I’ve spoken with hundreds of people with phobia (mainly emetophobia and agoraphobia) and dozens of therapists who treat it. A major topic is setbacks, relapse, and lost progress. I’m writing today to say that there is no such thing as a setback in phobia recovery.
I don’t mean that there won’t be hard days. There will be hard days. I also don’t mean that there won’t be days where you go back to old habits, that will happen too. What I mean, is recovery is not linear, and a bad day or old habits do not set you backward in time. When we think of recovery we often think of a graph, like this.
In fact, this is the graph from Bia’s impact report, where we show that users report significant improvements during their time using Bia. I can tell you this with 100% confidence, no one, and I mean no one, recovers from phobia immediately, on their first try, without hard days or setbacks. It does not happen, just like someone learning a language doesn’t say the wrong thing from time to time, or someone learning a new instrument doesn’t occasionally play the wrong note. We use graphs because they are simple and easy, but it’s the wrong way to think about recovery. A much better visual is a pyramid.
In this visual, every single day, you add a stone to your pyramid. This includes good days but almost more importantly it includes bad days. Each bad day is an opportunity to process and learn. Most people with phobia are incredibly hard on themselves, and these “bad days” exist as a constant torture of guilt, shame, and regret, on top of the day to day suffering we experience. Part of the recovery process is to pause here, and give yourself some credit. Imagine someone else who was your age when your phobia started. They are scared, alone, suffering, they are confused. Would you put the same guilt, shame, and regret that you place on yourself on this person? You wouldn’t. And you shouldn’t to yourself.
When you fall back to old habits, that’s a stone in the pyramid. When you set a goal for yourself and you don’t reach it, that’s a stone in the pyramid. You try something new and it doesn’t go as expected, that’s a stone. Every day of life, in our careers, school, personal relationships, hobbies and more, we get stones to add to our pyramid.
When will the pyramid be done?
Never.
That doesn’t mean we have to suffer from phobia forever. Each time our pyramid gets bigger, we can see more of the world around us. Even after my recovery from emetophobia, I still get to add stones to my pyramid, and stand tall on the top and experience life through a lens that has been crafted by decades of days, good, but I think more importantly, the bad ones too.
I am extremely excited to announce today that Bia has partnered with the Center for Anxiety and Behavior Therapy, or CABT for short. They are the first organization in history, as far as I can find, that offers therapist continuing education units on the topic of emetophobia specifically. I was jumping out of my chair when I found their website and the resources they offered. They’ve formed The Emetophobia Institute, a practice offering workshops for individuals and parents, and training for clinicians. The Emetophobia Institute is run by Dr. David Yusko and Dara Lovitz, two people who understand emetophobia extremely well.
Dara is an emetophobic in recovery and was in fact a client of Dr. Yusko. They’ve combined their two unique perspectives of emetophobia into helpful resources for individuals, parents, and clinicians. They have a book together call Gag Reflections, which I recommend due to this unique and powerful duel perspective. Last year, I took Bia to them and I was happy to find their mission was the same as mine: To make emetophobia recovery easier and more accessible.
We’ve kicked off our partnership with some exciting work coming soon. First, providers signing up for Bia can get a discount to the CABT’s trainings. Bia’s provider portal combined with the expert instruction from The Emetophobia Institute mean that no clinician needs to be concerned or confused about treating emetophobia. Second, we’ve kicked off research to raise awareness about emetophobia and inform clinicians on the signs and proper treatment. Finally, we are developing a new clinician directory for providers to advertise their expertise in emetophobia, helping clients find therapists who know and understand emetophobia. Not to mention, their feedback and expertise continues to shape and improve the tools in Bia, helping individuals take recovery into their own hands at an affordable cost.
It’s always been extremely important to me that Bia was built correctly, safely, and with the partnership of experts. This partnership with CABT is solid confirmation of that mission, and I am so excited about the work to come. In 2025, I am absolutely confident that more people will learn about emetophobia, get help, and feel better, than ever before.
