S3E19 Dr. Erin Neely, author of Emetophobia: an ERP Activity Book (for kids)

SEASON 3 of Emetophobia Help features people from the Facebook group “Emetophobia NO PANIC (Recovery)”

TRIGGER WARNING: Words such as "vomit,” “throw up” and "sick" may be used. No upsetting stories will be told without a specific episode trigger warning.

Host: Anna Christie, Psychotherapist and Emetophobia Specialist

Intro Music: YouTube Audio Library, "Far Away (Sting)" by MK2, Used with Permission.

Anna’s Website for emetophobics: www.emetophobiahelp.org

EMETOPHOBIA RESEARCH CHARITY: www.emetaction.org

Facebook Group: "Emetophobia NO PANIC"

Anna & David's BOOKEmetophobia: Understanding and Treating Fear of Vomiting in Children and Adults: Russ, David, Dr., Christie, Anna S., 

"Free Yourself from Emetophobia" (Keyes/Veale) and 

“The Emetophobia Manual” (Goodman) for adults.

FOR KIDS:
 "Turnaround Anxiety Program" with Emetophobia supplement (McCarthy/Russ) and 

 Emetophobia! The Ultimate Kids' Guide eBook : Russ. PhD, David

Transcript

Anna: 0:27

Well I'm very excited to be here recording today with child psychologist Dr Erin Nealy. Dr Nealy works with children on the autism spectrum, as well as kids with anxiety and panes. She's in private practice in New Hampshire in the United States. The reason that I asked her to come on is because I found her book. I'm always looking for books and things about a metaphobia. She has written a book called A Metaphobia an ERP activity book. It's absolutely a beautiful book. This is when I'm sorry that I have a podcast and not on a YouTube channel, because it's just so colorful and funny and cute and just a beautiful book. So welcome, Erin.

Dr. Neely: 1:24

Thank you, that was all very kind. It's lovely to meet you. Thanks for having me on.

Anna: 1:29

Yeah, Maybe you could start by just sharing with us the inspiration you had behind writing this book and what you hope that you know I assume it's for kids, So what you hope kids will get out of it.

Dr. Neely: 1:46

Yeah, so I often treat children emetophobia, emetophobia and, as we know, kind of the primary treatment for that is exposure And I often make different kinds of handouts and tools and things to use with my clients And I just wanted to put together a book that I could share with other therapists, ideally to save them time, just to give them to do the work for them, so that they could just buy a whole book with all of the tools and things in it for working with a child with a metaphobia.

Anna: 2:25

Right. Well, you're a woman after my own heart, because I, as I reach a kind of retirement age, i tell most people I'm going to work till I die.

Dr. Neely: 2:35

So I probably got another 20 years to go.

Anna: 2:37

But I think about you know that proverb about give a man a fish, he can eat for a day, but teach him to fish and he can eat for a lifetime. So I think about sort of educating other therapists because there's not a lot known about a metaphobia Like how did you get into it? You know what was your first experience of it?

Dr. Neely: 3:05

I've been doing this work for a really long time. I don't know that I can remember the first one, but a lot of the children that I see have have a metaphobia as well as other phobias. I mean, oftentimes I find that if a child is afraid to vomit, then they're afraid of lots of other things, and so I really had to. It was in my training, obviously in graduate school, how to do ERP, but obviously you know when you're working in the field, you need to continue to develop your skills and develop some comfort with it. So I really just started educating myself about it And being as creative as I can. Kids don't let you just sit and talk at them. You have to have games and you have to be funny, and there's lots of things you need to do to keep their attention and to make therapy not boring drudgery but something that they enjoy and feel empowered by, and so that's kind of where a lot of those tools came from Was that sort of spirit.

Anna: 4:21

Yeah, that's really interesting. I mean, I was gonna say I was shocked to hear that you learned any of this in school, however long, unless you just graduated. But I don't think so. Nope, But I'm sure you learned about ERP, exposure response prevention. Have you come across therapists and I ask this because I have come across therapists that do CBT and they're willing to do the cognitive exercises with clients, like restructuring people's thoughts, the way they think about what they're afraid of and so on but they're not willing to do exposure?

Dr. Neely: 5:06

Have you found that sometimes I do, And I think it comes from people's discomfort with discomfort. I think therapists want to be helpful and to make people feel better at the heart of things, And the idea of making especially a child that's where my expertise is. The idea of making a child uncomfortable on purpose is not a popular idea, And so there are therapists who really avoid it, which is a bummer, because it's kind of one of the best treatments for all kinds of anxiety is to go do the uncomfortable thing.

