Exposures For Fear Of Body Sensations

The Exposures For Fear of Body Sensations handout helps clients and therapists identify feared stimuli, create exposure hierarchies, and plan exposure exercises and experiments to overcome this fear.

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Offers theory, guidance, and prompts for mental health professionals. Downloads are in Fillable PDF format where appropriate.

Overview

Fearful responses to physical sensations are common in several disorders. Interoceptive exposure (or ‘symptom induction’) is an effective treatment for these fears, typically preceded by the development of a fear ladder or exposure hierarchy. Clients sometimes find it difficult to develop appropriate exposure tasks or identify manageable ‘steps’ between behavioral experiments.

The Exposures For Fear Of Body Sensations information handout is designed to help clients and therapists identify feared stimuli, develop exposure hierarchies, and plan appropriate exposure exercises and behavioral experiments. It also contains information about safety-seeking behaviors which may need to be addressed during exposure.

Why Use This Resource?

Exposure is one of the most effective interventions for overcoming fear. It involves individuals repeatedly facing their fears to reduce their fearful responses and reverse the patterns of avoidance that perpetuate them.

  • Provides examples of exposure exercises for addressing fear of body sensations.
  • Helps clients and therapists identify feared stimuli and develop exposure hierarchies.
  • Assists in planning effective exposure exercises and behavioral experiments.

Who is this for?

Health Anxiety

Address physical sensations that trigger health concerns.

Panic Disorder

Target feared bodily sensations associated with panic attacks.

Vomit Phobia (Emetophobia)

Facilitate exposure to sensations linked to nausea and vomiting.

Integrating it into your practice

01

Assess

Ensure the client relates to the fear described in the handout.

02

Review

Go over the list of exposures for facing this fear.

03

Identify

Pinpoint specific items that would make the client feel anxious or afraid.

04

Expand

Explore additional scenarios that would make the client fearful.

05

Clarify

Specify the safety behaviors the client might use to cope with their fear.

06

Check

Ensure that the process of exposure is clear and makes sense to the client.

07

Plan

Discuss how the client might begin exposing themselves to their fears.

Theoretical Background & Therapist Guidance

Exposure is one of the most effective strategies for overcoming fear (Hofmann & Smits, 2008). It involves individuals repeatedly confronting their fears in order to reduce their fearful responses and break the patterns of avoidance that maintain those fears (Springer & Tolin, 2020).

Exposure-based interventions have been integrated into several therapeutic approaches, most notably cognitive behavioral therapy (CBT). These interventions can take several forms, including in-vivo exposure, where clients confront their fears in real life; imaginal exposure, where they face their fears through imagination or narrative; and virtual reality exposure.

Different theoretical frameworks for understanding exposure-based treatments have emerged, including emotional processing theory and inhibitory learning theory. While there is ongoing debate about the mechanisms behind exposure, the general stages of exposure tend to be consistent:

  1. Identifying a fear stimulus.
  2. Articulating expectations about facing the stimulus.
  3. Prolonged exposure to the stimulus without distraction.
  4. Monitoring changes in fear levels.
  5. Reflecting on insights gained from the exposure.
  6. Repeating the exposure.

Before beginning exposure, clients typically develop a fear ladder or “exposure hierarchy” (Beck et al., 1985). This is an individualized list of stimuli – such as activities, situations, or sensations – that provoke fear in the client and are therefore avoided. Once the list is created, the items are ranked and ordered according to the level of fear they induce.

FAQs

Review the provided list and help the client identify additional idiosyncratic fears.
Identify these coping strategies beforehand and encourage the client to refrain from them during exposure exercise to maximise results.

How This Resource Improves Clinical Outcomes

This resource can help clients:

  • Develop targeted exposure exercises and behavioral experiments.
  • Plan ways to face and overcome their fears.
  • Ensure exposure is as helpful and effective as possible.