If you are suffering from emetophobia, there has never been a better time to start recovery. Get started in 5 minutes with Bia, or sign up for an affordable workshop with The Emetophobia Institute.
If you are a clinician, it’s important to understand emetophobia is one of the most common and debilitating specific phobias impacting almost 1 in 12 individuals. Most individuals with emetophobia go decades without treatment. Emetophobia treatment is often unique, in that it is not the same as other specific phobias and typically requires a slower, more incremental approach similar to OCD. Bia provides you an easy tool to assign ERP homework, with pre-made curated exposure hierarchies and guiderails that prevent over exposure and resulting drop-outs. The CABT provides you continuing education units on a disorder that is so common, that mentioning it on your website will likely result in a wait list of clients in need.
If you work in a school or in-patient clinic, Bia is a massively cost effective way to get your kids back in school and free from their phobia. Bia provides step-by-step incremental exposure with resources and training for parents and a dashboard with automatically charted progress.
Interested in using Bia but have questions? Please contact us anytime.
When I built Bia, I started using it every day. I spent 15 or so minutes using it in the morning, I used it on the bus on the way to work, I used it while waiting in line at the bank. Things were finally clicking for me. I noticed myself sitting through vomit scenes in T.V shows without shutting my eyes. I noticed myself feeling full after a meal and not spiraling into thinking I had the flu. A positive cycle was forming where I was doing new things and feeling good, so doing even more new things was becoming easier and easier. I shared all this progress with my therapist. He asked me ‘Why do you think everything is working right now?’. This post is about my answer to that question.
I had attempted therapy for emetophobia multiple times, but never felt like I could fully conquer it until now. What was different? I had to compare the two versions of myself – me now vs me from 7 years ago. I realized that my recovery from emetophobia was only a little bit about vomiting and a lot about confidence and empathy for myself. I used to visualize recovery from emetophobia as a line. If the line goes up I am recovering, if it goes down I am feeling terrible. Obviously life is more complicated and as my phobia retreated from my life I started visualizing my recovery as a pyramid. Each stone in the pyramid as essential as the rest.
The Foundation: Practicing exposure and response prevention gave me the skills and confidence to tackle other problems in my life. I called my closest friends and I told them about my emetophobia – they had never known. I explained how I had wanted to go to the bars with them but always found an excuse not to go. I told my parents that phobia is why I quit playing soccer in high school, and I asked my wife if she remembered I made us leave our high school prom early (She didn’t). I felt connected and closer to the people around me for sharing my emetophobia. A foundation to my pyramid was formed.
Empathy for My Past Self: Thinking back I could so clearly remember all the times that phobia was behind the wheel of my actions. I was so frustrated with myself for letting phobia dominate me. I wanted to scream at myself. I pictured it, this little 8 year old boy – terrified to eat pizza or ride in the back of the car – and I’m just screaming at him. Releasing this guilt and understanding that boy was just doing the best he could was a massive part of my recovery. A weight was lifted, more stones were laid.
Emetophobia is Not My Identity: I honestly didn’t understand other people. Were they just pretending that the movies, concerts, and bars were fun? These places are cramped, full of germs and potential sick people. I wondered why in the world people enjoyed traveling. How do they get to the bathroom quickly when they needed to? I accepted all of this as my personality and had resigned from the possibility of enjoying these things. However, I started to realize these were decisions my phobia was making. I actually wondered, will I enjoy going to concerts now? My emetophobia didn’t like traveling, but I ordered a passport because I was going to find out if I liked traveling. I went to a concert. I met some friends downtown for drinks. I paid attention to discomfort that was specific to my phobia (dirty discomfort) or discomfort that was just me not enjoying the activity (clean discomfort). I learned that I love live music, I love riding the subway into town for lunch, and I don’t like bars because they are just loud and not my style. I was discovering my personality – and because I had connected with my friends and family about my emetophobia I could share my true personality with them. I finally felt like myself for the first time. Importantly, I was happy about this revelation instead of frustrated that it took so long to happen, because I had already forgiven that 8 year old kid. The pyramid was climbing higher and higher.