Anna: 5:53

Right, yes, And in a way that you can cope with it little by little usually That's right.

Dr. Neely: 6:00

yeah, in small doses exactly.

Anna: 6:03

And baby steps sometimes. Sometimes, steps are very baby.

Dr. Neely: 6:10

That's small as they need to be.

Anna: 6:12

Right, yeah, other people can take giant leaps from time to time. But Exactly Yeah, i think, dr David Russ, that the child psychologist who I just published a book with he said something about I'm going to make you scared on purpose and your parents are going to pay me for it, and it's you know, try to just kind of be a little bit try to just kind of be a little bit, a little bit funny, i guess, sorry.

Dr. Neely: 6:43

Yes.

Anna: 6:46

There's a kitten scratching at a door, So we're going to see whether that's whether he gives that up. Yeah, all right, cut all of this bit out and let him out. Anyway, it really is a beautiful book. Can you kind of give like a little bit of an overview of some of the key activities or exercises in this book and you know how they, how they are helpful?

Dr. Neely: 7:14

Yeah, sure. So it's designed to be used for sort of the whole range of a metaphobia, and so it starts with exposure to words, and so there's different kinds of word activity. There's sort of like a mad libs kind of game in there. There's a word search, there's coloring in words, and then it kind of moves on into introductory level, sort of visual, cartoony kind of images of vomit and vomit related things, and then it's got some pictures, some actual photographs of vomit, so you can draw a picture around the vomit, and then it kind of ends with Doing things that might actually make you a little bit nauseous and the very. The final activity in the book is actually Call it barf bingo, and so you can get, you can check off the different bar, the different activities, and it's sort of a culmination of doing all of the exposure sort of all in one Right, this barf bingo is pretty cool.

Anna: 8:33

I'm reading the car. Make some fake vomit. Pour soup in the toilet. I'm just picking out a few things. Make a video of you fake barfing. I mean, kids would love this stuff. Play, guess this smell. That's funny. I'm sure that's a game you, you play. I don't know what it is, but um, yeah, poor, yeah, it's um, it, it's, it's pretty cool and it's not over, it's not overly gross. I have to say like it. You know there's sure horrible Unit, which I think is important that I know some therapists also have their clients watch YouTube videos, but I go through them and put them on my website because some things I think are even too growth They're, you know they're not sure help you get better.

Anna: 9:23

They're just something no one wants to see. That's right.

Dr. Neely: 9:27

Why would you, why would?

Anna: 9:29

you, you know, have have kids.

Dr. Neely: 9:32

Yeah, those links on your website are really great.

Anna: 9:35

Yeah, i'm, thank you. I'm always Trying to keep them Current and relevant, and now David Ross is. He's drawn a lot of the cartoons that are on that site now, so I can't I only draw stick figures.

Dr. Neely: 9:52

So I'm very appreciative of that.

Anna: 9:55

Yeah, and so do you Envision that this, this book, would be something that therapists would buy And give to their clients, or do you have any thought that it could be used in any way as a self-help or for parents to help?

Dr. Neely: 10:13

Yeah, that's a really good question that I kind of struggle with because You have to get kind of the dose right, although I, you know, i have listened to your podcast and listened to other people talk about how they've kind of Self-helped it themselves and perhaps maybe an adult could do that for themselves, but with children I think I Would. I am cautious to have it be a self-help kind of situation, because I think parents really want their kids to be better right, understandably so And I would hate for them to push too hard because they can make it worse if you push too hard, and so it would be a good idea to have a well-informed person about how to help you choose the right dose, like the right level of exposure.

Anna: 11:13

Yeah, yeah, that's probably true. I'm kind of now that we have a book out and we have a website up and I have this podcast. now I'm thinking about people who don't have any money or insurance. And so I'm just kind of thinking okay, what could I do, how could I you know?

Anna: 11:37

I am running some classes, for I'm going to try that with 10 people in the class. Oh cool, see how you know just and for a very reduced. You know nothing like 10 sessions would cost with the therapist. But yeah, people with kids. I think you're right. I've, even when I was working with children, been scolded sometimes that I wasn't pushing enough. You know that I don't know how to experience that. The child doesn't get better fast enough, or Yeah.

