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Hello, my friends! This episode is just a straight forward question and answer episode with some really awesome questions. This week I am also working on a book proposal for a traditional publisher, which means that you would be able to buy this potential book in stores. That’s a bucket list item of mine and I’m excited to keep you updated in the coming weeks/months.

Questions for this week:

• How can I get help when I’m too anxious to call a therapist?
• How can I get over my fear of vomiting?
• How can I get through high school when I have been depressed for years?

I was diagnosed around 15 with Borderline paired with Generalized Anxiety. I have been hospitalized and have had my attempts with suicide. Due to money issues and a strong minded mother who didn’t necessarily believe in psychological treatment my treatment was stopped at 16ish. Now at 23 I have manage to survive with a supportive spouse. I have graduated and now am a teacher with benefits in which I can use to get help. Much needed help because these mood swings can be destructive.

Being a very self-aware individual I push myself into some harsh paradoxes where I recognize what needs to be done but bringing myself to do these things is incredibly difficult. I am great at my job (not being pretentious) and I love my middle schoolers as middle school was hard for me. However, middle school is also a trigger along with the stress that comes with being a teacher in my first year. But, I couldn’t imagine doing any other job.

Getting to my question, I want to get better I recognize I have destructive behaviors that affect my spouse and my sister (we all live together) but I can’t bring myself to pick up the phone and call a doctor. My anxiety is so bad that I cannot bring myself to call because I am overwhelmed with where to start, feeling dumb, and just being confused.

Where can I start? Or some of the steps I can make to just work my way to pick up the phone? How do I begin to tame strong anxiety/co-dependence that keeps me from well, adulting and or helping myself.

I’m going to answer one of your questions here and not the other – the question of what to do about your anxiety and co-dependence is tough. My biggest suggestion would be getting professional help because borderline can be really hard to make a dent in all by yourself. You as a really good question – what can one do when they need therapy but are too anxious to actually pick up the phone and call. Well there are options.

First off, many people don’t know this, but in this day and age, you can often make therapy appointments without ever actually having to talk to someone on the phone. If you go to the therapist’s website or look for them using tools like Psychology Today’s Find a Therapist tool, you often have the option to send a message or email to them.

I have a guide that shows you exactly how to use that tool to search for a therapist online, but when I go there and put in my zip code, a majority of the people have a button right there to email. Funny enough, I actually prefer to set up appointment via email. It’s easier than having to manage the phone with one hand, the calendar in the other, etc. I also, like many other psychologists and therapists, basically never have time to answer the phone and end up returning calls like once a week, though I have an administrative assistant now that helps.

Another option is to have a buddy help. You could have them call for you or with you. There is nothing to be embarrassed about – you are seeking therapy for a reason. Out of anyone, a theraist would understand if you need to take a slightly nontraditional route to getting into session. This person could even accompany you to your first appointment and wait in the waiting room etc.

Do what ever you need to do to give you that extra boost of motivation or comfort – the thing that gives you the extra umph that you need will be different for everyone. The important part is getting it done and following through.

Another tool that is available to people who are having challenges that prevent them from utilizing face-to-face therapy is online therapy. Many individual providers will list this service on their website. You can also look into tools like Talkspace, BetterHelp, or 7 Cups, which provide different services for internet therapy.

I will say that it is ideal for you to find a way to do face-to-face sessions. So much of borderline is about relationships and it can be so helpful to work those things out in the actual session room. It’s easier to avoid and be fake over text/internet. In general the effects are similar for online therapy for a variety of issues, but I haven’t seen anything on borderline. My hunch says that in-person treatment will be much more beneficial.

Just remember: it’s not a one time shot. Say you call and mess up and don’t end up leaving a message or you go to session and close up and don’t give any real information about yourself. You can always rectify that later. Sometimes you just need to get started and then you can course correct later.

I have suffered from agoraphobia for about 40 years. The panic attacks that feed on this anxiety have an interesting manifestation, in that I end up vomiting. This stems back to an incident after a family night out for dinner when I was 7 years old where I vomited before getting in the car to come home. Ultimately I think this has become more so a fear of vomiting and the agoraphobia is avoiding situations where I may vomit (work, meetings, restaurants, planes, trains, cabs – you name it). So the avoidance is strong with this one.

The past 2.5 years this became so bad that I had to give up work (this was actually suggested by a therapist who was also telling me that I needed exposure). My job involved international travel, official functions and speaking engagements and lots of time in situations that bought about the panic attacks and the vomiting. I was unable to actually leave the house for work or get in the car or attend a family function without vomiting.

I have successfully been practising mindfulness meditation for the past 2 years, and have undertaken CBT with a therapist, including using CBT journals for restructuring thinking which have been very beneficial. I have been doing the self help stuff for 18 months now with a lot of success. But I am still missing something.

Now to my question! I absolutely get that exposure to the panic attacks is crucial to dealing with this. But given the outcome of a panic attack is vomiting which is pretty socially awkward in all situations, I still avoid some things just because I can’t get my head around the exposure side of it. I don’t like vomiting, so can you suggest what I can do to get on top of the exposure side of this where I can manage the outcomes better?

It actually sounds like you have developed a disorder called emetophobia – literally a fear of vomiting. Agoraphobia is an associated disorder for many people with this disorder because there’s this certainty that you will vomit and a fear that you won’t have a safe or easy place to do it. I am familiar with the disorder, but haven’t directly treated it in any of my clients, so I’m going to summarize some information from emetophobiaresource.org. Anna Christie is a counselor with a lot more experience than me.

Before beginning exposure activities, you want to be sure that you have taught yourself how to initiate your relaxation response through breathing practice. Exercise in general is also really important here – you want to be as physically fit as possible so that your body doesn’t feel like it constantly needs to compensate for poor health with the fight or flight response. You want to start an exposure exercise at your baseline level 0 or 1, then you find the lowest level of stimulus that can generate anxiety for you.

Really try to generate that anxiety. If it gives you a 2-3, that’s perfect. Work yourself back down and try to come to your baseline. Then do it again. The idea is you want to master this level until you don’t feel any anxiety and then move on. The idea is that you want to try to put yourself in the shoes of the media that you use for exposure. Really put yourself in their shoes and try to internalize the experience. This is as close as you can get without real In Vivo exposure.

Some ideas that you can use:

• Picture or word that is triggering
• Sentences/phrases/statements
• Silly cartoons
• More detailed drawings
• People looking unwell
• Pictures of before and after vomiting
• Pictures of real people being sick – less to more graphic
• YouTube videos – cartoons, babies real people
• Sounds – less to more graphic

You can also talk to your doctor about possibly prescribing and antiemetic that can help you suppress your nausea while you work on exposing yourself to anxious stimuli in real life situations. Of course you will want to rule out other possible medical causes for your tendency to vomit. I highly suggest you work on this with your therapist as well. Give them this website and work with them collaboratively to try this approach.

I’m 16 and in my last year of secondary school, (I guess that would be a sophomore in high school in the states). I have exams like everyone in the summer which basically determine my education from there on.

Problem is, I’m kinda behind. I’ve had depression since around the age of 13. So all that kinda meant I missed a lot of school; I literally just spent my days in bed either sleeping, wasting time on YouTube or watching movies.

This year I’ve just about managed to stay in school but my concentration is so bad, everything I learn in class I seem to forget and when I get home, instead of studying and revising I’m so exhausted all I want to do is get in bed.

I guess my question here is, how do I study and get school done while being so depressed? I’ve learnt there isn’t exactly an answer but any tips would be appreciated.