How do you deal with a rational phobia?
December 31, 2015 8:50 AM   Subscribe

I have a big fat annoying anxiety-inducing, sleep-disrupting phobia of bedbugs. I'm already doing CBT to limited success; what other avenues should I explore?

I'm scared shitless of bedbugs and obsessively anxious about it. The thing is, I know it's not like a phobia of spiders or sharks -- bedbugs really are awful, and a huge pain to get rid of, and taxing on your mental health. I know someone who had them years ago who pretty much has PTSD from the experience. I also live in a large city where they are not uncommon.

But my fear of them is obsessive and not healthy and it's not how I want to live. It popped up around 5 years ago when bedbugs were all over the news, and gets much worse in times of stress. I am a generally anxious person, and I also have minor allergies and skin issues that means I am frequently itchy, prone to red patches and hives.

I am in CBT, though due to the cost don't go as often as I like, and taking an SSRI, which is helping somewhat but not as much as I would like. It's not an all-day, all-consuming fear like it has been sometimes, but I have small bedbug panics at least a few times a week. Every skin reaction, every random spot on my bed, even every time I hear about bedbugs is enough to set me off. My GP is reluctant to prescribe benzos, and it would take me several months of waiting to see a psychiatrist. My therapist thinks I have an anxiety disorder as well as OCD tendencies.

Have you kicked or improved a phobia that is basically rational? What did you do? What other avenues should I explore? I know exposure therapy isn't exactly an option here.
posted by anonymous to Health & Fitness (18 answers total) 2 users marked this as a favorite
Live more in the present reality by talking with your irrational fear. Offer yourself a better time in the real present, rather than pricked and stimulated by irrational fears. You have labeled fear of bedbugs as rational but it is not, if it interferes with your daily, bed bug free life.

At any time there are millions of things and events to fear. Fear doesn't help even on the cliff edge. Only a rational understanding of life, and rational acts protect any of us from harm. Fear is not protective, only acts. Rational fear is an oxymoron.
posted by Oyéah at 9:00 AM on December 31, 2015 [2 favorites]

My GP is reluctant to prescribe benzos, and it would take me several months of waiting to see a psychiatrist. My therapist thinks I have an anxiety disorder as well as OCD tendencies.

Is there a way for you to see a different GP, or for you to have your therapist speak to your current GP about the potential benefits of a low dose of a benzo? Because, rational or not, you have anxiety that is clearly limiting your quality of life in an unacceptable way, and there is really no reason why taking benzos responsibly should be a no-go for you.

Like, in September I went to my doctor because my anxiety was way off the charts and she was more than happy to write a prescription for Xanax. In fact, she suggested it. And my anxiety, in the grand scheme of things, is on the milder side. If your doctor is close-minded about benzos, he/she may not be the right fit for you.

Anyway, I had bedbugs in 2010 and it took literally years for me to not wig out when I got a mosquito bite. I wish I had specific advice, but the truth is that I just toughed it out instead of seeking help. I think a good med + therapy combo could really help you, though. Good luck!
posted by schroedingersgirl at 9:03 AM on December 31, 2015 [1 favorite]

OP, I just want to add that there is no shame in having this (or any) fear, or in needing professional help to manage it.
posted by schroedingersgirl at 9:08 AM on December 31, 2015

I know it's not like a phobia of spiders or sharks -- bedbugs really are awful

No, they're really not. At worst, they cause a few itchy red bumps no worse than the hives you already have anyway. I think you'll find that, as unlikely as it may be, sharks are capable of slightly more damage than that.

What you have is absolutely a phobia, and it is NOT rational. Admitting that would be a good first step.
posted by Sys Rq at 9:50 AM on December 31, 2015 [14 favorites]

Building on what Oyéah said: when you catch yourself obsessing, ask yourself, "Ok, what use would me laying awake obsessing right now have in defending against bed bugs? Is this useful, or am I torturing myself?"

Have you been doing the thought+response CBT writing exercises? Where you spit out all your obsessive thoughts on paper, then rationally respond to them once you've calmed down?

I have a red mark, it could be a bed bud bite!

But it could also be a mark from a purse strap, a mosquito bite, or a random skin reaction. You get those all the time, and they're never bed bugs.

I might have bed bugs right now!

But I don't. I haven't done anything to put myself at risk lately or seen any bed bugs.

Etc etc. You are likely familiar with this method, but only if you stick with it are you going to learn how to talk yourself down from ledges.
posted by Juliet Banana at 9:52 AM on December 31, 2015 [3 favorites]

I am an anxious person who went through a couple of years of really serious bedbug anxiety.

Things that have helped that are specific to bedbugs:

1. I remind myself that I know several people who had bedbugs and got rid of them quickly and easily, and it was a pain but it wasn't that bad. Some people have horrible nightmare situations, it's true, but not everyone does - those are just the ones we read about.

