Interoceptive exposure. coping with feared physical sensations

Interoceptive exposure is a specific technique within exposure therapy, particularly useful for the treatment of Panic Disorder and other forms of anxiety where there is an intense fear of one's own internal physical sensations.

It consists of deliberately and in a controlled manner inducing these feared sensations in order to learn that they are not dangerous and to reduce the anxiety associated with them.

The Fear of Internal Sensations

People with Panic Disorder often develop a "fear of fear," that is, an intense fear of the physical sensations that accompany anxious arousal (such as palpitations, dizziness, difficulty breathing), since they catastrophically interpret these sensations as signs of imminent danger (e.g., a heart attack, suffocation, or loss of control).

This hypersensitivity and misinterpretation of normal or benign bodily sensations maintains the cycle of panic.

The Interoceptive Exposure Procedure

Interoceptive exposure involves performing a series of exercises designed to deliberately provoke some of the physical sensations the person fears.

These exercises are done in a safe environment, under the guidance of a therapist, and in a gradual manner.

Some examples of exercises include:

• Controlled hyperventilation: Breathing rapidly and deeply for a short period to induce dizziness or a feeling of unreality.

• Brief, intense physical exercise: Running in place or climbing stairs to induce rapid heart rate and rapid breathing.

• Spinning in a chair: To induce dizziness.

• Breathing through a thin straw: To simulate the sensation of shortness of breath.

• Tensing muscles: To experience tension.

During and after each exercise, the person remains in the situation, observing the sensations without trying to escape from them or perform safety behaviors, until the anxiety decreases through habituation.

Goals and Benefits

The goals of interoceptive exposure are:

• Disconfirming catastrophic beliefs: Helping the person learn, through direct experience, that the feared physical sensations are not dangerous in themselves and do not lead to the anticipated catastrophic consequences.

• Habituation to the sensations: Reducing the intensity of the anxiety response to these sensations through repeated exposure.

• Increasing tolerance to discomfort: Developing the ability to experience these sensations without reacting with panic.

• Reducing bodily hypervigilance: Decreasing the tendency to be constantly aware of one's internal sensations.

Interoceptive exposure is a crucial and highly effective component of cognitive-behavioral treatment for panic disorder because it directly addresses the fear of one's own physiological reactions.