Abstract
Interoceptive exposure is an intervention developed in the context of panic disorder targeting the fear of physical symptoms. Originally, the rationale for interoceptive exposure was exclusively based on interoceptive conditioning of bodily fear symptoms. Further developments over the past 30 years substantially widened the uses as well as the rationale behind interoceptive exposure. In consequence, this intervention is used in various disorders in addition to panic disorder, although the use in the treatment of panic is still its most common application. In this chapter, first the origins of interoceptive exposure will be detailed. Secondly the use of interoceptive exposure within a cognitive therapy framework (behavioral experiments) will be explicated. Also, the use of interoceptive exposure as a tool to increase tolerance for aversive bodily symptoms will be highlighted.
Based on case reports and the limited empirical literature, the most common as well as some uncommon forms of interoceptive exposure and its uses will be illustrated. In addition, a brief overview of the efficacy literature concerning interoceptive exposure will be given.
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References
Abramowitz, J., Deacon, B., & Whiteside, S. P. (2010). Exposure therapy for anxiety: Principles and practice. New York: Guilford Publications.
Antony, M. M., Ledley, D. R., Liss, A., & Winson, R. P. (2006). Responses to symptom induction exercises in panic disorder. Behavior Research and Therapy, 44(1), 85–98.
Asmundson, G. J. G., & Stein, M. B. (1994). Resting cardiovascular measures in patients with panic disorder and social phobia and health control subjects: Relationship to habitual exercise frequency. Anxiety, 1(1), 26–30.
Barlow, D. H. (1988). Anxiety and its disorders. New York: The Guilford Press.
Barlow, D. H., & Craske, M. (1989). Mastery of your anxiety and panic. Albany: Greywind.
Barlow, D. H., & Czerny, J. A. (1988). Psychological treatment of panic. New York: The Guilford Press.
Beck, J. G., & Shipherd, J. C. (1997). Repeated exposure to interoceptive cues: Does habituation of fear occur in panic disorder patients? A preliminary report. Behaviour Research and Therapy, 35(6), 551–557.
Bennett-Levy, J., Butler, G., Fennell, M. J., Hackmann, A., Müller, M., & Westbrook, D. (2004). Oxford guide to behavioural experiments in cognitive therapy. Oxford: Oxford University Press.
Bonn, J. A., Harrison, J., & Rees, L. (1973). Lactate infusion in the treatment of “free-floating” anxiety. Canadian Psychiatric Association Journal, 18(1), 41–46.
Bonn, J. A., Harrison, J., & Rees, W. L. (1971). Lactate-induced anxiety: Therapeutic application. The British Journal of Psychiatry, 119(551), 468–470.
Bouton, M. E. (2002). Context, ambiguity, and unlearning: Sources of relapse after behavioral extinction. Biological Psychiatry, 52(10), 976–986.
Clark, D. M., & Salkovskis, P. (1989). Cognitive therapy for panic and hypochondriasis. Oxford: Pergamon Press.
Craske, M., & Barlow, D. H. (2008). Panic disorder and agoraphobia. In D. H. Barlow (Ed.), Clinical handbook of psychological disorders: A step-by-step treatment manual (4th ed., pp. 1–64). New York: Guilford Press.
Culver, N. C., Stoyanova, M., & Craske, M. G. (2011). Clinical relevance of retrieval cues for attenuating context renewal of fear. Journal of Anxiety Disorders, 25(2), 284–292.
Dattilio, F. M. (2003). Emetic exposure and desensitization procedures in the reduction of nausea and a fear of emesis. Clinical Case Studies, 2(3), 199–210.
Eifert, G. H., & Forsyth, J. P. (2005). Acceptance & commitment therapy for anxiety disorders. Oakland: New Harpinger Publications.
Eifert, G. H., & Heffner, M. (2003). The effects of acceptance versus control contexts on avoidance of panic-related symptoms. Journal of Behavior Therapy and Experimental Psychiatry, 34(3–4), 293–312.
Evans, I. M. (1972). Conditioning model of a common neurotic pattern—Fear of fear. Psychotherapy-Theory Research and Practice, 9(3), 238–241.
Feldman, J. M., Giardino, N. D., & Lehrer, P. M. (2000). Asthma and panic disorder. In D. I. Mostofsky & D. H. Barlow (Eds.), The management of stress and anxiety disorders. Boston: Allyn & Bacon.
Flink, I. K., Nicholas, M. K., Boersma, K., & Linton, S. J. (2009). Reducing the threat value of chronic pain: A preliminary replicated single-case study of interoceptive exposure versus distraction in six individuals with chronic back pain. Behaviour Research and Therapy, 47(8), 721–728.
Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. [Research Support, U.S. Gov’t, P.H.S.]. Psychological Bulletin, 99(1), 20–35.
Goldstein, A. J., & Chambless, D. L. (1978). Reanalysis of agoraphobia. Behavior Therapy, 9(1), 47–59.
Greeven, A., van Balkom, A. J. L. M., Visser, S., Merkelbach, J. W., van Rood, Y. R., van Dyck, R., et al. (2007). Cognitive behavior therapy and paroxetine in the treatment of hypochondriasis: A randomized controlled trial. American Journal of Psychiatry, 164(1), 91–99.
