Emetophobia: The real reason you always feel nauseous.

As a therapist, when I treat those with emetophobia they always complain of how they constantly feel nauseous. However, by the end of therapy their nausea goes away.

During therapy they always state their nauseous is real and that it must mean they are ill, are more likely to vomit or complain of underlying health condition.

However, if a course of talking therapy can stop nausea, then it can’t just be down to biology, there is something psychological going on causing the nausea.

 So what is the real reason you always feel nauseous. This comes down to three things:

1)       Anxiety.

2)       The dislike of feeling nauseous.

3)       And self-focused attention.

Let’s explore each of these and how they can cause nausea:

1)       Why does anxiety matter:

Anxiety and nausea are closely linked because of the body’s stress response. When you’re anxious, your body kicks into high alert, triggering a series of physical reactions.

• Firstly, your body releases stress hormones like cortisol and adrenaline, which can affect digestion and cause nausea.

• Secondly, your brain and digestive system communicate constantly. Anxiety can change this balance, leading to increased nausea.

• Thirdly, anxiety causes stomach muscles to tighten, making you feel queasy.

• Lastly, when you're anxious, you tend to focus more on physical sensations, which can amplify nausea.

To put it simply. The more anxious you feel, the more nausea you will feel.

When you worry about vomiting, you will naturally feel anxious. When you feel anxious you feel more nauseous, which then validates your fears.

 2)       Those with emetophobia hate the feeling of being nauseous:

No one likes feeling nauseous. However, those with emetophobia are even more sensitive to it as they worry it is a sign of impending vomiting.

This dislike of the feeling causes an increase in distress when you feel anxious. This can cause a self-repeating cycle. You are afraid to vomit, leading to anxiety, which causes nausea. Nausea then makes you feel more likely to vomit which, in turn, triggers your phobia and makes you more afraid.

The more negatively you view nausea, the more stress and anxiety it will cause you. This increases the nausea.

 3)       What is self-focused attention?:

Self-focused attention is when we turn our attention away from the external world and into our bodies. There are two main forms of this.

The first is “body scanning” where you decide to scan your body to look for a symptom (This is usually done to monitor physical symptoms), while the second is following noticing a symptom when you decide to pay more attention to it.

You may do this:

• When you have a “what if…” thought about vomiting and want to check how you are feeling.

• In response to noticing a gastrointestinal symptom.

• If you are trying to figure out if something is wrong.

Self-focused attention causes many issues:

• Anxiety: When you scan your body, you either find what you’re looking for or don’t. Regardless, you will typically feel some level of heightened anxiety just before scanning. If you start to notice a distressing symptom then your anxiety spikes. And anxiety can cause nausea.

• Increases strength of symptoms: Body scanning and focusing on our symptoms intensifies how strong they feel. This can increase the anxiety these symptoms cause us. And anxiety can cause nausea.

• Causes symptoms: Body scanning can actually cause you to experience symptoms as it increases your ability to notice sensations which are usually automatically filtered out by your brain. You can easily try this out. Pause for five minutes and really focus on any body part you choose. You will probably start to notice things you never noticed before. Now imagine doing this when you find these symptoms are scary. It just raises your anxiety. And anxiety can cause nausea.

• Increases fear of symptoms: The more you notice and worry about nausea, the worse you feel it. This increases your fear and anxiety. And anxiety can cause nausea.

• Pre-occupation: The constant need to check for symptoms keeps you thinking about nausea and vomiting. This always keeps the potential for vomiting in your mind and increases anxiety. And anxiety can cause nausea.

If we body scan or focus our attention onto our symptoms we increase how strong they feel and can cause more anxiety. Which causes nausea. This can produce nausea even when it was not there before we started looking for it.

Watch this video if you want to know more about self-focused attention:

Breaking the Cycle:

There are three ways to break out of this cycle:

• Reduce body scanning: Body scanning and paying extra attention to symptoms is a choice. Now you know it’s downsides, make a conscious effort to postpone, reduce or eliminate doing it.

• Reduce self-focused attention: Next time you notice you feel nauseous, try paying less attention to it and see what happens. Your anxiety should reduce and with it, a reduction in the nausea.

• Learn to accept nausea calmly: If you don’t allow yourself to panic or become anxious due to it, then the cycle will end, and the nausea will slowly reduce on its own. It is important to realise that you are feeling nauseous because you are anxious, not because you are about to vomit.

Therapy:

Emetophobia is treatable. I recommend reaching out to a BABCP accredited CBT therapist or self-referring yourself to the NHS talking therapies services which can offer Emetophobia support.

Written by David Kaneria - CBT Therapist