Work Life Balance: As you might know, life with emetophobia sucks. Nothing is fun, and mundane things like going grocery shopping are challenging and terrifying. I was a software engineer for work and it was easy to bury myself in work. It was safe, but I sat on the side lines while my friends went camping and traveled abroad. Again I wondered if this was just a personality thing – maybe I like working? Well, as I become more successful at telling my phobia to f*ck off, my life became bigger. My wife and I would catch the train downtown for a day of coffee, shopping, and lunch, and I could ride the train home with a full belly (and have zero anxiety). For the first time in my life going out after work was fun. I started to work a bit less and my perspective on life changed a bit. My career ambitions changed – this was scary. But closing my laptop at 5:00 pm meant I was free to do what I want and it became easier and easier.
Crafty Emetophobia: Through all of these life changes emetophobia tried every possible avenue to break back into my life. I had frequent dreams related to vomiting, I worried about a relapse, I wondered if I was just telling myself I was recovered but I actually wasn’t. Over the span of 20 years emetophobia had perfected its arguments – it was like a professional debate team ready to twist every point I made. Ken Goodman says in his book, The Emetophobia Manual, that beating emetophobia is a move by move game. He says when anxiety comes back, don’t fret and think ‘oh no’. Instead welcome it back with open arms. Say ‘Hi anxiety, nice to have you back. Are you ready for me to beat the sht out of you?’.
“Hi anxiety, nice to have you back. Are you ready for me to beat the sh*t out of you?”
I’ve accepted that either through chemical imbalance, physical neuron connections, or 20 years of habit, emetophobia (and OCD) will continue try to creep its way back. But I have my recovery pyramid foundation built, of which I stand on top and say ‘Come on anxiety, I dare you’.
Your Recovery Pyramid: Everyone’s recovery will look different. Bia is designed to help you build your recovery pyramid, and we add new content and activities each week to help expand the foundation you need to take your life back from phobia. Thank you for reading about my journey with emetophobia and I’m wishing you all the best in yours.
We recently reached a major milestone – 10,000 exposure exercises have been completed on Bia. In this post, we will celebrate the courage and growth of people around the world.
It takes immense courage to turn around and face a phobia. It’s often the last thing people imagine themselves doing. Facing a phobia may involve processing past trauma, guilt, and shame. Phobia thrives off feedback cycles in the brain that strengthen associations over time – exposure works to incrementally reverse these feedback cycles and turn them into positive ones. It is a process of trust. It is a process that involves intentionally practicing sitting in discomfort.
“People living with phobia are living every day in spite of their fear. This is why they are the most courageous people you will ever meet. But many people with phobia don’t see it that way, they are so hard on themselves and expect they will have to ‘tough it out’ to get better. Once they see they are already living extremely courageously, they can channel that energy toward recovery. I believe recovery starts with being kinder to yourself and it ends with confidence and freedom.”
– Willy, Founder and Fellow Emetophobic in Recovery
10,000 completed exposure activities is a testament to the courage of those living with emetophobia. Since we launched Bia, people have shown up every day to practice exposure, revisit difficult exercises, and overcome challenges. Research shows exposure is an effective treatment for phobia. We built Bia to help people start and follow through with exposure practice. With 10,000 exposure activities completed, we are just starting the journey of helping people take their life back from phobia.
Congratulations
To those that have started your recovery journey, congratulations. Oftentimes, getting started is the hardest step. To those considering starting your journey, the perfect moment to start is right now. You deserve a life free from phobia.
