Interoceptive exposure is an essential component in the cognitive behavioral treatment of panic attacks and panic disorder. This structured resource guides clients how to safely induce and maintain contact with feared body sensations.
Offers theory, guidance, and prompts for mental health professionals. Downloads are in Fillable PDF format where appropriate.
Includes client-friendly guidance. Downloads are in Fillable PDF format where appropriate.
An editable Microsoft PowerPoint version of the resource.
Interoceptive exposure is a powerful technique for treating panic and anxiety by confronting and reducing fear responses to bodily sensations. The approach encourages patients to experience feared sensations under controlled circumstances, breaking the cycle of avoidance and catastrophic misinterpretations that serve to maintain panic. By creating opportunities for new learning, this method helps patients discover that these sensations are safe and tolerable. Interoceptive exposure is consistent with both habituation-based models — which emphasize reduced distress through repeated exposure — and inhibitory learning theory, which highlights the importance of violating negative expectations to build new, non-threatening associations with bodily sensations.
Interoceptive exposure challenges patients to face feared bodily fears head-on, reducing anxiety through direct experience rather than avoidance.
Addresses misinterpretations of bodily sensations experienced as catastrophic.
Provides opportunities to challenge fears relating to perceived physical symptoms.
Tests predictions about potentially harmful outcomes related to body sensations.
Pinpoint the fear-inducing bodily sensation and related cognitive appraisal.
Familiarize the patient with the process for interoceptive exposure.
Engage the patient in activities that intentionally recreate the feared sensation.
Document symptoms, appraisals, and anxiety levels during exercises.
Discuss any discrepancies between feared and actual outcomes.
Engage in repeated exposures to reduce anxiety responses.
Gradually introduce more complex exposure scenarios.
Interoceptive exposure is grounded in the cognitive-behavioral model, which proposes that panic attacks result from misinterpretations of benign bodily sensations. Individuals with high anxiety sensitivity tend to interpret normal physiological fluctuations — such as a racing heart, breathlessness, or dizziness — as signals of serious physical or psychological danger. These catastrophic misappraisals lead to heightened vigilance, fear, and avoidance, which in turn reinforce the anxiety response. Foundational work by Clark et al. (1997) and Chambless and Gracely (1989) highlighted the role of these interpretations in the maintenance of panic disorder, and later research has built upon these insights.
Interoceptive exposure seeks to disrupt the cycle of panic by intentionally evoking feared bodily sensations in a controlled and systematic way, allowing patients to confront and re-evaluate their beliefs. The mechanism of change has historically been described through the lens of habituation: anxiety is expected to decline through repeated exposure as the individual learns, experientially, that the sensations are tolerable and do not lead to the feared outcomes. Influential treatment programs such as Barlow and Craske’s (2007) Mastery of Your Anxiety and Panic have long emphasized habituation as a route to symptom relief, encouraging repeated and prolonged engagement with feared sensations.
More recent advances in the science of exposure therapy have shifted focus toward inhibitory learning theory as a more comprehensive account of how exposure achieves its effects. Rather than relying solely on the reduction of fear through repeated exposure, this model emphasizes the creation of new learning that competes with — and inhibits — existing fear associations. Exposure is most effective when it violates the individual’s negative expectations, such as the belief that dizziness will lead to fainting, or that increased heart rate signals a heart attack. Inhibitory learning theory highlights key principles to enhance therapeutic impact, including variability in exposure stimuli and contexts, removal of safety behaviors, the use of affect labeling, and sustained attention to disconfirming evidence (Craske et al., 2008; Craske et al., 2014). Research by Deacon et al. (2013) has shown that structuring exposures to maximize expectancy violation results in greater long-term fear reduction than approaches focused purely on habituation. These findings are supported by an expanding empirical literature demonstrating that optimizing inhibitory learning processes improves treatment outcomes across anxiety disorders (Craske et al., 2022; Pittig et al., 2016). This theoretical shift also allows for greater flexibility in how exposure is delivered, emphasizing the value of new, non-threatening associations over immediate reductions in anxiety.
Interoceptive exposure has demonstrated efficacy across a range of disorders characterized by bodily fear, including panic disorder, health anxiety, generalized anxiety disorder, and irritable bowel syndrome (Craske et al., 2011; Lee et al., 2006). It provides a practical and evidence-based means of helping patients learn that uncomfortable internal experiences are not inherently dangerous. Clinicians should guide patients through exercises that are challenging but safe, encourage reflection on the mismatch between feared and actual outcomes, and adapt the approach to meet individual needs while maintaining the core principle of confronting and reevaluating feared sensations. When implemented with care, interoceptive exposure offers a powerful avenue for reducing anxiety and enhancing psychological flexibility.
