Why is my emetophobia worse at night?

Many people with emetophobia often say that their anxiety is so much worse at night. This is not a coincidence but occurs for a really specific reason.

To explain why this occurs, we need to talk about a vicious cycle those with emetophobia often fall into when they encounter a triggering situation. This cycle is made up of 4 areas and each symptoms starts a chain reaction.

These areas are:

• Anxious thoughts about being sick. This can also include mental images or memories of being sick.

• The feeling of anxiety.

• Physical symptoms (such as nausea).

• Uncertainty and being intolerant to it.

Each one of these areas can be scary for those with emetophobia. But what is worse is they all link with each other and cause the other symptoms to increase. For example, thoughts about being sick, will trigger, anxiety and nausea etc. Or, if you notice nausea, then that can trigger thoughts and anxiety. And so on.

It often looks similar to this:

Why is night-time worse for anxiety?

The thing about night-time is that it allows these four areas to activate more easily.

When lying in bed:

1) It is easier for the mind to wonder and cause anxious thoughts and when you have your eyes closed, it is easier to see anxious mental imagery in your mind.

2) Because you are still, it is easier for you to notice stomach sensations or nausea.

3) Nothing is distracting you from the feeling of anxiety.

4) As we are more tired, we typically are less resilient to stressors. Often are intolerance to uncertainty feels stronger than during the day. Which leads to more overthinking.

So at night, it is much more likely that at least one of these symptoms occur. This starts that chain reaction.

5) Often those with Emetophobia have a belief that being sick is more common at night. If you have children, you might start to worry about them being sick. This makes night time feel like much more of a threat.

How to improve night time anxiety?

There is a concept in therapy which states that people are not bothered by an event but the meaning we place onto the event.

For example, if you are on a treadmill and your heart is racing, you will most likely not bothered because you know why it is happening. However, if you are lying still in bed and your heart starts to race without a known reason, then it is possible to have anxious thoughts such “I am having a heart attack”. It is the same symptom but has a very different meaning and interpretation. This leads to a very different outcome for your anxiety.

This is the same for those with emetophobia. For example:

• If the meaning you place on your anxious thoughts is that “they must be true" and “it is going to happen” then you will feel anxious. If the meaning is “that is a random thought” and “it doesn’t mean it is going to happen”, the same thought becomes less scary.

• If the meaning you place on anxiety is “it must be a sign that something bad is happening” then you will always panic when anxious.

• If the meaning you place on physical symptoms (such as nausea) is that “it must mean I have caught something or eaten something bad”, then you will panic.

• If the meaning you place on mental images or memories of being sick is that it is a premonition of what is to come, then you will panic.

So, to help with this, you need to become more aware of the fact that these symptoms are most likely being caused just because it is night-time and not a sign that you are sick. If you change how you view these symptoms, then you change how you feel about them.

So:

• Thoughts: You need to learn it is okay to have thoughts and that having thoughts about being sick, is not the same as being sick.

• Anxiety: You need to learn to not see anxiety as a problem or a sign that something bad is happening.

• Nausea : You need to learn that the sensations are most likely benign and caused by you just being more aware of your body.

• Mental images: You need to learn mental images are safe and not a sign of what will happen

The best way to achieve this is to stop reacting or acting upon these symptoms. Only that way do you realise that these symptoms are safe. Its sounds tough, but do nothing and see what happens. Each time you react, you only learn to be afraid.

How to realise that thoughts are ‘just thoughts’:

One of the first step in overcoming anxiety is to start noticing our experience. Often when we have anxiety we spend a lot of time focusing on the physical feeling of anxiety or our nausea but rarely stop to recognise the thoughts that are behind these symptoms. These thoughts are just interpretations and predictions that we have about the potential for future problems. However, instead of us realising they are ‘just thoughts’ we often act on them as they are factual truth or a premonition of the future. It is unlikely you have be taught to see thoughts as just thoughts. So you need to learn this very important skill.

So lets try out some exercises to show you how this works. For this to work. I want you to really think about a thought that concerns you. Maybe something about an upcoming event that scares you or about nausea, gagging or being sick. Think about it for the next 20 seconds. Allow yourself to feel anxious about it. Get all caught up in it.

Try it now: Get anxious

Okay, now, I want you to add a phrase in front of that same anxious thought. In your mind or out loud add “I am having the thought that” in front of your thought. Keep repeating this for about 20 seconds. As you do this, try to really realise that this anxious thought this is nothing but a thought.

Try it now: “I am having the thought that”

Well done. Do you notice any space or distance from the thought?

Lets add to this. Now let’s add in another phrase in front of that one. Add “I notice that” in front of “I am having the though that”. As you do this, really try to notice that you are not your thoughts. You are just observing the thoughts.

Try it now: “I notice that, I am having the thought that”

So this may not be the case for everyone. But most people start to notice that they feel a little bit more distanced from their thought. Hopefully the thought as moved from a fact to just an idea in your mind. Just some words, letters, ideas or images in your mind. Maybe you might also feel less worried or anxious about it. If that is the case then great! But see this as the bonus that sometimes happens and not the goal. The only goal is to help you realise that it is ‘just a thought’. A thought that you have the freedom to act on however you wish. A thought that can be taken seriously, or chosen to not take seriously.

Task: Practice this for a week. Start to notice the things that go through your mind. Sometimes thoughts can be useful, however, most often they are not and jut fueling your anxiety. As soon we start to see thoughts as nothing more than random words, phrases and images that do not always need to be acted upon, we can start to act differently. The point of this is not to get rid of your thought or to even change how you feel (at first), the aim is to give you the freedom to respond to the thought in the way you want to and to help you realise that you might not need to act on it or give this thought all your attention.

Therapy for night time anxiety:

Night time anxiety sucks. It really does. It can be hard to do nothing in response to these symptoms. I work with those with emetophobia on a daily basis. They, and you can learn to overcome their night-time anxiety. If you are interested in private therapy, reach out [Therapy for Emetophobia (fear of vomiting) — Emetophobia UK].

Written by:

David Kaneria - Emetophobia Specialist