Exposure is hard. It’s also the most effective treatment for emetophobia that we know of. Bia’s mission is to lower the barrier to starting exposure and help you follow through. We do this with our interactive, guided exposure activities. You can use Bia from your phone, tablet, or computer, in short sessions where ever you are comfortable.
How Does Exposure Work?
Exposure is just like practicing a musical instrument before playing on stage, except we are practicing experiencing discomfort so that when it comes in real life we are prepared with techniques and tools to handle it. Exposure works using a hierarchy of triggers, an ordered list of words, images, videos, and activities that you move through at your own pace. As you conquer each step in your hierarchy, you reduce sensitization, remove bad habits, re-wire the brain, and develop confidence and skills that apply to all aspects of life. Exposure is often paired with behavioral therapy and other insights. We like to visualize recovery as a pyramid, exposure it one part of the pyramid, but so are relationships, professional, and lifestyle changes. Exposure is proven to be effective at treating emetophobia, you control the pace and order of exposure, and vomiting is never required.
Exposure is Hard
If you’ve tried or considered exposure, you know it is hard. It takes immense courage for someone with phobia to face their fear. Am I doing exposure correctly? Can I do exposure too fast? Can exposure make it worse? These are all common concerns that prevent people from seeking therapy. Bia completely solves these concerns with Guided Exposure.
What is Guided Exposure?
Guided Exposure adapts to your input and automatically adjusts exercise to help you practice exposure at a pace you are comfortable with. If your discomfort goes higher than the limit you set, Bia wont show you any new content. If your discomfort spikes from a specific piece of content, Bia will present techniques to help you process and retry. If your discomfort remains flat over a long period of time, Bia will switch up the activity to help keep you engaged and check for safety behaviors. Essentially, guided exposure is the first and only tool that ensures your exposure sessions follow a structured, step-by-step approach.
How does it work?
Personalized
When you create your personalized journey with Bia, you set your discomfort start, goal, and limit. Your discomfort start is what your phobia makes you feel now. Your discomfort goal is what you imagine you would feel if you did not have any phobia. Your discomfort limit is what you are willing to experience as a part of practicing with Bia. These values act as guide rails, creating an exposure experience that is tailored to exactly what you need.
Clean and Dirty Discomfort
Bia uses the concept of clean and dirty discomfort. Clean discomfort is what anyone would experience when sick. Dirty discomfort is what our anxiety and phobia adds on top. You may have heard people say “No one likes being sick”. They are referring to clean discomfort, and may have no idea of the dirty discomfort you are experiencing. Bia works to remove dirty discomfort from your life completely, by helping you to accept the clean. Can you imagine what your life would be like with only clean discomfort?
The Exposure Curve
The goal of exposure is to experience dirty discomfort and practice techniques to process it, instead of avoiding it or relying on safety behaviors. By processing dirty discomfort, we will turn it into clean discomfort, discomfort that anyone would feel doing this activity. Bia will guide you along the curve and always slow down if your discomfort goes above your limit
Your Journey
Your journey with Bia is a set of milestones. Each milestone is broken down into exercises, and each exercise is broken into phases. You control the order of the milestones and which exercises you work on. There are never any tricks, traps, or surprises. Guided exposure automatically walks you through your journey, one step at a time, slowing down when needed. If a single phase of a single exercise is challenging, Bia will help you slow down and conquer it. Every challenge is now an opportunity.
Using Bia with a Therapist
If you have experience with exposure, or are using Bia in live sessions with a therapist, guided exposure can be turned off. When off, Bia will still pause activities if your discomfort crosses your limit, but staying engaged and repeating challenging content will be up to you.
Bia’s guided exposure ensures you don’t move too quickly in exposure, stay with content until you conquer it, and teaches you skills to apply in life. We know everyones phobia is different, that’s why guided exposure is combined with custom goals, limits, hierarchies, practice frequencies, unique daily lesson plans, and more, to make Bia a tool that adapts to your needs.