Dr. Neely: 12:06

Yeah, as fast as people would like. Sure, yeah, it kind of happens all the time and it's hard to change, take time and it's hard to see your child suffer. So people really understandably want their child to get better as fast as they can. Right, And as a therapist, it really is one of my values to help people get better as fast as they can. You know, i really try to work as swiftly as possible, but people are people and they're going to do things at their own pace.

Anna: 12:38

That's right. Yeah, i think that I know that when I was a child, of course, there was none of this knowledge around, unfortunately. But I did go to several psychiatrists and I don't know who else maybe psychologist.

Dr. Neely: 12:54

When I was a kid I don't know who they were, But they were.

Anna: 12:58

Sometimes they would know what I was afraid of and they would kind of throw it all at me in a sense of talking about it, and that made me just not want to go back. I'm talking about being about eight or nine years old and thinking I do not want to go back. I don't want to talk about this. Yeah, and sometimes I think you probably Have you found any examples of children that can't even Like they don't even want to hear the word or For sure, yeah, and so where do you start there then? I mean, they don't even want to. They don't want this workbook yet because they don't want to even think about it.

Dr. Neely: 13:40

Yeah, yeah exactly I did. There's one activity in the book for that sort of thing where it's just a picture of It's multiple photographs of food and it's talking about eating. What did this person eat is what the task is, and you try to identify all the different kinds of foods And that's sort of a pre-exposure Oh okay, exposure, because it's literally just to foods, and so there is a way to work around it. You start with hinting at it, you can start with, you start with what are the things that you avoid, and you give the child a chance to tell you all the things that are dangerous And you really help them feel like you hear them, these are the things I'm avoiding because they're dangerous. And so you take all of that really seriously and you can catalog it And eventually you kind of get to the place where Sorry, that was my, i don't know if you heard that Okay, i'll turn it off, i apologize, but really you get to the place where, as they talk about what they're avoiding, they start getting into how that has gotten in the way of their life.

Dr. Neely: 15:02

You know, like the birthday party they can't go to, or the car they can't get in, or the vacation they're scared to go on because it means getting on a plane. You start to gently kind of have those reminders of all the things that a metaphobia has taken away. And then you start with you know what would they like to get back, you know what's important to you, what do you miss, and you start with their goals. So you really establish that trust. You don't throw all the scary things at a person in the beginning because that's a violation of trust. You know they really need to feel like you're on their side and that you care about the same things that they do. And then you just really hold really clearly like you deserve access to the whole world. You know this is all. You should have the same access to everything. And eventually they kind of come around to that. They develop the anger about what a metaphobia has taken away and some motivation to do the hard things.

Anna: 16:07

Yeah, that's really. I mean, i'm sitting here, of course, i get to look at you and you have such a lovely demeanor and a beautiful face that just exudes warmth comes out of you, and that's important with adults as well as children. Some therapists maybe they could, you know, concentrate on some other areas at least from the stories. I hear the stories.

Anna: 16:45

I hear from my clients who have had really bad experiences and miraculously they're willing to try again with someone else, you know, which is honestly a miracle, because they've been treated with mainly with misunderstanding. I would say not so much treated with abuse or anything, It's just yeah, it's just a just complete misunderstanding.

Anna: 17:11

What do you find are you know? so there was a thank you for that answer about how you, how you even start with with a child that doesn't want to talk about it, and that shows the value, i think, of being with a therapist, if you possibly can to have your child.

Anna: 17:29

You know, because I think parents don't think of backing up and and you know, sitting in that place where, like, tell me everything about your life. And you know I don't because I don't know. But what do you find are some of the common challenges along the way as kids are going through this work, and how does the book address that?

Dr. Neely: 17:57

So you often find, once you've established motivation for change, there often comes a point where they're, you know, they're doing their homework assignments, they're doing their exposures between sessions diligently, and then there's sort of a place where the rubber hits the road, so to speak, where now it's time to do something harder, you know, and so and that's when you really have to figure out, you know, how small does this step need to be in order to accomplish it? And so it takes a fair amount of creativity, and that's kind of what I was hoping that the book would help with. Is that creativity like what's going to be the next kind of exposure? You know, it's really not.

Dr. Neely: 18:51

The book is not sort of a how to or a manual in any way, it's really just activities, and so my hope is that, as people need support for the creative steps that have to happen along the way, that they can pull out the book and be like we haven't done this yet or we did something cartoony, let's, let's try doing a photograph this time. And so I'm just hoping it supports people's creativity, because I feel like that's the hardest part about doing ERP.

