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Interoceptive Exposure

Interoceptive exposure (exposure to bodily sensations) is a critical part of CBT treatment for panic disorder. This information sheet and worksheet describe the rationale and practice of this technique.

Unhelpful beliefs about body sensations are critical maintaining factors in a range of disorders such as panic, health anxiety, or chronic subjective dizziness. Biased beliefs lead to biased behaviour – typically avoidance. While attempted avoidance of certain situations or events can sometimes be successful, attempted avoidance of normal bodily sensations is rarely so adaptive and can be particularly restrictive.

Exposure to bodily sensations (interoceptive exposure) is an important component of treatment – especially for panic, but for any problem where normal body sensations are experienced as threatening. Interoceptive Exposure is a three-page guide that gives information about the rationale for this technique, safety information regarding its use, and a series of interoceptive exposure exercises. Interoceptive exposure can be a particularly powerful in-session behavioural experiment in therapy – a graded approach to homework is recommended.

Interoceptive exposure exercises are not inherently dangerous, but are designed to trigger bodily sensations that some people find uncomfortable. If clients suffer from medical conditions including epilepsy, seizures, cardiac conditions, asthma or lung problems, neck or back problems, or are pregnant, then they should check with their doctor whether it is safe for them to complete interoceptive exposure exercises.

The instructions on the interoceptive exposure worksheet are straightforward. Instructions are given for each task along with a recommended time (which can be increased once clients have some proficiency with each task), a section for recording symptoms/sensations that were noticed, and a section for recording the peak anxiety experienced during the exercise. Clients may also want to record how long it takes for any unusual body sensations to return to normal. Additional overall instructions are that clients should: complete each exercise for the allotted time (stopping early counts as avoiding), focus on their body sensations during each exercise, and let go of any safety behaviours that might interfere with the task.

  • Barlow, D. H., Craske, M. G. (2007). Mastery of your anxiety and panic (Fourth edition). Oxford: Oxford University Press.
  • Chambless, D. L., & Gracely, E. J. (1989). Fear of fear and the anxiety disorders. Cognitive Therapy and Research, 13(1), 9-20.
  • Clark, D. M., Salkovskis, P. M., Öst, L. G., Breitholtz, E., Koehler, K. A., Westling, B. E., … & Gelder, M. (1997). Misinterpretation of body sensations in panic disorder. Journal of Consulting and Clinical Psychology, 65(2), 203.
  • Deacon, B. J., Lickel, J. J., Possis, E. A., Abramowitz, J. S., Mahaffey, B. G., & Wolitzky-Taylor, K. (2012). Do cognitive reappraisal and diaphragmatic breathing augment interoceptive exposure for anxiety sensitivity? Journal of Cognitive Psychotherapy, 26(3), 257-269.
  • Lee, K., Noda, Y., Nakano, Y., Ogawa, S., Kinoshita, Y., Funayama, T., & Furukawa, T. A. (2006). Interoceptive hypersensitivity and interoceptive exposure in patients with panic disorder: specificity and effectiveness. BMC Psychiatry, 6(1), 32.

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