked in on us, you might have considered we were taking a nap or thinking about what animal shapes we could see in the coffee stains on the ceiling.

So there we were, slowing pushing large, hopefully sanitary spoons into our mouths. So this is what it’s like to be a heterosexual woman or gay man, I wondered. Tara used her breathing skills and looked at the card as she manipulated the spoon. At first she couldn’t get the spoon very far into her mouth. That was fine. We made a mark on the handle to show how far she progressed and her homework was to simply get the mark further along the shaft. After two or three weeks, she was very close. We practiced again in session, she continued to push the spoon and voila!, she got it far enough back, causing her to gag and dry heave. Being the young, somewhat naïve professional at that time meant that I wasn’t fully prepared for all possible outcomes; thus, the garbage can wasn’t within her reach, causing her to spit up stuff onto the floor.

“How do you feel?” I asked and handed her a tissue.

She wiped her mouth. “A little gross, but not completely skeeved like I thought I would.”

“Is it fair to say that the experience paralleled what you wrote on the card?” I asked.

“Definitely,” she said and smiled.

For Tara and me, that was basically it. She was able to get just calm enough to have the medical procedure done, and then she agreed to use the tools she learned to work on other areas of her life. As irrational as many phobias may seem, the very nature of them generate intense terror, so kudos to her for fighting through that. And no, I don’t know how the treatment impacted her relationship with her boyfriend, so don’t bother asking.

* It’s not accurate to say that people who suffer from Bulimia enjoy the inherent act of throwing up. Rather, some report that the entire ritual, which can consist of binging and purging, can feel liberating. But the vomiting in and of itself is not reported as pleasurable.

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11 Responses to “Overcoming a Phobia, Creatively…And Kind of Sexually”

  1. BL1Y says:

    Warning: Do not use this technique to cure homophobia.

  2. Great article. I’ve never heard of this type of phobia before. I definitely have a phobia of feeling unsafe which negatively affects so many aspects of my life, like Tara’s did. As always, I am a work in progress.

  3. Paul Baker says:

    Good Information.

  4. Shay says:

    Linked to it on FB earlier this morning/last night. I was tempted to headline it as “Dr. Rob teaches how to deep throat” but I decided against it.

  5. Scootah says:

    I’ve heard of this technique being used before, but never for a phobia of vomiting…

    Strangely enough – this made me think of a friend who’s been trying to suppress her gag reflex for years but has never gotten the knack for it. Her gauge of if a guy is fun or not now is if she’s doing something with him that trips her gag reflex, and he goes to get a towel to clean up the vomit – he’s no fun. If he grabs her by the hair and pulls her onto his err… spoon… he’s her kind of guy.

    I’m scared of spiders. Putting a bunch of them down my throat until I vomited, I think probably wouldn’t help with the phobia.

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  9. Veronique Ruprecht says:

    I just love this

  10. […] Overcoming a Phobia…Creatively […]

  11. Adrift says:

    you have coffee stains on your ceiling…?