Anna: 19:22

Right, yes, and I think especially with kids, because you have to not be boring on top of being effective. right, yes, but yeah, i like that that you could. You could almost use it as a you know, like you don't.

Anna: 19:40

It doesn't have to go in order from page one through to the end page, there's a really cool, a very cool table of content. it's an annotated table of contents, which is great because it that little annotation you know. so say there's a, there's a blank page. for example, draw vomit And your annotation says doing this activity as the therapist side by side with the patient, allows the therapist to choose what to put in their vomit picture, given the person's history, the conversation while drawing can be about colors, textures and foods. So that's just an example, really brilliant.

Dr. Neely: 20:21

Yeah, that's an exaggeration.

Anna: 20:26

I don't know I mean it. it's not just a blank page draw, vomit, right, it's got you know, it's almost like it's got little hints, little helpful hints.

Dr. Neely: 20:36

Yeah, I wanted to give a little bit of some ideas about how to use the pages, because with many of them there are kind of multiple ways of using them.

Anna: 20:45

Right, yeah, that makes sense. Aside from this book, do you have other strategies or resources that you would recommend? We do have quite a few therapists. listen to the podcasts. Any other things that you would recommend for working with kids with a metaphobia?

Dr. Neely: 21:08

I feel awkward doing it, but I would actually suggest my other book, the A-Z.

Anna: 21:12

Guide to.

Dr. Neely: 21:13

Exposure I can show you, although people won't necessarily see it. It's an A-Z Guide. so, from airplanes to zombies, it's just lists and lists and lists of different kinds of exposures to use for different fears. It's not just a metaphobia, but for all the different things that kids can be afraid of. Again, i find that if I see a child who has a metaphobia, they often have other phobias as well. So even while writing it, i was finding that I was pulling the book out just again to be those reminders of what are the different levels, what are the different steps, what are the different size, doses of an exposure to a particular thing that you can do.

Anna: 22:05

It saves time for therapists and clients building a hierarchy too, which I found way back when I had a metaphobia as an adult and went to therapists and they wanted to build a hierarchy. I actually didn't know what a hierarchy would be. I was then saying if I'm anywhere near anyone who feels sick or vomits, i'm absolutely terrified. If I'm not, i'm fine. That was no hierarchy and they would get frustrated, which is why we have our website in a hierarchy. It's in an order. It's not perfect for everyone, but some of the research would suggest that you don't have to do everything in absolutely perfect order with ERP anyway.

Anna: 23:07

Yeah, I think I could sit and talk with you all day about your practice.

Dr. Neely: 23:14

Absolutely.

Anna: 23:15

I was going to ask before was that the book that you wrote with someone else?

Dr. Neely: 23:20

It was yeah, with Dr Don Heibner.

Anna: 23:25

Right, and I think for some reason we know her. I can't remember. I think David knows her or she's written other books by herself, perhaps She has for sure the facing mighty fears about throwing up.

Dr. Neely: 23:41

It's another smaller book for children which is more of a manual, like not a manual, but more of a how-to self-help model. Right, and that just came out as well, I think.

Anna: 23:52

It's amazing how, in just the past three years, there was nothing on the market and now there are three self-help books for a metaphobic adults and our book for therapists, and a number of different resources for children. There's one called Tummy Troubles, i think by Jane E Mosh. And the other one that David Russ wrote and published himself. he put it up on Amazon. I can't remember what it's called. Sorry, David, He's not listening.

Anna: 24:31

But, you know what, if you go to Amazon and just put in a metaphobia under the book section, there isn't very much, so it doesn't take much to kind of comb through. And there are a few sort of scammy ones, but I usually buy anything new that I see. So well, you have been a wonderful, wonderful guest.

Dr. Neely: 24:56

Erin and.

Anna: 24:57

I think that it's really helpful. I just really want to plug this book and I will put a link to it at least for Amazoncom in the show notes, so people are listening and want to order it and look through it. Or if your child is going through treatment for a metaphobia, you could give it to their therapist or recommend it.

Dr. Neely: 25:20

Right, That would be a good idea. Yeah, for sure.

Anna: 25:23

Yeah, well, lovely having you here. Thanks so much again.

Dr. Neely: 25:27

Thank you, Anna. It was lovely to meet you And I appreciate all the work that you've done to help people as well.