The unique and conditional effects of interoceptive exposure in the treatment of anxiety: A functional analysis

Boettcher, Hannah T.; Barlow, David H.

doi:10.1016/j.brat.2018.12.002

Cited by 16 publications

(10 citation statements)

References 63 publications

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“…These studies led to the conclusion that interoceptive exposure can be used as a transdiagnostic intervention (Boswell et al, 2013) and constitutes an important active mechanism in Eustis et al's (2020) Unified Protocol for anxiety disorder. However, Boettcher and Barlow (2019) also found that interoceptive exposure implemented on its own for claustrophobia was less effective than the same for panic disorder, and that situational exposure was also required to decrease claustrophobia symptoms. Their results showed that interoceptive exposure on its own was most effective when the feared trigger was generated internally, whereas externally generated fear triggers, such as social cues, also require exposure to external situations.…”

Section: Co-emergence Model Integration Within Therapy General Implicmentioning

confidence: 95%

Co-emergence Reinforcement and Its Relevance to Interoceptive Desensitization in Mindfulness and Therapies Aiming at Transdiagnostic Efficacy

Cayoun¹,

Shires

2020

Front. Psychol.

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Interoception, the ability to feel the body’s internal sensations, is an essential aspect of emotional experience. There is mounting evidence that interoception is impaired in common mental health disorders and that poor interoceptive awareness is a major contributor to emotional reactivity, calling for clinical interventions to address this deficit. The manuscript presents a comprehensive theoretical review, drawing on multidisciplinary findings to propose a metatheory of reinforcement mechanisms applicable across a wide range of disorders. We present a reconsideration of operant conditioning through the co-emergence model of reinforcement, which is a neurophenomenological account of the interaction between cognition and interoception, and its consequences on behavior. The model suggests that during memory processing, the retrieval of autobiographical memory (including maladaptive cognition) is dependent upon its co-emerging interoceptive cues occurring at the encoding, consolidation and reconsolidation stages. Accordingly, “interoceptive reinforcement” during emotional distress is a common factor to all emotional disorders and a major cause for relapse. We propose that interoceptive desensitization has transdiagnostic benefits, readily achievable through the cultivation of equanimity during mindfulness training and can be integrated in cognitive and behavioral interventions to permit a transdiagnostic applicability. We summarize the contributions of this approach into 10 specific and testable propositions.

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Section: Co-emergence Model Integration Within Therapy General Implicmentioning

confidence: 95%

Co-emergence Reinforcement and Its Relevance to Interoceptive Desensitization in Mindfulness and Therapies Aiming at Transdiagnostic Efficacy

Cayoun¹,

Shires

2020

Front. Psychol.

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“…First, the reviewed work on interoceptive conditioning has focused mainly on the acquisition rather than on the extinction of interoceptive fear. Although cognitive behavioral therapy including interoceptive exposure is an effective treatment strategy (Boettcher & Barlow, 2018;Craske et al, 2011;Flink, Nicholas, Boersma, & Linton, 2009;Pompoli et al, 2018;Zucker et al, 2017), there is considerable room for improvement (Freire, Zugliani, Garcia, & Nardi, 2016;Mitte, 2005). We do not currently know how extinction of interoceptive fears may differ from extinction of exteroceptive fears, nor do we know how it could be facilitated.…”

Section: Future Directionsmentioning

confidence: 99%

Interoception, conditioning, and fear: The panic threesome

Diest

2019

Psychophysiology

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The present article aims to illustrate and review evidence on how associative learning involving interoceptive stimuli (interoceptive conditioning) can lead to changes in physiological, emotional, and perceptual outcomes. We first outline a functional perspective on Pavlovian conditioning and provide a general introduction and historical background on interoceptive conditioning as a special instance of Pavlovian conditioning. Next, biological and learning accounts of panic disorder are discussed, followed by an analysis of which stimuli and responses may be most promising to model learning that is relevant to panic disorder. Finally, studies on interoceptive fear conditioning with respiratory stimuli are reviewed and discussed, and future directions are outlined. K E Y W O R D Sanxiety, conditioning, interoception, psychopathology, respiration, startle blink BOX 1 Six propositions a 1. Unlike the continuum of exteroceptive stimulation, which is the body material of all our conscious experiences, the continuum of interoceptive stimulation leads largely to unconscious reactions. 2. Interoceptive conditioning, whether involving conditioned or unconditioned interoceptive stimuli, is readily obtainable and is by its very nature largely unconscious in character. 3. While interoceptive conditioning is by its nature more limited than is exteroceptive conditioning with respect to total kinds and variety of stimulations, the interoceptive kinds of stimulations are, on the other hand, by their very nature much more recurrent, periodic, and organism bound, making interoceptive conditioning an almost built-in function that is constantly generated and regenerated in the very process of living and acting. 4. Interoceptive conditioning is somewhat slower in formation than is exteroceptive, but, once conditioned, it is more fixed and irreversible (less readily extinguished). 5. When equal but opposing interoceptively produced and exteroceptively produced reactions are juxtaposed, the interoceptive reactions dominate the exteroceptive ones, with the final result that preceding exteroceptive stimuli become conditioned stimuli for succeeding interoceptive reactions, whereas preceding interoceptive reactions become strengthened by exteroceptive reactions succeeding them. 6. The juxtaposition of conditioned interoceptive and exteroceptive stimuli of the same conditioned reaction, unlike similar juxtapositions of exteroceptive stimuli of different modalities, produces a certain amount of conflict and decrementation of conditioning. a (Razran, 1961, p. 97)

