Interoceptive Exposure Therapy: What It Is, How It’s Used, & Examples

What Is Interoceptive Exposure Therapy?

Interoceptive exposure therapy is a type of cognitive behavioral therapy (CBT) that focuses on treating panic disorders. People with panic disorder can begin to equate body sensations with the symptoms of panic, which can then trigger anxiety and panic attacks.² Interoceptive exposure allows a person to experience these physical sensations of a panic attack in a safe and controlled environment.

What makes interoceptive exposure therapy uniquely successful is that it targets the physical sensations rather than the feared object itself. For many people with mental conditions like panic disorder, PTSD, or anxiety, the physical sensations are the most distressing part. Many of these physical sensations can not be avoided in everyday life, for instance, feeling winded when walking up stairs.

Somatic symptoms that interoceptive exposure therapy aims to mimic include:

• Hyperventilation
• Increased heart rate
• Shaking
• Chills
• Shortness of breath
• Sweating
• Dizziness
• Lightheadedness or “head rush”

Interoceptive Exposure Vs. In Vivo Exposure

Both interoceptive and in vivo are exposure therapies designed to help a person face their feared situation. Interoceptive exposure therapy allows a person to experience body sensations similar to the physical sensations of a panic attack, while In vivo therapy directly exposes a person to the person, place, or thing that creates anxiety. So whereas interoceptive exposure therapy works with the physical sensations, in vivo exposure involves direct exposure to the object that triggers the distress. For example, a person with a fear of heights would work with the sensation of a racing heart in interoceptive exposure versus standing on a cliff for in vivo.³

What Is the Purpose of Interoceptive Exposure Therapy?

The goal of interoceptive exposure therapy is to end the anxiety spiral that exertion or other physical sensations that mimic panic can cause. For example, when a person experiences physical symptoms that remind them of a panic attack, this can cause them to feel like they are panicking. In turn, this can cause the person to start fearing future panic attacks.

A person who experiences these symptoms may start to equate the physical symptoms with panic, even though they are completely unrelated. For example, a person who is outside on a hot day and starts sweating, which causes them to fear that they are having a panic attack. This type of therapy exposes them to the physical sensation, so can stop fearing it.

What Can Interoceptive Exposure Therapy Treat?

Interoceptive exposure therapy is used to treat panic disorder as well as other disorders that create panic-like symptoms such as shaking, sweating, racing heart, and difficulty breathing. This can also include specific phobias, generalized anxiety, and PTSD.

Interoceptive exposure therapy is used to treat the following disorders:⁴

• Generalized anxiety
• Panic disorder
• Specific phobias
• PTSD
• Substance use disorders

How Does Interoceptive Exposure Therapy Work?

When a person experiences physical sensations similar to a panic attack, such as a racing heart or sweating, this can cause their amygdala to trigger the fight-or-flight response. This makes the sensations more intense and can create panic. The bodily symptoms feel intolerable. Interoceptive exposure therapy works by helping a person tolerate and withstand those bodily sensations without experiencing the resulting anxiety or panic.

Interoceptive Exposure Therapy Examples

Interoceptive exposure therapy involves creating or mimicking the feared physical sensations that a person may equate with anxiety or panic attacks. This can include using exercise to raise the heart rate, inducing hyperventilation, having a person spin around to create dizziness, or being exposed to hot conditions to induce sweating.

Examples of interoceptive exposure therapy include:

• A client is asked to breathe through a straw for 2 minutes while closing their nasal passageway to mimic hyperventilation.
• A client is asked to spin around repeatedly in an office chair to invoke dizziness.
• A client is asked to sit in a hot room or sauna to start sweating.
• A therapist has their client exercise vigorously for two minutes to raise their heart rate.
• A client puts their head between their knees and then stands up quickly to create the sensation of a head rush.

Benefits of Interoceptive Exposure Therapy

Interoceptive exposure therapy can be beneficial because it helps to break the association between physical sensations and mental distress. Many of the sensations are experienced during a panic attack or other mental condition or experienced on a regular basis. For instance, anyone can experience a rapid heart rate or sweating during exercise or find themselves feeling lightheaded if they stand up too fast.

Concerns & Limitations of Interoceptive Exposure Therapy

Since this type of therapy actually induces physical symptoms through the exertion of other means, it may not be a good idea for someone with a medical condition that could be exacerbated. Anyone considering this type of therapy will want to check with their healthcare provider to make sure it is medically safe for them.

Physical conditions that may prevent someone from trying interoceptive exposure therapy include:

• Pregnancy
• Epilepsy
• Heart condition
• Asthma
• High blood pressure
• Vertigo

What to Expect From an Interoceptive Exposure Therapy Session

In the first session, the provider will take a thorough history, make a diagnosis and develop a treatment plan. This includes creating a fear hierarchy, in which the feared body situations are listed and ranked from least to most severe. Treatment duration will vary. In general, exposure therapies are not meant to be long term and a person can expect improvement in weeks or months.

After measuring the distress level with a SUDS scale, the therapist will administer the exposure by creating the feared physical sensations. This can include things like having the client breathe CO2, spin around, or exercise to raise their heart rate. These exercises can also be done at home. The goal is for the client to realize that the sensations are not dangerous and can be tolerated.⁵

Creating A Subjective Unit of Discomfort Scale (S.U.D.S)

An individual will work with their therapist to create a S.U.D.S. that will be used throughout their treatment. A SUDS scale is a subjective measurement that allows a person to determine their level of distress or discomfort and determine whether it is getting better or worse. Usually, this is on a scale of 0 to 10.

How to Find a Specialist for Interoceptive Exposure Therapy

Interoceptive exposure therapy is provided by therapists who are trained and experienced in CBT, specifically exposure therapies. This type of therapy is usually done in an office or clinic setting. An online therapist directory or online therapy platform can be a good choice for helping a person find a therapist specializing in this type of therapy for panic disorder treatment and anxiety treatment.

In My Experience

Interoceptive exposure therapy could be a great option for a person whose fears primarily focus on body sensations. As a trauma therapist, I often work with clients on noticing, describing, and reducing the distress associated with physical sensations. I believe this could be a very helpful tool in conjunction with EMDR and other trauma therapies to desensitize the stress related to somatic experiences.