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.
Keywords
Conditioned Stimulus Panic Disorder Panic Attack Behavioral Experiment Specific PhobiaReferences
- Abramowitz, J., Deacon, B., & Whiteside, S. P. (2010). Exposure therapy for anxiety: Principles and practice. New York: Guilford Publications.Google Scholar
- 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.CrossRefGoogle Scholar
- 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.PubMedGoogle Scholar
- Barlow, D. H. (1988). Anxiety and its disorders. New York: The Guilford Press.Google Scholar
- Barlow, D. H., & Craske, M. (1989). Mastery of your anxiety and panic. Albany: Greywind.Google Scholar
- Barlow, D. H., & Czerny, J. A. (1988). Psychological treatment of panic. New York: The Guilford Press.Google Scholar
- 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.PubMedCrossRefGoogle Scholar
- 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.Google Scholar
- 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.PubMedGoogle Scholar
- Bonn, J. A., Harrison, J., & Rees, W. L. (1971). Lactate-induced anxiety: Therapeutic application. The British Journal of Psychiatry, 119(551), 468–470.PubMedCrossRefGoogle Scholar
- Bouton, M. E. (2002). Context, ambiguity, and unlearning: Sources of relapse after behavioral extinction. Biological Psychiatry, 52(10), 976–986.PubMedCrossRefGoogle Scholar
- Clark, D. M., & Salkovskis, P. (1989). Cognitive therapy for panic and hypochondriasis. Oxford: Pergamon Press.Google Scholar
- 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.Google Scholar
- 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.PubMedCrossRefGoogle Scholar
- 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.CrossRefGoogle Scholar
- Eifert, G. H., & Forsyth, J. P. (2005). Acceptance & commitment therapy for anxiety disorders. Oakland: New Harpinger Publications.Google Scholar
- 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.PubMedCrossRefGoogle Scholar
- Evans, I. M. (1972). Conditioning model of a common neurotic pattern—Fear of fear. Psychotherapy-Theory Research and Practice, 9(3), 238–241.CrossRefGoogle Scholar
- 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.Google Scholar
- 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.PubMedCrossRefGoogle Scholar
- 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.PubMedCrossRefGoogle Scholar
- Goldstein, A. J., & Chambless, D. L. (1978). Reanalysis of agoraphobia. Behavior Therapy, 9(1), 47–59.CrossRefGoogle Scholar
- 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.PubMedCrossRefGoogle Scholar
- 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.PubMedCrossRefGoogle Scholar
- Hermans, D., Craske, M. G., Mineka, S., & Lovibond, P. F. (2006). Extinction in human fear conditioning. Biological Psychiatry, 60(4), 361–368.PubMedCrossRefGoogle Scholar
- 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.CrossRefGoogle Scholar
- 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.CrossRefGoogle Scholar
- 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.CrossRefGoogle Scholar
- 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.PubMedCrossRefGoogle Scholar
- 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.PubMedCrossRefGoogle Scholar
- Mckay, D., & Moretz, M. W. (2008). Interoceptive cue exposure for depersonalization: A case series. Cognitive and Behavioral Practice, 15(4), 435–439.CrossRefGoogle Scholar
- 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.PubMedCrossRefGoogle Scholar
- 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.PubMedCrossRefGoogle Scholar
- 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.CrossRefGoogle Scholar
- 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.PubMedCrossRefGoogle Scholar
- Razran, G. (1961). The observable unconscious and the inferable conscious in current soviet psychophysiology. Psychological Review, 68(2), 81–147.CrossRefGoogle Scholar
- 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.PubMedCrossRefGoogle Scholar
- 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.PubMedCrossRefGoogle Scholar
- 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.PubMedCrossRefGoogle Scholar
- Schmidt, N. B., & Trakowski, J. (2004). Interoceptive assessment and exposure in panic disorder: A descriptive study. Cognitive and Behavioral Practice, 11(1), 81–92.CrossRefGoogle Scholar
- 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.PubMedCrossRefGoogle Scholar
- 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.PubMedGoogle Scholar
- Tryon, W. W. (2005). Possible mechanisms for why desensitization and exposure therapy work. Clinical Psychology Review, 25(1), 67–95.PubMedCrossRefGoogle Scholar
- 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.CrossRefGoogle Scholar