Common Questions About Anxiety

Emetophobia: The Fear of Vomiting

Emetophobia — the intense fear of vomiting — is surprisingly common among people with anxiety disorders. One listener asked about helping their 16-year-old daughter with this specific phobia.

While no one enjoys vomiting, people with emetophobia go to extreme lengths to prevent it. This fear becomes highly impactful, creating additional complications for those already working to face their anxiety.

The most empirically validated treatment approach is through exposure therapy. However, I want to be absolutely clear: ethical exposure therapy for emetophobia would never involve a therapist intentionally causing a client to vomit. Instead, exposure might involve words, stories, images, or sounds related to vomiting.

People with emetophobia often want specificity in their guidance. They may struggle to generalize broader anxiety management principles to their particular fear, believing that vomiting is uniquely terrible compared to other feared outcomes.

If you’re supporting someone with emetophobia, understand that it’s a challenging condition that often requires specialized help, but recovery is absolutely possible.

Nocturnal Panic Attacks: When Anxiety Strikes During Sleep

Nocturnal panic attacks — those that wake you from a dead sleep — are particularly jarring. One listener described waking up after their first sleep cycle already in a heightened anxious state, asking about exposures for this specific situation.

These attacks can feel especially disorienting because they occur without an obvious trigger. You’re suddenly awake, heart pounding, body sweating, gasping for air — and you were just sleeping moments before.

The principles for handling nocturnal panic attacks are fundamentally the same as daytime panic attacks, though admittedly more challenging to implement. The key difference is that you don’t need to create an exposure situation — you’re already in one when it happens.

Instead, focus on the response prevention aspect: resist the urge to engage in safety behaviors like getting ice packs, waking your partner, or using distraction techniques. Practice allowing the experience to run its course, knowing it will end on its own.

With consistent practice, nocturnal panic attacks typically become less impactful and may decrease in frequency or disappear entirely.

Is Focusing on Breathing a Distraction?

A common question about anxiety management involves breathing: “Is concentrating on my breath when anxious a distraction or an appropriate coping strategy?”

This is an important distinction. In my approach, we never focus on breath as a direct way to control anxiety levels. Trying to manually operate on anxiety itself often becomes like chasing your tail.

Instead, scheduled breathing breaks serve as a way to step back from fighting against uncomfortable experiences. Focusing on breath can help you reset and move away from resistance, not as a method to regulate or calm your nervous system directly.

The intent matters here. If you’re focusing on your breath to distract yourself because “I won’t be able to handle anxiety otherwise,” that’s problematic. But using breath focus to foster mindful acceptance of your current experience is a valuable practice.

Rumination About Rumination

Perhaps one of the most meta questions involves ruminating about rumination itself. One listener described becoming hyperaware of their thought processes after learning that rumination perpetuates suffering, creating a new fear cycle.

This is incredibly common — getting trapped in thinking about thinking, or worrying about worrying. The key principle here is recognizing that you don’t need to monitor, evaluate, or control your thoughts.

Your task is to experiment with having no specific thought-management strategy at all. Allow your brain to think whatever it wants, acknowledging the process of thinking itself without judging the content.

Remember this fundamental truth: you can choose what thought to have, but you can never choose what thought not to have. All thoughts are permissible, even the uncomfortable ones.

External Sources of Anxiety

Especially lately, many people wonder how to handle anxiety triggered by external events. How do we live through challenging times without becoming overwhelmed?

It’s completely normal to feel anxious when facing external stressors. The difference between normal anxiety and disordered anxiety often lies in what we focus on.

Someone experiencing normal anxiety focuses on why they’re anxious — the relationship issue, work problem, or global concern triggering their feelings. However, those with disordered anxiety quickly shift from “the world is a mess” to “I can’t handle feeling this way.”

External stressors are inevitable. The trap occurs when you morph from concern about external events to preoccupation with your internal state. If you find yourself more interested in how you feel than why you feel that way, it may indicate an opportunity to work on your relationship with your internal experiences.

Fear of Becoming Suicidal Against Your Will

A surprisingly common fear among people with anxiety disorders is the worry about becoming suicidal against their will. This fear stems from the broader anxiety about losing control of one’s thoughts and actions.

This concern typically sounds like: “Since I can’t control my anxious thoughts, what if I start having self-harm thoughts and can’t control those either?”

I experienced this fear myself during the worst of my anxiety disorders. I’d ask people to hide things like scissors, knives, or medication bottles — not because I wanted to harm myself, but because I feared having a thought I couldn’t resist.

Here’s the reality: thoughts are not impulses. In the context of anxiety disorders, thoughts don’t make you do things you don’t want to do. There’s no fundamental difference between worrying about having suicidal thoughts and worrying about screaming obscenities in church or making a scene in public.

If you’re actively planning to harm yourself, please get help immediately. But if you’re worried about having unwanted thoughts that you fear might somehow make you do something against your will — that’s a common anxiety presentation, not evidence of actual risk.

Looking Beyond Specific Symptoms

Many questions I receive focus on specific thoughts, symptoms, or fears. People often ask: “Can you talk about this particular thought I’m having?” or “What about this specific fear?”

While these concerns feel uniquely important, focusing on the content of specific thoughts rarely helps long-term. The process that creates these fears will simply morph into something else if you only address the current content.

That’s why people in support communities often share how their fears have shifted: “Six months ago I was afraid of going insane, but now I’m afraid of something happening to my kids.”

The broader principle matters more: learning that all sensations, thoughts, and emotions are permissible, even when they’re disturbing or uncomfortable. The process by which you’ve become afraid of your own thoughts and bodily sensations is what truly needs addressing.

Recovery comes not from eliminating specific anxious thoughts, but from changing your relationship with internal experiences altogether.

Links Of Interest

• Find my “Practical Mindfulness for Anxiety Recovery” Groups
• My Panic Attacks Explained Workshop
• My Agoraphobia Explained Workshop
• My Panic and Agoraphobia Recovery Guidebook
• Follow me on Instagram
• My YouTube Channel
• Disordered – With Josh Fletcher

Disclaimer: The Anxious Truth is not therapy or a replacement for therapy. Listening to The Anxious Truth does not create a therapeutic relationship between you and the host or guests of the podcast. Information here is provided for psychoeducational purposes. As always, when you have questions about your own well-being, please consult your mental health and/or medical care providers. If you are having a mental health crisis, always reach out immediately for in-person help.