Introduction to the Special Issue on Interoceptive Exposure in the Treatment of Anxiety and Related Disorders: Novel Applications and Mechanisms of Action

Abstract

Interoceptive exposure (IE) involves having an individual repeatedly induce and experience feared arousal-related sensations (e.g., shortness or breath, heart palpitations, dizziness) as a means of reducing the fear of those sensations. IE exercises such as hyperventilation, chair spinning, and breathing through a straw have been demonstrated effective in the treatment of panic attacks and panic disorder, both as part of a broader cognitive-behavioral program and as a stand-alone intervention. This article introduces a special issue of the Journal of Cognitive Psychotherapy focusing on cutting-edge findings on novel applications of IE in the treatment of anxiety and related disorders and research that begins to investigate IE’s mechanisms of action. We set the stage for the following series of six original articles by first providing a historical review of the use of IE in cognitive-behavioral treatments of panic. We then provide a brief overview of the various theoretical perspectives that can be applied to understanding the mechanisms of action of IE in reducing fear of fear: conditioning, cognitive restructuring, emotional processing, self-efficacy, and emotional acceptance. Finally, we provide a brief overview of the articles included in the special issue. This special issue should prove helpful to cognitive-behavioral therapists in improving and expanding their use of IE in clinical practice. The issue also should stimulate additional research on the mechanisms of action of IE to ultimately permit refinement of treatments for anxiety and related disorders and, it is hoped, enhance the efficacy of cognitive-behavioral psychotherapy.

Anxiety sensitivity and PTSD symptom severity are reciprocally related: Evidence from a longitudinal study of physical trauma survivors.

“…In fact, evidence indicates that interventions to diminish anxiety sensitivity and thereby to decrease PTSD symptoms may prove promising. For example, Wald and Taylor (2007) have provided preliminary evidence that interoceptive exposure—which involves gradual, repeated exposure to feared bodily sensations in supervised therapeutic exercises—can reduce anxiety sensitivity, presumably by helping participants to understand that these sensations are not associated with calamitous consequences (Stewart & Watt, 2008). Similar research also indicates that physical exercise may also serve to reduce anxiety sensitivity (Broman-Fulks & Storey, 2008; Smits et al, 2008).…”

An Active Inference Approach to Interoceptive Psychopathology

“…The most effective interoceptive exposures closely reproduce the specific sensations associated with a given patient's emotional distress. For example, interoceptive exposure for panic disorder uses strategies that direct patients to attend to their feared sensations and challenge their catastrophic cognitions so that the sensations of physiological arousal no longer provoke panic and avoidance behavior (Stewart & Watt 2008). To date, the majority of interoceptive exposures have focused on reproducing cardiovascular sensations (e.g., racing heart), respiratory sensations (e.g., shortness of breath), or vestibular sensations (e.g., dizziness) using simple and controllable provocation procedures (e.g., running in place to achieve a racing heart, breathing through a straw to achieve shortness of breath, spinning in circles to achieve dizziness).…”

Cognitive-Behavioral Therapy for Anxiety Disorders in Youth

“…Any symptoms of anxiety would be countered with relaxation, as the goal would be to avoid the experience of anxiety in order to condition an association between the once-feared stimuli and relaxation. However, such an approach has largely fallen out of favor, in part because it has been found that the relaxation training component of the treatment was often not necessary and in part because of updated theories regarding the mechanisms responsible for change in exposure therapies [41–43] . Today exposure-based treatments generally have four basic phases (1) instruction, (2) hierarchy development, (3) exposure proper, (4) generalization and maintenance.…”