Swallowing is something that everyone does, many times per day. How does something so familiar become a source of anxiety?
Bodily Functions and Conscious Control
The human body relies on several important functions every day to keep it going. Many of these are totally outside your control. For example, your heart will continue beating automatically – you can’t make it beat or not beat on purpose, even if you try. Digestion is another good example – your stomach will digest whatever you consume without any purposeful influence from you.
Other body functions are fully in your control. For example, raising your hand is something your body will only do when you make it – your hand won’t spontaneously raise on its own!
Still other body functions fall somewhere in between – they’re not fully outside your control nor fully in your control. They occur without conscious effort, but can also be performed on purpose. Breathing, blinking, and swallowing are three good examples of this. Breathing happens continuously, and yet you can also take a breath on purpose. The same goes for blinking. Swallowing happens automatically when we are eating or drinking, but can also be done on command.
These bodily functions that are both automatic AND can also be controlled consciously are those that most often become sources of anxiety.
Anxiety About Swallowing
How does anxiety become associated with swallowing? Typically, swallowing gets associated with something scary or threatening. This could be something physically uncomfortable or painful, like a choking incident, or even an unsettling thought about swallowing or losing control. For other people, just noticing swallowing can lead to anxious thoughts about it. You may fear that you are swallowing too much or not frequently enough.
Once you’re fearful of or anxious about something, you naturally pay more attention to it. This is helpful for your survival in situations where you have to escape danger. But over time paying attention in this way makes you more sensitive to the thing you’re fearful of and fuels anxiety (a process called sensitization). This is how anxiety around swallowing becomes an ongoing problem. It holds true whether your anxiety around swallowing started with a scary event or just by noticing your own swallowing.
Anxiety Disorders and Swallowing
Anxiety about swallowing can be part of many different anxiety disorders and other behavioral conditions. Below are the most common such disorders, and how swallowing can become a source of anxiety for each:
- Panic attacks/panic disorder
- Panic attacks grow from anxiety around the bodily sensations that come from the fight-or-flight response. These include changes in the gastrointestinal (digestive) tract, which also includes dry mouth. This can bring attention (and fear) to sensations of difficulty swallowing.
- Specific (situational) phobia
- The most common phobia related to swallowing is a fear of choking. With a phobia, there is a lot of fear around any situation involving the feared object or situation, such as choking.
- Obsessive-Compulsive Disorder (OCD)
- Obsessive thoughts get stuck and increase distress, and lead to compulsions, or repetitive behaviors, to try to control or get rid of the distress. OCD symptoms can latch onto internal body sensations, like swallowing. This is a type of OCD sometimes called sensorimotor OCD.
Anxiety around swallowing can also be a part of other conditions that have little to do with anxiety, such as eating disorders. For example, with anorexia nervosa or restrictive eating, anxiety around swallowing food and drink can be due to painful emotions that arise when thinking about the impact of consuming them on body weight, size, or shape.
Unhelpful Coping with Anxiety about Swallowing
Most people who are anxious about swallowing try to avoid swallowing or avoid situations that could lead to choking. (Of course, you can’t fully avoid swallowing altogether because it’s an essential body function!) They also often try to swallow in ways that feel “safer” or less risky. The most common way people do this is by relying on safety behaviors. A safety behavior is something you do that gives you a feeling of being safe or protected from a scary outcome. Some examples of safety behaviors related to anxiety about swallowing are:
- Only consuming foods that feel “safe” to swallow
- For example, a liquids-only diet or “soft” foods such as smoothies, yogurt
- Excessive chewing of food to make it softer, or breaking it down into smaller pieces
- Excessive water consumption to wet the throat and make swallowing “easier”
- Asking others to be nearby, or keeping your phone available to call 911 while eating or drinking
The problem with safety behaviors is that while they lower anxiety in the short term, they actually make it worse in the long term. They reinforce the idea that swallowing is in some way risky and/or scary, and become like a crutch.
How Can CBT Help?
Anxiety around swallowing can cause significant disruption in your day-to-day life, and can negatively impact your mood. Cognitive-behavioral therapy (CBT) has many techniques that are effective at reducing anxiety, and these also work for anxiety related to swallowing. Some of these include:
- Reducing safety behaviors and avoidance
- Reducing and eliminating these breaks the cycle that keeps anxiety about swallowing going over time.
- Exposure therapy
- Exposure therapy treats anxiety by helping you approach rather than avoid the things that cause anxiety and fear, so you can learn to withstand it. This desensitizes you to those things so they no longer trigger anxiety.
- Helping you reevaluate how you think about swallowing
- CBT can help you identify and change unhelpful patterns in your thinking that keep you anxious.
Working with a CBT therapist can help you live without limitations from anxiety around swallowing. Contact us if you would like to get back to no longer paying attention to your swallowing.