Improving the experience of a fear-facing habit

February 2, 2024 12:56 PM

I recently started swallowing pills again after being unable to do so for years due to a severe phobia (combined with some actual mechanical difficulties that are currently under control). My speech therapist recommended I maintain a habit of swallowing a pill every day so it wouldn't slowly creep back to feeling impossible, but now that the excitement of "conquering" the phobia has warn off, but the fear hasn't completely gone away, I really dread it!

While I've been ABLE to maintain the habit so far, it's increasingly tough to motivate myself to face the fear anew every day. I was wondering if anyone had any recommendations for rewards to add during/after the exercise or other strategies to build some kind of more positive associations for the ritual.

Additionally, if anyone has ever had a similar experience, did you ever STOP fearing the scary thing, or was it more of a 'get comfortable with being uncomfortable' type of adjustment?

FYI, the speech therapy has ended and the speech therapist recommended against going back just for more work on the phobia; she didn't think it would be a good use of time or money.

posted by space snail to Health & Fitness (19 answers total)

Best answer: I have a somewhat similar aversion, though it's not really a phobia per se. I really hate exercising. I've hated it all my life, so I've avoided it to my detriment. But I finally got myself into a routine that I've maintained for almost four years now, even though I still hate it. My mantra is something I got from British writer Oliver Burkeman: "The capacity to tolerate minor discomfort is a superpower". Here's the extended quote:

The capacity to tolerate minor discomfort is a superpower. It’s shocking to realise how readily we set aside even our greatest ambitions in life, merely to avoid easily tolerable levels of unpleasantness. You already know it won’t kill you to endure the mild agitation of getting back to work on an important creative project; initiating a difficult conversation with a colleague; asking someone out; or checking your bank balance – but you can waste years in avoidance nonetheless. (This is how social media platforms flourish: by providing an instantly available, compelling place to go at the first hint of unease.)

It’s possible, instead, to make a game of gradually increasing your capacity for discomfort, like weight training at the gym. When you expect that an action will be accompanied by feelings of irritability, anxiety or boredom, it’s usually possible to let that feeling arise and fade, while doing the action anyway. The rewards come so quickly, in terms of what you’ll accomplish, that it soon becomes the more appealing way to live.

posted by akk2014 at 1:05 PM on February 2, 2024 [42 favorites]

Best answer: Additionally, if anyone has ever had a similar experience, did you ever STOP fearing the scary thing, or was it more of a 'get comfortable with being uncomfortable' type of adjustment?

After being choked and then developing a swallowing issue, I was able to get past some issues (including fabric near my neck), but it took probably 3 years to go from “muscling through” to “tolerating” to “okay.”

I’d recommend looking up completing the stress cycle and finding a thing to end yours - dancing and singing are mine, but you may find something else! I think in your shoes I’d light a candle, swallow, blow out the candle, and then have a dance to a fav song.
posted by warriorqueen at 1:14 PM on February 2, 2024 [5 favorites]

(I should add, I didn’t know how to complete the cycle then! Also Burnout is a good book on the stress cycle.)
posted by warriorqueen at 1:15 PM on February 2, 2024

It wasn't a fear thing, just a general inability to master the skill, but as a kid, my mother trained me to take pills by giving me a small box of Smarties (Canadian Smarties are like M&Ms) every day. If I swallowed the first one like it was a pill, I got to eat the rest of the box. If I didn't swallow the first one like it was a pill, I didn't get to eat the rest of the box.

Is there a reward food you could use in place of 'real' pills that would serve as both a placebo and a reward?
posted by jacquilynne at 1:48 PM on February 2, 2024

I have no direct experience of this, but I feel like the ideal reward would be as pill-like as possible: a candy (shaped as similar as possible to the pill you take, ideally) that you can then chew and eat after the pill. the idea would be to also create positive associations with having the pill-shaped thing in your mouth. I would suggest you try swallowing an actual candy like the pill first (And then eat one), but I would worry that if you know it's not a pill, when it eventually is a pill you might somehow not transfer your new-found ease to an actual pill.

