The worn yellow page features 13 easy tasks for most teens: eat out, walk the dog, go a day without a panic attack – among 10 others.
For Clark Topjon, they were unfathomable.
The 16-year-old Kansas City boy jotted them down two years ago before beginning exposure therapy for an emetophobia, or severe fear of vomiting.
Countless vomit videos, puke-flavored jellybeans and handfuls of fake throw-up later, Topjon just smiles at his shaky, ninth-grade handwriting.
The goal list, now more like a certificate, bears 13 checkmarks. Every last task is now habitual.
Exposure therapy took only two months and seven sessions to help Topjon. Before that, his emetophobia worsened over three years, despite medical, homeopathic and talk treatments.
Roughly 15 percent of Americans develop phobias, says Thomas Wise, American Psychiatric Association co-chair of the Committee on Adult Psychology. If unaddressed, they can worsen over time and turn serious, even life-threatening.
In the U.S., exposure treatment – facing fears – has steadily gained acceptance in the last couple decades, Wise says.
For phobias, exposure therapy is the sole proven cure. But still, many people with phobias are slow to seek, and find, it.
“It’s great that it turned out this way,” says Greg Topjon, Clark’s father. “The only regret is the poor kid lost three years of really neat time.”
By definition, phobias are any anxieties that limit life, like a fear of cars too intense to drive to work or a fear of dogs that keeps someone from walking outdoors.
Ashley Smith, psychologist for the Kansas City Center for Anxiety Treatment, likens them to fire alarms that sound with the simple lighting of a candle or stovetop.
“Until you realize it’s a false alarm,” she says, “you’d be running out of the house all the time.”
In Topjon’s case, this meant hours on end in the bathroom, afraid he might vomit. He also started phoning his parents incessantly and skipping breakfast for fear the hungry feeling meant he might get sick.
Topjon went to his primary care doctor, who started him on Zoloft, an antidepressant. He also tried numerous talk and homeopathic therapists.
Sometimes, he improved. But the progress was always precarious and short-lived. Another incident would send him straight back into instability.
“What we got from every place we went to before the Kansas City Center for Anxiety Treatment was coping stuff,” Greg Topjon says. “It was all just tools and props to cope, to just make it through the day, and it had nothing to do with curing it.”
Clark Topjon turned to the center out of desperation. The week before, he had dipped into depression and even spoke of suicide. After numerous other centers, it was a last resort.
“It literally saved his life,” says his mother, Di Topjon.
The Kansas City Center for Anxiety Treatment keeps an assortment of potentially fearful sights. The ones prescribed commonly include clown figures, hypodermic needles, fake blood and cages of spiders and snakes.
The staff also takes patients with embarrassment fears to supermarkets to have them clap in public. For a fear of speeches, the staff poses as inattentive students, throwing paper planes and talking as the patients present a topic.
Dr. Amy Jacobson resorted to vomit-flavored jellybeans and home-cooked fake vomit – favorites for emetophobia – to treat Topjon.
But she saved all this at the start. Most professionals, Smith says, use a “graduated” approach which, albeit slower than “flooding,” is milder and less traumatic.
So, at first, Topjon merely thought of vomiting, then looked at pictures and watched movies of people throwing up.
Only later did he eat the jellybeans; hold a hand in fake vomit, which he then thought was real; and gag himself – all with Jacobson telling him he was going to vomit.
But even gradual exposure with phobias isn’t easy. The Center for Anxiety Treatment uses a stress scale from one to 10, with level 10 being total panic, for patients to self-monitor their anxiety.
“The first couple of times, I was 9, 10 the whole time,” Topjon says.
The anxiety often weighs on the therapists, too.
“The hardest part is tolerating their distress,” Smith says of her patients. “I certainly would do it a different way if other ways worked.”
But Smith says it helps to know that even the panic attacks are harmless and that her patients need her help.
“People can actually strengthen their symptoms by trying and not being successful,” she says. “If people could do this on their own, they would.”
She also reminds herself that the reward is well worth the struggle – something Topjon hopes everyone with a phobia will realize.
“You can’t give up,” he says. “There’s always something that can fix it. You just have to have faith in that.”