Interoceptive Exposure

The cognitive behavioral model of anxiety proposes that appraising a stimulus as threatening leads to emotional and bodily reactions of fear and arousal, which in turn motivate avoidance and safety behaviors. These behaviors may provide effective relief of anxiety in the short-term – explaining their repeated use – but in the long-term they prevent new learning about the true nature of the threat and maintain a vicious cycle of anxiety. 

Unhelpful beliefs about body sensations are critical maintaining factors in a wide range of disorders such as panic attacks and panic disorder, health anxiety, chronic pain, irritable bowel syndrome, and chronic dizziness. Misappraisals of body sensations trigger emotional and bodily reactions of fear and heightened arousal, which in turn trigger behavioral responses – typically avoidance and safety behaviors – designed to protect oneself from danger. It is often the case that a rapidly escalating feedback loop or vicious cycle is established:

Interoceptive exposure exercises are not dangerous, but they do tend to induce at least moderate feelings of discomfort. Clinicians should ensure that patients are in good general health before beginning. It is advisable to check with a medical practitioner whether it is safe for a patient to complete interoceptive exposure exercises if they are pregnant, or if they suffer from epilepsy or seizures; cardiac conditions; asthma or lung problems; or neck, back, or other physical difficulties. 

The Interoceptive Exposure exercise introduces a series of exposure tasks targeting a range of physiological systems and psychological symptoms. For each exercise there are brief instructions along with a recommended duration for which to attempt the task (which can be increased once clients have some proficiency with each exercise). Space is also given for recording any symptoms or sensations that the patient experiences, and for recording the peak anxiety that the patient experienced during the

• Barlow, D. H. (2004). Anxiety and its disorders: The nature and treatment of anxiety and panic. Guilford press.
• 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.
• 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(6-7), 413-421.
• Deacon, B., Kemp, J. J., Dixon, L. J., Sy, J. T., Farrell, N. R., & Zhang, A. R. (2013). Maximizing