When I was a kid I called Rockets "pill candies". I would go with something like that because they're so yummy.
posted by If only I had a penguin... at 1:51 PM on February 2, 2024

Just the other day I realized that a horrible physical body thing that I dread but must do has transitioned from being "I can hardly stand doing this!!!!" to "I really dislike this!" to "I can do this quickly and then move on." It's taken about 6 months at a rate of 2x/week.

Good luck to you.
posted by BlahLaLa at 1:53 PM on February 2, 2024 [5 favorites]

I used to hate swallowing pills thanks to a fear of choking and emetophobia (gagging on anything would send me into an anxious spiral). Over the years, as I've had to start taking daily medication, I've become used to it to the point of being able to swallow multiple pills at once, even!

My advice would actually be the opposite of your therapist's -- I would be looking to make the act of pill swallowing as quick, easy and forgettable as possible. The goal is to make it just something you do, a normal part of your day. If you ritualise it with a reward, it sticks out, it's a big event, it's something you can become anxious about.

The way I conquered my fear was to turn pill taking into something I did while I did something else. I'd pick a bit of my book to read, or I'd watch a YouTube video, or just walk around the room while I did it. The more I took my mind off the act, the easier it was to complete. I still do it when I have a tough time, I force my mind off thinking about the act. I'd recommend trying this. Even just getting up and walking to the other side of the room, or looking at a houseplant or something and really concentrating on it as you take the pill, might help.

Good luck to you!
posted by fight or flight at 2:17 PM on February 2, 2024 [3 favorites]

I'm curious if you're doing something to make taking the pill feel "safer" or less scary, because if you're doing it daily the fear should actually go away (and stay away), usually before too long, unless you're doing something to avoid the exposure (e.g., only taking the pill in a "safe" environment or with certain special rules followed) or unless there's a more "intense" version of pill taking you're fearful of and avoiding. (For example, maybe you've gotten used to taking small pills and you're fearful of taking large ones, or able to take pills but fearful of capsules.) It's also possible that you jumped in at too high a level of exposure -- What about it creates the fear or dread? Does the pill feel too large? Do you worry about it catching in your throat and choking you? Is there discomfort as it goes down? A therapist should be able to help you with this, and won't think it's a waste of money to help with a phobia.

Also, I used to have a pill phobia and now I can take pills with no discomfort, to answer your question.
posted by shadygrove at 2:17 PM on February 2, 2024

What meal to you regularly eat rapidly? Try swallowing a candy pill every day about three quarters of the way through that meal, when you have a nice relaxed gullet that has been swallowing solid things for a couple of minutes without a problem before you attempt the pill.

And invest in some pill sized and shaped candy you really like.

Try swallowing towards the end of drinking a nice big glass of ice water as cold shrinks and numbs your throat tissue. Also try making pills out of ice. That way you KNOW if it sticks in your throat you aren't going to have it stuck there for more than a few seconds at most.
posted by Jane the Brown at 2:40 PM on February 2, 2024 [3 favorites]

If cold water seems like a bad idea, try swallowing pills with liquid that is really hot instead, as heat causes your muscles to relax. Tea or coffee as hot as you can enjoy it may work to chase the pill.
posted by Jane the Brown at 2:47 PM on February 2, 2024 [2 favorites]

I have this fear too and it’s tough! I feel ya. Over time I’ve gotten more comfortable with the uncomfortable; it still takes me a little bit of time to swallow even tiny pills. Every time I make it through my vitamin box without anything getting stuck in my throat, it feels a little easier. For me, sparkling water from a can helps a LOT to mask the feeling of the pill. Maybe you could make a delicious soda water based beverage to enjoy once the pill(s) have been swallowed. Good luck!
posted by sucre at 3:05 PM on February 2, 2024

Try it with a yogurt drink or bottled smoothie. I am AWFUL at taking pills and this almost completely eliminates the problem.
posted by showbiz_liz at 3:21 PM on February 2, 2024

My friend’s grandpa was a well renowned dentist with a specialty in saliva and dry mouth. He taught her, and she taught me, that to swallow a pill it can help to get it on the tip of your tongue and curl your tongue up, like you’re tossing it down your throat, while leaning your head back. It really works! It’s something about how your muscles are shaped with that movement. Makes most pills really easy to swallow and I don’t feel anything at all. Sometimes I have trouble with my throat after an uncoated pill because of anxiety issues, and swallowing additional pills with the tongue-toss action helps a lot. So give that a try with your daily pills and see if it helps. I do think that aiming to make it super boring and just something you do, and not making an elaborate ritual around it, is probably the way to go. Anything to make it a non-event.
posted by Mizu at 4:14 PM on February 2, 2024