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“…More generally, re-tuning conscious and subconscious responses to somatic sensations is commonly employed in numerous behavioral interventions across various disorders. For example, addition of interoceptive training to standard therapies for anxiety disorders ( 109 , 110 ), eating disorders ( 111 ), and select pain disorders ( 112 , 113 ) yields incremental benefit in mitigating symptoms, demonstrating the transdiagnostic utility of such an approach. A more refined understanding of the relationship between interoceptive sensibility and premonitory urge may allow further optimization of behavioral therapies for CTD.…”

Section: Discussionmentioning

confidence: 99%

Altered Interoceptive Sensibility in Adults With Chronic Tic Disorder

et al. 2022

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BackgroundInteroception refers to the sensing, interpretation, integration, and regulation of signals about the body’s internal physiological state. Interoceptive sensibility is the subjective evaluation of interoceptive experience, as assessed by self-report measures, and is abnormal in numerous neuropsychiatric disorders. Research examining interoceptive sensibility in individuals with chronic tic disorders (CTDs), however, has yielded conflicting results, likely due to methodologic differences between studies and small sample sizes.ObjectiveWe sought to compare interoceptive sensibility between adults with CTD and healthy controls, adjusting for co-occurring psychiatric symptoms, and to examine the relationship of interoceptive sensibility with other CTD clinical features, in particular, premonitory urge.MethodsWe recruited adults with CTDs and sex- and age-matched healthy controls to complete the Multidimensional Assessment of Interoceptive Awareness, Version 2 (MAIA-2), as well as a battery of measures assessing psychiatric symptoms prevalent in CTD populations. CTD participants additionally completed scales quantifying tic severity, premonitory urge severity, and health-related quality of life. We conducted between-group contrasts (Wilcoxon rank-sum test) for each MAIA-2 subscale, analyzed the effect of psychiatric symptoms on identified between-group differences (multivariable linear regression), and examined within-group relationships between MAIA-2 subscales and other clinical measures (Spearman rank correlations, multivariable linear regression).ResultsBetween adults with CTD (n = 48) and healthy controls (n = 48), MAIA-2 Noticing and Not-Worrying subscale scores significantly differed. After adjusting for covariates, lower MAIA-2 Not-Worrying subscale scores were significantly associated with female sex (β = 0.42, p < 0.05) and greater severity of obsessive-compulsive symptoms (β = –0.028, p < 0.01), but not with CTD diagnosis. After adjusting for severity of tics and obsessive-compulsive symptoms, a composite of MAIA-2 Noticing, Attention Regulation, Emotional Awareness, Self-Regulation, Body Listening, and Trusting subscales (β = 2.52, p < 0.01) was significantly associated with premonitory urge.ConclusionStudy results revealed three novel findings: adults with CTD experience increased anxiety-associated somatization and increased general body awareness relative to healthy controls; anxiety-associated somatization is more closely associated with sex and obsessive-compulsive symptoms than with CTD diagnosis; and increased general body awareness is associated with greater severity of premonitory urges.

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The unique and conditional effects of interoceptive exposure in the treatment of anxiety: A functional analysis

Cited by 16 publications

References 63 publications

Co-emergence Reinforcement and Its Relevance to Interoceptive Desensitization in Mindfulness and Therapies Aiming at Transdiagnostic Efficacy

Co-emergence Reinforcement and Its Relevance to Interoceptive Desensitization in Mindfulness and Therapies Aiming at Transdiagnostic Efficacy

Interoception, conditioning, and fear: The panic threesome

Altered Interoceptive Sensibility in Adults With Chronic Tic Disorder

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