Getting Started
If you have never tried exposure before, Bia is a great starting point to see if it is for you. If you have tried exposure unsuccessfully, Bia can be a way to build good habits in short sessions. If you are in therapy, Bia provides a curated library of hundreds of words, sentences, audio clips, images, videos, and activities to ensure you fully overcome all aspects of your phobia.
It takes immense courage to face your phobia. Bia is designed to make practicing discomfort as easy as possible. You deserve a life free from phobia.
Thank you
I built Bia on the weekends for over 4 years as I went through several rounds of therapy for my lifelong emetophobia. Building Bia became my therapy, a way for me to learn about my phobia and focus on recovery. Bia transformed into a place where I could monitor my progress and visualize my growth. I started using Bia every morning, and I felt myself taking my life back from phobia. I knew it had potential to help others. Now Bia is used by people all over the world to take their life back from phobia one step at a time. I am happy to share I have recovered from emetophobia, and I believe you can too.
Can you burp? Many people with emetophobia cannot.
Retrograde Cricopharyngeal Dysfunction (R-CPD), also called no-burp syndrome, was first published about in 2019 [1]. The cricopharyngeus muscle sits at the top of the esophagus and normally relaxes for eating and when under gas pressure. However for some this muscle fails to relax when under gas pressure causing pain, bloating, painful hiccups and more.
R-CPD can be successfully treated[2] by applying muscle relaxing medication to the cricopharyngeal muscle.
We don’t know if there is a link between R-CPD and emetophobia. Could the muscle disorder cause nausea and reduce burping which leads to emetophobia? Could emetophobia cause people to suppress the natural muscle movements in the throat leading to R-CPD?
R-CPD is not to be confused with globus pharyngeus which is the feeling of a lump in the throat.
Tightness in the throat muscles is one example of many feedback loops of phobia[3]. Physical discomfort triggers anxiety which increases physical discomfort. Part of phobia recovery is identifying and breaking these feedback loops.
The Motivation. Bia began as a personal project during my first attempt to overcome emetophobia. After a few weeks of in-person exposure therapy I had two realizations. First, I dreaded it. Second, I knew it was working. I dreaded it because each week my therapist pushed me further along in a hierarchy of exposure, and they were moving faster than I felt comfortable. It was working because each therapy session I conquered things I never imagined doing and I felt this growth positively impacting my life outside of therapy. This led me to start my own library of exposure content. I wanted a way to practice exposure and make progress on my own terms.
Conquer Emetophobia. The original version of Bia was called Conquer Emetophobia. It was a list of exposures (words, sentences, and images) in a set order. I could load up this list on my phone or computer and practice moving through from start to finish. For a little while, this was enough, and I had taken a few things in my life back from emetophobia – like watching movies without fear of vomit scenes, or, hear words like vomit without having to leave the room. I shared this small site with a few other people who were also recovering from emetophobia and we shared in celebration when we conquered things we thought we never would.
Tracking Progress. Conquer Emetophobia sat unchanged for a few years. Meanwhile emetophobia slowly crept back and it felt like I ‘lost’ my progress. I was motivated to gain the freedom I knew I could have. I added the ability for Conquer Emetophobia to record history over time. I wanted to know how uncomfortable each bit of content made me and then I wanted to track that over time as I repeated exposure. I knew that once I had this number it would motivate me to practice regularly.
Research Based. I went back to therapy for emetophobia more motivated than ever. I truly believed exposure could work and I wanted someone to help me make progress. My second therapist was fantastic and for the first time in my life I could picture a life without emetophobia. I worked on Conquer Emetophobia every day and on every weekend. I bought a small library worth of books on phobia, OCD, and exposure. I reached out to therapists who specialize in emetophobia. All of this information went into the website as I expanded the capabilities to track progress, added more content, and ensured the exposure approach was based on research.