2. I have read up on other causes of itching. I remind myself that my pores get irritated and itch sometimes for no reason, that you can pick up tiny itchy fibers/bits of things that you can't see, that dry skin itches, etc. When I get anxious, I remind myself that itching is almost always not bedbugs.

3. I do not let myself read about bedbugs on the internet.

4. I have bedbug protocols for travel and certain purchases so that I don't worry as much about bringing them home. I know that my protocols are probably mostly overkill, but they are worth it for peace of mind. I have clarified with my housemates that no one can bring home discarded furniture or untreatable discarded fabric.

Also, a situation: I volunteer for a place that sometimes does childcare. For a while, we were located across the street from a horrible apartment building with a bedbug problem. We'd get little kids coming over all the time, bearing coats and bags and blankets. I was very anxious about this all the time. One time, we found a bedbug. I just about died. And you know what? The place never got bedbugs. We had a bedbug, maybe even several, but we never developed an infestation. After I realized that, I relaxed a little. Bedbugs are obviously terrible, but now I remind myself that they are not as pervasive or ineradicable as the worst cases in the media show.
posted by Frowner at 10:00 AM on December 31, 2015 [7 favorites]

If you've never had them yourself, here's the thing: They aren't fun? But people way overblow how bad it is, and I think for people with anxiety problems, that's a huge issue. They're really, really annoying. But even as someone who was really very reactive to the bites? They weren't that hard to deal with. They weren't easy, but they weren't as bad as people make out. Bugs are a popular thing to get hyperbolic about. I treated my apartment myself both times I've had them, spent less than $40 each time, I'm pretty sure. Not counting mattress and box spring encasements, but if you tend to be really reactive to stuff? Just get those now if you don't already have them. (Dust mites aren't anybody's friend.) I'm pretty sure the people who throw out their furniture are usually massively overreacting. I'm not particularly tidy OR handy and if I can handle it, anybody can.

It's rational to be unnerved by the possibility, but the big thing to work on is not catastrophizing it. If you get bit, by bedbugs or anything else, there's a very nice trick with hot water and a spoon that isn't as permanent as they suggest but at the very least for me only needed doing a couple times a day during the worst of it. If you keep your place reasonably tidy, then treating won't be that big a deal. Without knowing anything about you, I can tell you that you absolutely, 100% can handle it if it happens. The media likes to play up how awful this is the same way they play up everything else. Yes, you're more likely to get bedbugs than to get bitten by a shark. But remember that you're looking at an inconvenience, not a life-shattering event.
posted by Sequence at 10:01 AM on December 31, 2015 [4 favorites]

Your question hits pretty close to home, Anonymous. I had a bedbug scare a few years ago (though not actual bedbugs, fortunately), and I have both OCD and skin that gets red at the least provocation, and although my bedbug phobia has settled down quite a bit, it can still flare up in times of stress/travel/ingrown hairs. I have a slightly raised mole on my back that I've mistaken for a bite countless times - it even itches until I remember, oh yeah, that's a mole.

My immediate, is-that-a-bite strategy is twofold: first, I try to determine if I've got a genuine itch or a psyching-myself-out itch. Either way, I itch, but psych-out itches are less severe, less constant, and easily forgotten. If I can distract myself by watching TV or going to Dunkin' Donuts, and forget that I itch, it was probably in my head. The other thing I do, if I am sure that what I have is a bug bite, is mentally start a two-week countdown. Bedbugs feed every... three days, I think? if I go two weeks without similar bites popping up, I figure I'm okay.

My more long-term strategy is to visualize the absolute worst outcome: we get a ridiculous bedbug infestation and have to move and throw out all our stuff. And I think: okay, fine. I can throw out all my stuff. I can go live at my mom's house or whatever. These are survivable things. It'll be tough and unpleasant, but I can get through it. For me, a lot of anxiety stems from things I can't control, so when I imagine the worst-case scenario it helps me to mentally wrest back some of that control.

It's rational to be afraid of bedbugs when you're at high risk of exposure. And I mean high risk, like you're in a hotel room and just saw a bug skittering over the mattress. It's not so rational to be afraid of them all the time, or to let that fear overwhelm you and interfere with your life. Thinking of it that way might help you a bit.
posted by Metroid Baby at 10:52 AM on December 31, 2015 [1 favorite]

My sister has suffered from horrible, debilitating anxiety in regards to vomiting. With your logic, this is rational because she most likely will vomit at some point in the near future. But, we all know that vomiting isn't the end of the world. Pointing that out wasn't really a help to her. What helped was CBT therapy and exposure. So for exposure, she didn't make herself vomit, but instead watched videos of people vomiting. No, you can't give yourself a bedbug infestation, but I wonder if something like reading testimonials on bedbug exterminator websites would be helpful for you.
posted by galvanized unicorn at 10:58 AM on December 31, 2015 [1 favorite]

bedbugs really are awful, and a huge pain to get rid of, and taxing on your mental health.