Griez, E., & van den Hout, M. A. (1983). Treatment of phobophobia by exposure to CO2-induced anxiety symptoms [Case Reports]. The Journal of Nervous and Mental Disease, 171(8), 506–508.
Hermans, D., Craske, M. G., Mineka, S., & Lovibond, P. F. (2006). Extinction in human fear conditioning. Biological Psychiatry, 60(4), 361–368.
Hunter, P. V., & Antony, M. M. (2009). Cognitive-behavioral treatment of emetophobia: The role of interoceptive exposure. Cognitive and Behavioral Practice, 16(1), 84–91.
Huppert, J. D., & Baker-Morissette, S. L. (2003). Beyond the manual: The insider’s guide to panic control treatment. Cognitive and Behavioral Practice, 10(1), 2–13.
Lang, T., Helbig-Lang, S., & Petermann, F. (2009). Was wirkt in der Kognitiven Verhaltenstherapie der Panikstörung mit Agoraphobie? Ein systematischer Review. Zeitschrift für Psychiatrie, Psychologie und Psychotherapie, 57(3), 161–175.
Leyro, T. M., Zvolensky, M. J., & Bernstein, A. (2010). Distress tolerance and psychopathological symptoms and disorders: A review of the empirical literature among adults. Psychological Bulletin, 136(4), 576–600.
Margraf, J., Barlow, D. H., Clark, D. M., & Telch, M. J. (1993). Psychological treatment of panic—Work in progress on outcome, active ingredients, and follow-up. Behaviour Research and Therapy, 31(1), 1–8.
Mckay, D., & Moretz, M. W. (2008). Interoceptive cue exposure for depersonalization: A case series. Cognitive and Behavioral Practice, 15(4), 435–439.
Melzig, C. A., Michalowski, J. M., Holtz, K., & Hamm, A. O. (2008). Anticipation of interoceptive threat in highly anxiety sensitive persons. Behaviour Research and Therapy, 46(10), 1126–1134.
Meuret, A. E., Ritz, T., Wilhelm, F. H., & Roth, W. T. (2005). Voluntary hyperventilation in the treatment of panic disorder-functions of hyperventilation, their implications for breathing training, and recommendations for standardization. Clinical Psychology Review, 25(3), 285–306.
Mystkowski, J. L., Craske, M. G., & Echiverri, A. M. (2002). Treatment context and return of fear in spider phobia. Behavior Therapy, 33(3), 399–416.
Otto, M. W., Safren, S. A., & Pollack, M. H. (2004). Internal cue exposure and the treatment of substance use disorders: Lessons from the treatment of panic disorder. Journal of Anxiety Disorders, 18(1), 69–87.
Razran, G. (1961). The observable unconscious and the inferable conscious in current soviet psychophysiology. Psychological Review, 68(2), 81–147.
Salkovskis, P. M., Hackmann, A., Wells, A., Gelder, M. G., & Clark, D. M. (2007). Belief disconfirmation versus habituation approaches to situational exposure in panic disorder with agoraphobia: A pilot study. Behaviour Research and Therapy, 45(5), 877–885.
Sanchez-Meca, J., Rosa-Alcazar, A. I., Marin-Martinez, F., & Gomez-Conesa, A. (2010). Psychological treatment of panic disorder with or without agoraphobia: A meta-analysis. Clinical Psychology Review, 30(1), 37–50.
Schmidt, N. B., Richey, J. A., Maner, J. K., & Woolaway-Bickel, K. (2006). Differential effects of safety in extinction of anxious responding to a CO2 challenge in patients with panic disorder. Journal of Abnormal Psychology, 115(2), 341–350.
Schmidt, N. B., & Trakowski, J. (2004). Interoceptive assessment and exposure in panic disorder: A descriptive study. Cognitive and Behavioral Practice, 11(1), 81–92.
Schmidt, N. B., Woolaway-Bickel, K., Trakowski, J., Santiago, H., Storey, J., Koselka, M., et al. (2000). Dismantling cognitive-behavioral treatment for panic disorder: Questioning the utility of breathing retraining. Journal of Consulting and Clinical Psychology, 68(3), 417–424.
Smoller, J. W., Pollack, M. H., Otto, M. W., Rosenbaum, J. F., & Kradin, R. L. (1996). Panic anxiety, dyspnea, and respiratory disease—Theoretical and clinical considerations. American Journal of Respiratory and Critical Care Medicine, 154(1), 6–17.
Tryon, W. W. (2005). Possible mechanisms for why desensitization and exposure therapy work. Clinical Psychology Review, 25(1), 67–95.
Zvolensky, M. J., Lejuez, C. W., Kahler, C. W., & Brown, R. A. (2003). Integrating an interoceptive exposure-based smoking cessation program into the cognitive-behavioral treatment of panic disorder: Theoretical relevance and case demonstration. Cognitive and Behavioral Practice, 10(4), 347–357.
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Gerlach, A.L., Neudeck, P. (2012). Interoceptive Exposure. In: Neudeck, P., Wittchen, HU. (eds) Exposure Therapy. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-3342-2_11
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