Clinicians Who Use This Resource Also Use

References And Further Reading

  • Barlow, D. H. (2002). Anxiety and its disorders: The nature and treatment of anxiety and panic (2nd ed.). Guilford.
  • Beck, A. T., Emery, G., & Greenberg, R. L. (1985). Anxiety disorders and phobias: A cognitive perspective. Basic Books.
  • Blakey, S. M., & Abramowitz, J. S. (2018). Interoceptive exposure: an overlooked modality in the cognitive-behavioral treatment of OCD. Cognitive and Behavioral Practice, 25, 145-155. DOI: 10.1016/j.cbpra.2017.01.002.
  • Boswell, J. F., Anderson, L. M., Oswald, J. M., Reilly, E. E., Gorrell, S., & Anderson, D. A. (2019). A preliminary naturalistic clinical case series study of the feasibility and impact of interoceptive exposure for eating disorders. Behaviour Research and Therapy, 117, 54-64. DOI: 10.1016/j.brat.2019.02.004.
  • Clark, D. M., Salkovskis, P.M., Ost, L. G., Breitholtz, E., Koehler, K. A., Westling, B. E., Jeavons, A., & Gelder, M. (1997). Misinterpretation of body sensations in panic disorder. Journal of Consulting and Clinical Psychology, 65, 203-213. DOI: 10.1037/0022-006X.65.2.203.
  • Craske, M. (2015). Optimizing exposure therapy for anxiety disorders: an inhibitory learning and inhibitory regulation approach. Verhaltenstherapie, 25, 134-143. DOI: 10.1159/000381574.
  • Craske, M. G., Wolitzky-Taylor, K. B., Labus, J., Wu, S., Frese, M., Mayer, E. A., & Naliboff, B. D. (2011). A cognitive-behavioral treatment for irritable bowel syndrome using interoceptive exposure to visceral sensations. Behaviour Research and Therapy, 49, 413-421. DOI: 10.1016/j.brat.2011.04.001.
  • Flink, I. K., Nicholas, M. K., Boersma, K., & Linton, S. J. (2009). Reducing the threat value of chronic pain: A preliminary replicated single-case study of interoceptive exposure versus distraction in six individuals with chronic back pain. Behaviour Research and Therapy, 47, 721-728. DOI: 10.1016/j.brat.2009.05.003.
  • Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99, 20-35. https://doi.org/10.1037/0033-2909.99.1.20
  • Hofmann, S. G., & Smits, J. A. (2008). Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. The Journal of Clinical Psychiatry, 69(4), 621.
  • Hunter, P.V., & Antony, M. M. (2009). Cognitive-behavioral treatment of emetophobia: The role of interoceptive exposure. Cognitive and Behavioral Practice, 16, 84-91. DOI: 10.1016/j.cbpra.2008.08.002.
  • Katerelos, M., Hawley, L. L., Antony, M. M., & McCabe, R. E. (2008). The exposure hierarchy as a measure of progress and efficacy in the treatment of social anxiety disorder. Behavior Modification, 32, 504-518. DOI: 10.1177/0145445507309302.
  • Kircanski, K., Mortazavi, A., Castriotta, N., Baker, A. S., Mystkowski, J. L., Yi, R., & Craske, M. G. (2012). Challenges to the traditional exposure paradigm: Variability in exposure therapy for contamination fears. Journal of Behavior Therapy and Experimental Psychiatry, 43, 745-751. DOI: 10.1016/j.jbtep.2011.10.010.
  • Knowles, K. A., & Olatunji, B. O. (2019). Enhancing inhibitory learning: The utility of variability in exposure. Cognitive and Behavioral Practice, 26, 186-200. DOI: 10.1016/j.cbpra.2017.12.001.
  • Springer, K. S., & Tolin, D. F. (2020). The Big Book of Exposures: Innovative, Creative, and Effective CBT-Based Exposures for Treating Anxiety-Related Disorders. New Harbinger Publications.
  • Stewart, S. H., & Watt, M. C. (2008). Introduction to the special issue on interoceptive exposure in the treatment of anxiety and related disorders: Novel applications and mechanisms of action. Journal of Cognitive Psychotherapy, 22, 291-302. DOI: 10.1891/0889-8391.22.4.291.
  • Tolin, D. F. (2012). Face Your fears: A Proven Plan to Beat Anxiety, Panic, Phobias, and Obsessions. John Wiley and Sons.
  • Tolin, D. F. (2016). Doing CBT: A comprehensive guide to working with behaviors, thoughts, and emotions. Guilford Press.
  • Walker, J. R., & Furer, P. (2008). Interoceptive exposure in the treatment of health anxiety and hypochondriasis. Journal of Cognitive Psychotherapy, 22, 366-378. DOI: 10.1891/0889-8391.22.4.366.
  • Watts, F. (1971). Desensitization as an habituation phenomenon: I. Stimulus intensity as determinant of the effects of stimulus lengths. Behaviour Research and Therapy, 9, 209-217, https://doi.org/ 10.1016/0005-7967(71)90006-4
  • Wolpe, J. (1990). The practice of behavior therapy (4th ed.). Plenum.

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