This really depends. I am anxious sometimes bordering on obsessive and I have critters in my house that occasionally bite me and I dislike it and I worry. However, bedbugs are not in some objective sense awful like a terminal illness or the end of a relationship. They are a fixable problem although the fix involves discipline and rigor and a lot of hassle and possibly expense. I am a capable and competent person but I figured out that my fear of bedbugs (and I live somewhere where they are NOT a problem for the most part) was mostly fear of hassle and fear of ... fear. So the things that helped me were

- basic steps like putting sticky-side-out tape on my bed legs and checking. No bugs = calm down
- reading about other people who I know personally who have had them and who were not only fine but didn't freak out about it at the time. A lot of anxiety is how it feeds on itself so it's like you're afraid of being anxious. Like tinnitus sucks, or can suck, but the worst part about it for a lot of people is the anxiety. I have tinnitus. I do not like it but once I stopped (through CBT and a lot of anti-anxiety work) worrying about it the actual symptoms of the ringing were manageable to me
- BENZOS, seriously. Once you get strung out on lack of sleep you get really ragged and do not think clearly. I don't know if you need another doctor or want to try some other meds or there is a good reason the doc won't give you benzos but I have some just to use on an as-needed basis and I find it's a good reset button that I only take a few times a month in teeny doses but helps me from going through days of unmitigated anxiety. If that's not an option than consider aggressive exercise, laying off the caffeine, all the other de-stressers.

The more you manage the anxiety the more the bug issue (which... there is no such thing as a rational phobia, you're sort of either phobic or you have a rational fear of something. I don't like to fly because it's a little dangerous but that's different from being phobic about flying, you sound phobic. Nothing wrong with that but it might help to sort out the disordered thinking a bit) will fade to background noise. Think about what your real fears are about (mine was worrying about my relationship since I doubted by long distance boy friend would be able to rid his house of bedbugs and it would ruin our relationship) and see if you can make progress on those. I wish you luck.
posted by jessamyn at 12:39 PM on December 31, 2015 [4 favorites]

Oh, jessamyn's comment about benzos reminds me: one thing I did when I was in the absolute depths of bedbug anxiety was to go away for a couple of days. I went bike camping with a friend (not even actually far from home, but a really different environment) and just being away enabled me to get some decent sleep and also unwind in general, and it helped immensely. If you're really miserably in the throes, can you go somewhere to get a change? Even a friend's house for a couple of days might shake you up.

Or try spending a weekend doing something really different from usual - if you could stay with a friend and spend the weekend doing winter biking or ice skating or some rigorous intellectual stuff, it might help reset your brain.
posted by Frowner at 12:53 PM on December 31, 2015

Heat treatment for bedbugs costs a couple thousand dollars but is extremely effective. Would you be able to relax if you saved this money, kept it in a separate account, and knew that if you ever DID get bedbugs that you'd be able to make the problem disappear quickly?
posted by metasarah at 12:59 PM on December 31, 2015 [5 favorites]

Nthing what others have said about bedbugs being a treatable problem.

The biggest danger of bedbugs, even if you have them - which you don't - is their ability to cause fear. The bites themselves are unpleasant, but they can't really hurt you. The treatments are potentially expensive and inconvenient, but they do work even if it takes persistence and discipline to succeed with them. The biggest problem is the fear, pure and simple.

The worst possible outcome from having bedbugs would be to live for years afterwards in fear of being infested again, and being hypervigilant and staying awake at night thinking about them. You are already experiencing the worst possible outcome from a bedbug infestation.

I say this by way of pointing out that your fear really isn't as "rational" as you say it is. As someone said above, a "rational" fear response would be if you were in a hotel room and saw a bedbug. And the purpose of fear is to keep us safe from danger, whereas the fear you're experiencing actually *is* the danger and therefore, by definition, can't be keeping you safe from itself.

