Interoceptive Exposure Strategies in the Treatment of Anxiety Disorders

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Interoceptive Exposure Strategies in the
Treatment of Anxiety Disorders

• Michael J. Telch, Ph.D.

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Major Treatment Components of CBT for Panic
Disorder

• Interoceptive exposure
• Major Aim
• To reduce fear of harmless bodily sensations such
  as heart racing, dizziness, lightheadedness, etc.
• Strategies
• Exercises designed to intentionally induce the
  feared sensations.

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Steps in Conducting Interoceptive Exposure

• Identify somatic hypersensitivity profiles
• Sources of data
• Interview
• Self-monitoring
• Validated scales I.e., ASI, BSQ
• Behavioral testing

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Steps in Conducting Interoceptive Exposure

• Provide clear therapeutic rationale
• PD patients develop false alarms to harmless
  bodily sensations
• Fear of bodily sensations contributes to further
  panic attacks and the fear of the attacks
• There are simple, effective exercises for
  correcting the false alarms connected to harmless
  bodily sensations
• Describe how the exercises work (i.e., exercise
  will intentionally bring on feared bodily
  sensation in order to train the brain that it is
  harmless. Dismiss the notion that the treatment
  is designed to bring on panic attacks
• Introduce monitoring form and describe the
  importance of rating intensity of physical
  symptoms independent from fear intensity.

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Steps in Conducting Interoceptive Exposure cont

• Begin interoceptive exposure training using
  exercises that target one somatic
  hypersensitivity profile
• Start with exercises that are likely to generate
  moderate but not severe levels of fear
• Model the exercise for the patient
• Have patient perform repeated trials of first
  exercise (in session), making sure the client
  understands the rating form and what the exercise
  is trying to accomplish (i.e., reducing the fear
  to the sensation)

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Steps in Conducting Interoceptive Exposure cont

• Use guided threat reappraisal to facilitate
  disconfirmation
• Identify patients core threat in performing the
  exercise
• Have the patient focus on evidence pertaining to
  the threat
• Look for signs of within-session habituation to
  reinforce the importance of the technique
• Acknowledge the challenging nature of the
  treatment and provide reassurance that the fear
  will diminish with repeated trials
• Assign homework to continue exercise and
  monitoring form prior to next visit
• Emphasize importance of between-session home
  practice and get commitment from patient to
  practice between sessions.
• Have patient call/email if they have questions

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Examples of Interoceptive Exposure Exercises

• Cardiovascular sensitivity
• Vestibular sensitivity
• Respiratory sensitivity
• Dissociation sensitivity

• Running in place, stair climbing, caffeine
  ingestion
• Spinning, head shaking, saunas, alcohol ingestion
• Aerobic exercise, breathing through straw,
  breath-holding, CO2, enclosed spaces
• Starring into a mirror, hyperventilation
  marijuana, D.A.V.I.D.