Best answer: I do have different a fear that I've worked on. I don't like my face in water. It was terrible and awful and prevented me from doing fun things like swimming and snorkeling. It even made showering unpleasant. I've showered basically daily for my entire adult life, and just dealt with the panic for a few second while washing my face. A couple years ago I took up swimming with the specific goal of putting my face in water. The first time I put my head underwater at the pool I almost hyperventilated and my heart was pounding and that was all I could do for the day. I worked on it for months and worked up to swimming a full lap with my face in the water.

I'm so happy I worked on it. My last vacation I was able to spend hours snorkeling and it was super fun. No panicked moments at all.

Different fear, but it went from terrible to unpleasant, to perfectly fine eventually.

Also I struggle with pills for mechanical reasons, not fear, but I find if I pair it with a drink I really like, it's much better. For me it's 1/2 cup of orange juice . I typically avoid the sugar so it's a special treat. Or chocolate milk sometimes too. If you have a drink you really try taking the pill with that maybe?

The other thing that helps me is to think something I really enjoy eating, like strawberries, while taking the pill. I imaging the smell and texture and tast of the strawberry and that helps me swallow a pill and takes my mind of the mechanics of it.
posted by CleverClover at 7:52 PM on February 2, 2024 [1 favorite]

The way my parents introduced me to swallowing pills is the same method I used with my kids.

It starts with chewing up a bite of food (a strawberry has a good texture for this), then popping in the pill immediately before swallowing, then pressing it into the chewed food between the tongue and the roof of the mouth while making sure not to bite the pill, then just swallowing like normal. That way, even quite big pills go down without even touching the sides.

Next step was doing the same thing with something like yoghurt or custard that doesn't need chewing. Swallowing with a mouthful of water came next; graduating to putting the pill in first and chasing it down with a swallow of water was last of all.

Any discomfort and we'd just go back one step. I actually ended up putting myself through an extension course for my own satisfaction and I can now dry-swallow just about any pill using only saliva to help, but that's not something I've tried to foist on the kids.

Perhaps you could retrain this way? You might care to try it out with something like a tic-tac or an M&M to find out how many steps back you need to go before your gullet stops noticing that there's a hard lump included in the bolus going down.
posted by flabdablet at 6:17 AM on February 3, 2024 [1 favorite]

The other option for training swallowing things without feeling the need to chew is using edible cake decorations, starting with 100s and 1000s, then increasing to the little silver ball cachous, then to Tic-Tacs, then to M and Ms - then you're also getting something sweetish as a reward.
posted by quercus23 at 7:06 PM on February 4, 2024

Response by poster: Thanks for the suggestions! The one about dancing gave me the idea to put on music while I do it, which seems to be helping to guide the anxiety in a more 'excitement to be meeting a goal/keeping a promise to myself' direction.
posted by space snail at 8:00 AM on February 5, 2024

Response by poster: Belated update, 1.5 months later, the pill swallowing has evolved from "daily source of dread that palpably hangs over me until I do it" to "hateful annoying chore I get over with when I remember I need to do it" which I think is an improvement. No particular rituals remain around it other than taking a test gulp of water to practice swooshing something down my throat.
posted by space snail at 7:22 AM on March 17, 2024 [1 favorite]

Response by poster: A further update, I was able to get confident enough with pill swallowing that I switched over one of my daily medications to pill form, and somehow the knowledge that swallowing the pill will get me the benefit of that medication has mostly cleared away the remainder of the fear and it's pretty routine now.

Other things that helped:
- It's like FIRST thing in the morning, so no time for dreading it
- The pill size is just right, not so small it gets lost in my mouth but not so big I worry about it getting stuck
- The medication will have consequences if I skip it, but the pills are also chewable if I have a fear emergency
posted by space snail at 5:33 AM on August 27, 2024 [1 favorite]