I don't know what the answer is, other than to wait the several months required to see a psychiatrist or else to dig deep into your pocket to see a private psychiatrist who specializes in phobias. I don't know if it would be a good or a bad idea to instead put that money into a savings account in case you ever need to get an exterminator or whatever - personally, I'd worry that you might end up wasting the money on callout fees for bugs that aren't there.
posted by tel3path at 3:45 PM on December 31, 2015 [3 favorites]

The thing is that lots of things are objectively possible and bad (like getting cancer), but the difference between doing what you can and taking lightly what you can't ("yeah I guess I don't always eat as well as I could") vs. letting it hurt your life (not wanting to travel because you won't know which restaurants meet some low-toxin all-organic criteria so you won't feel comfortable eating anywhere) is -- in my experience, and especially if these symptoms are relatively new -- one of brain and body chemistry. So you might try the full suite of biophysical anxiety management strategies: good sleep, exercise, reducing stress elsewhere in your life, checking with a psychiatrist on meds. (I emphasize "in my experience;" I'm being educated by hearing about others' success with CBT strategies here.)
posted by salvia at 4:48 PM on December 31, 2015

... To clarify (without abusing the edit window), I found CBT strategies really helpful in battling back obsessive tendencies when they arose, but it was biophysical strategies that did the most to actually end the battle altogether.
posted by salvia at 4:52 PM on December 31, 2015

Nthing that as long as you tell yourself it's a rational fear, you're not really dealing with it.

A story: I know a teenage boy, who after years of trying to deal with it using some CBT strategies, finally got hardcore CBT training to help him with his one "rational" fear, that his mother would be killed when she left the house. He knew it wasn't rational and he had tons of distractors to use, and with one therapist he and his family actually had a plan of what exactly what would happen if his mother was killed.

Even though he knew that his mom dying (obviously terrible) would be dealt with, every damned time she opened the front door, he'd start to panic and his brain filled out with grisly images.

What worked for him: under the care of the Boston University Center for Anxiety-Related Disorders, he had CBT and exposure therapy. There were elements of self care, recognizing cognitive distortions, some understanding of why brains do what they do and:

through exposure therapy, learning that 1. your brain can't make a bad thing happen and 2. if the worst thing happens, it's not even close to how bad you think it will be.

Over the course of several months, this boy did exposures starting from his mom leaving the room for 5 minutes and he had to rank how anxious he was every 30 seconds. Over time, the exposures increased (to the point where he had to write and read a narrative that his mother* had been killed) and working with a therapist and using CBT tools, he was able to realize that he was capable of living with THE SCARIEST 10 OF 10 ANXIETY. He learned that facing the scary thing did not make the thing happen. He learned that he could handle anxiety and that a feeling is just a lizard-brain feeling and it's not a fact.

So what I'm saying is that you could put all of these procedures into place that rationalize your actual odds of getting bedbugs, etc., but what you need to really do is face the fear and see that even if THIS THING happened, you'd actually be okay.

So, I suggest finding a competent CBT practitioner and if you call the BU CARD, they can give you names of their therapists around the US.

*I would say that I am this kid's mom., but it's his story to tell. I will say that competent CBT and exposure therapy can change your life.
posted by yes I said yes I will Yes at 5:59 AM on January 1, 2016

My GP is reluctant to prescribe benzos, and it would take me several months of waiting to see a psychiatrist.
Are you at least on the list to see a psychiatrist? Yes it may take months from when you start trying, but that's another reason why you need to get yourself on that list right now instead of adding more delay.
posted by anaelith at 8:36 AM on January 1, 2016

Make the appointment now with the psychiatrist. Because a couple of months from now, you can always cancel it if you don't need it anymore, but at least you'll have it if you still need it then. Don't not make the appointment because you're frustrated about the wait. February will be February regardless of whether you've set up this appointment; set it up, and then see if you need it when it's closer to the actual date.

As for bedbugs, I'll say that I absolutely agree that this is an irrational phobia. I have terrible allergies. (like, when I did allergy testing, every plant, animal, and environmental trigger puffed up red. And also I'm allergic to the #1 most common medication they give to people in anaphalaxis. So I'm basically F'ed.) My skin is really sensitive, and I have hives to some degree almost all the time, and no conventional allergy meds really do the trick. I also have an anxiety disorder, diagnosed and treated (pretty successfully) with a combination of an MAOI and a benzo (Xanax), but I still get feelings of anxiety and panic sometimes.

I also had a pretty bad case of bedbugs about 10 years ago. And you know what? It was sort of gross, and pretty irritating. But it was not life-altering. We washed everything that could be washed, and we threw a lot of things away, and it sucked and was expensive. But nobody died, and we managed, and we got rid of them over the course of a few weeks and a few exterminator treatments, and everything was okay.

A rational level of fear would be, "wow, this would be pretty irritating and I feel a little skittish thinking about it." What you're feeling now is not rational. What you're feeling now seems to me to be about 10% real worries about bedbugs and 90% symptoms of anxiety. So you need to treat the anxiety as soon as you can. And until then, you need to keep reminding yourself that this is panic talking, not an actual, rational thing in the world that a person who is not experiencing a medical condition would have this much distress over. Because that's what this is: this is an illness, not a rational response to the fact that there are bugs in the world.
posted by decathecting at 8:55 AM on January 1, 2016 [2 favorites]

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