My thoughts on Channel 4’s ‘The Fear Clinic: Face your phobia’ featuring emetophobia…

Whether you watched it or not, I explore the topic of exposure therapy in relation to emetophobia…

As a Thrive Programme Coach (treating countless emetophobes) for over 8 years, but also as a former emetophobia sufferer myself, I wanted to share some thoughts on the Channel 4 programme ’The Fear Clinic: Face your Phobia’ last night.

For anyone who didn’t watch it, here is a quick summary. The series follows a radical clinic in Amsterdam that helps people overcome phobias through intense exposure therapy. Last night, they had 3 more sufferers on, with fears of birds, frogs, and vomiting that they were ‘curing’ in just a few days with exposure therapy.

Before I carry on, this post doesn’t AT ALL undermine the person on the programme's efforts to overcome her emetophobia. I think she was INCREDIBLY brave to go and do that treatment, particularly live on TV (particularly given that we know the shame and social anxiety many emetos experience around this phobia - some never even tell anyone about it because they’re so worried they’ll be judged). 

So I’m absolutely not having a go at her: I actually have a huge amount respect for her. I’m just frustrated on her behalf because the process of overcoming this phobia does not have to be this intense, frightening or anxiety inducing. I know, because I’ve done it, and I help others to overcome it with minimal distress too. Our Thrive Programme 'Emetophobia Free' course is specifically designed for (and very successful at) treating emetophobia. And if I'd watched even a few minutes of the programme last night in the worst days of my phobia, I think I'd have been so anxious and emotional today thinking that this was potentially my only hope at overcoming it and knowing that was literally my worst nightmare come true. That's why I wanted to write this - to tell other sufferers out there that exposure is NOT the only option for beating this... 

I’m sure many of my fellow Thrive Programme Coaches (particularly former emetophobes) would agree with me that most emetophobes would never dream of doing something as extreme as exposure therapy. A few clients of mine have tried it prior to working with me and (unsurprisingly, given that it’s hugely ineffective for emetophobia) it either hasn’t worked for them, has made them temporarily better for a few days but then they’re back to ’normal’ phobia symptoms again, or it’s actually made them feel WORSE. So I was pretty dubious to see them using this technique with an emetophobe.

There are many reasons exposure therapy doesn’t often work for emetophobes, but they include crucially that:

a) phobias are not actually about the thing itself (they are about the combination of thinking styles, beliefs and learned behaviours that result in a pattern of frightened, panicky reactions around those things),

b) sufferers have such a strong desire for control and such black and white beliefs about sickness that you’d be hard pressed to get them to let go of control enough to do exposure in the first place, and if they do they have a really hard time tolerating the loss of that much control in one go, and

c) the strong reactions they have learned to create in relation to sickness means that even if they do go through exposure, they are likely to find it INCREDIBLY stressful and distressing. Hence why they can feel worse afterwards.

Some things in the programme that I found particularly unhelpful:

- Telling the sufferer (also called Lisa!) that her phobia was a) because her mum was sick so often, and b) due to the trauma of her parents’ divorce (if statements like that were really true, then people would be afflicted with their phobias and fears until the end of time because we can’t change our past experiences)

- When Lisa expressed fear about seeing the volunteer throw up, the response was that ’this lady is really nice and just wants to help you.’ Whether she is ’nice’ or not is absolutely irrelevant. She’s not scared of the lady, she’s scared of the intense emotions she knows she is about to experience by being forced to see/hear something she currently believes is the most terrifying thing on the planet

- When she expressed this terror (or from a Thrive Programme perspective, expressed the belief she has built about sickness - sickness isn’t actually terrifying, emetophobes have learned to believe that it is), this is not challenged AT ALL.

- Because of this, Lisa was clearly getting increasingly distressed and panicky. If you don’t challenge an emeto’s beliefs about sickness, even gently at first, you are unwittingly colluding with them that this thing is as terrible and awful as they are telling you.

- Unless an AWFUL LOT of pre-exposure therapy work was cut out of the TV episode (plausible, but unlikely given that the clinic runs a radical exposure programme, so the technique is literally to expose you to that thing from the get go), then essentially all they were doing was putting a very frightened person in front of something they believe is akin to a gun being pointed at their head, with no new skills or insights to challenge their thinking, and are just hoping that they magically begin to cope better with it. If that worked, people would never come to us because one episode of vomiting and BAM they’d be cured.

- A chance to challenge her belief could have been when Lisa apologised to the volunteer who was there to make herself sick for the exposure part. It would have been easy enough to explain that she doesn’t need to apologise to the volunteer because sickness itself is not terrifying, and for most people sickness really isn't a big deal at all - including this woman who is willing to even make herself vomit for the purposes of the programme. But Lisa wasn’t challenged at ALL, leaving her to continue feeding her belief that it was awful and then feel bad that the woman was having to go through it to help her (stoking the social anxiety ingredient of this phobia even further).

- I appreciate that Lisa seemed to have improved slightly by the end of the programme. In our experience though, if you don’t challenge underlying beliefs and reasons they’ve created a huge phobia of sickness in the first place, this is likely to be temporary as their old thinking is still there.

- As I said at the start, this post doesn’t AT ALL undermine Lisa’s efforts - I’m just frustrated on her behalf because the process of overcoming this phobia (or actually any phobia) does not have to be this awful or immerse. As a former emetophobes, I actually felt upset for her just watching it, knowing that it was utterly unnecessary to put her through all of that. 

Key takeaways

Here’s some important reminders/takeaways for anyone suffering currently who wants to overcome their phobia without having to sit in a room literally listening to someone vomiting (trust me, that never worked for me!):

1. You do not need to be constantly exposed to it to overcome it.

2. The phobia is not about sickness. It’s about the combinations of thinking styles, beliefs, and learned behaviours (as well as other factors like desire for control and a low level of coping skills that need to be slowly built up) that drive the strong, frightening and overwhelming emotional reactions the emetophobe experiences. THAT is what they are really frightened of, and that is the part they need to learn to challenge and change.

3. If you do that, you can overcome your phobia without needing any exposure at all

4. Whilst sickness might feel terrifying to you right now, it does not have to be that way forever. It CAN change. Myself and the countless other sufferers - some of whom are now Coaches too! - are evidence of that.

5. No one would enjoy watching or listening to someone being sick. I watched the programme, and I can’t say I enjoyed it!! I know many people who’ve never had this phobia who wouldn’t enjoy that either. It’s not a nice thing to see or hear. But it’s something you can learn to change your response to, so it doesn’t ruin your whole life.