Responsive, Personalized, Effective. Research of effective exposure led to a customizable hierarchy with enforced milestones. The site adapts to high or low levels of discomfort based on the same guidance given to therapists, and interactive component like typing, describing, and speaking, were added to increase content engagement. I received positive feedback from therapists and fellow emetophobes. I was using the site every morning. It was a massive confidence boost to start my day conquering my phobia. I started to believe this could help other people.
The Ah-Ha Moment. I continued to conquer my own phobia in steps and as I did so I expanded the content available on Conquer Emetophobia. Cartoon images, cartoon videos, real images, real videos, activities, building out the website became my therapy. Every weekend I added new content, and during the week I conquered it through repeated exposure on my phone. This incremental approach was working for me – but I kept seeing comments on youtube, reddit, and elsewhere, people saying that emetophobia was ruining their life. They tried to watch this video but couldn’t. The same struggle I experienced during my first attempt at exposure therapy, it was too much too fast. So I knew, this tool had the potential to help people conquer their phobia in incremental, safe steps.
I knew this tool could help someone start recovery by offering the lowest level of exposure and letting them control the pace. I knew this tool could help someone conquer specific goals. And I knew this tool could help someone build confidence for daily life. I knew all this because I was using it for that exact purpose.
Bia. My wife said I needed a better name. She suggested Bia, coming from the end of phobia. I loved it. The site is about taking life back from phobia and the name even takes Bia back from phobia. I renamed the site and started sharing it around to positive feedback and growth ever since.
For those following along, thank you for your support. I am now working on Bia full time. I’m always interested in your stories and feedback, please contact us anytime. Also, check out this related blog post about the evolution of the Bia’s design.
Dance like no one is watching is a common phrase. It’s fun, it says no one is judging you, enjoy your life. I find this similar to my original approach to handling my emetophobia. I would tell myself, ‘I am not going to throw up’, ‘Dance like you are not going to throw up’. This was reinforced by everyone around me saying the same thing. Parents, friends, teachers would tell me I was not going to throw up. But this is a trap, because emetophobia is persistent and clever. If I said ‘I’m not going to throw up’ emetophobia would find some way to convince me I might. I would analyze my food, monitor for signs of illness in myself and others, smells, movements, temperature. It was a never-ending battle and usually emetophobia would win, convince me I might throw up, and ‘Dance like I won’t throw up’ became ‘Dance later when I feel better’, except I rarely felt better.
My breakthrough with emetophobia came with a subtle but extremely powerful mind shift. It took years of therapy and practice to make this shift, but when my brain finally believed it I knew I had taken my life back from emetophobia.
Dance Like Everyone Is Watching
Dance like everyone is watching is powerful. There is no more what if. You’ve already decided it’s happening. Emetophobia feeds on the what if. Take away the what if and emetophobia will starve. But just stopping ‘what if’ is hard, we’ve been practicing and getting good at asking what if our whole lives. To stop the ‘what if’, we need a new skill, to say ‘It will happen’. Just like we built up and practiced asking what if, we need to practice saying ‘It will’. Once I could tell myself, ‘I might throw up today’ emetophobia had no more power over me. Again, this shift didn’t happen overnight. I had to tell myself this over and over before I believed it. It was similar to the battle I had been having my whole life.
I used to say “I’m not going to throw up” and emetophobia would find ways to convince me. Fighting that battle made emetophobia stronger, more clever.
Now I say “I might throw up” and emetophobia tries to tell me all the ways that would be awful and horrible. I have to sit in that discomfort, and not let emetophobia scare me out of my life. Fighting this battle was very hard, and took a long time, but as I beat emetophobia back I felt my life growing.
Ultimately, I had to choose which of these paths I wanted to take. For 20 years I was fighting the ‘I wont throw up’ battle, and I am not sure it can be won. My therapist told me, I could always go back to that fight, why not try another approach? ‘I might throw up’ has been a life-saving approach, a battle I can win. Now, I dance like everyone is watching.
