Intense fear, terror, panic or dread my leave you feeling physically and emotionally drained to the point where even normal activities may be avoided or curtailed. You may experience a number of distressing or debilitating symptoms including, but not limited to, tightness in the chest, racing heart, difficulty breathing, trembling hands or limbs, racing thoughts or being in a mental fog, or feeling detached from your body. You may have obsessive thoughts and excessive worry, and self-medicate or engage in other behaviors to calm your nerves.
Anxiety and worry are twins. They both refer to one’s personal anticipation of a negative outcome. They are based on thoughts and beliefs related to events past, present and future. They are rooted in past experiences of perceived failure or lack of mastery, which continue to cause emotional and physical distress in everyday living and future expectations.
Anxiety, or worry, are tied not only to negative thoughts and beliefs, but to fear of bodily symptoms or sensations. These symptoms or sensations can lead one to feel scared, threatened and vulnerable which, in turn, may perpetuate or reinforce fear or anxiety. Fear of bodily sensations maintain or increase in the presence of safety-seeking or avoidance behaviors. In denying one’s distressing physical symptoms through avoidance of places where they are likely to occur, one may inaccurately judge or overestimate their severity and the meaning they hold. Likewise, holding negative beliefs about one’s physical symptoms or sensations, increases one’s level of panic which, in turn, means symptoms are more likely to be feared or avoided. Implicit in this process is the concept that if the symptom precedes an experience of anxiety, one’s body then becomes sensitive to it. Put another way, one’s physical symptoms become predictors of fear.
Exposure and Response Prevention (ERP) is one of the most researched and effective treatments for anxiety disorders. It is based on the premise that if you are afraid of something, you must face that fear in order to learn that you can handle it. Avoiding what you fear maintains or increases your anxiety and often generalizes to other situations which lead to new fears, anxieties and avoidance.
Exposure and Response Prevention is based on Cognitive-Behavioral Therapy (CBT). The concept behind CBT is that there are three contributing factors: the way you think, the way you feel, and the way you behave. While many therapies will focus “only on the way you think and feel,” with Exposure and Response Prevention the behavior becomes the main focus when it comes to an anxiety disorder because behavioral change is the true and most meaningful measure of whether or not a person is still anxious. It is through learning how to face your fears and practicing in real-life situations that your anxiety decreases and can eventually extinguish altogether.
The Role of Interoceptive Exposure in Treating Fear of Bodily Sensations
Interoceptive exposure means exposure to bodily sensations. Such exposure is an essential element in the process of gaining a more accurate, or realistic, assessment of the danger they pose. By eliciting fearful body sensations, identifying maladaptive thoughts and beliefs associated with these sensations, and sustaining the feared sensations without avoidance or distraction, a shift can come about whereby these sensations are no longer seen as a threat.
One caveat. Interoceptive exposure exercises are teaching tools for learning more about one’s symptoms of panic. While not dangerous, they will deliberately induce moderate levels of discomfort and as such, it might be normal to want to avoid such uncomfortable sensations in the short-term. However, in the long-term avoidance of uncomfortable sensations only reinforces the very panic one dreads.
Another caveat. Before attempting exposure-based exercises, one should be in generally good health. You may want to check with your physician before attempting interoceptive exposure, which is designed to be uncomfortable but not painful. For example, persons with cardiac conditions, epilepsy or seizures, lung problems or asthma, neck or back conditions, or other physical problems may inadvertently exacerbate, rather than remedy, physical symptoms.
The kinds of interoceptive activities one engages in depends on one’s physical symptoms. For persons with Generalized Anxiety Disorder (GAD), caffeine might be administered to make thoughts race and induce worry about loss of control. Individuals with social anxiety (or social phobia) might deliberately induce sweating before giving a speech.
The aim of interoceptive exposure is to replicate actual symptoms experienced during an anxiety or panic attack and in the process desensitize one’s conditioned response that the physical sensations will cause an attack to occur. The end result is that uncomfortable physical symptoms are seen as just that, uncomfortable, rather than a sign of impending doom or disaster.
Consider how the physical symptoms associated with running five miles on a treadmill might mimic the same symptoms associated with a panic attack. Whereas the panic prone person might make this connection and attribute what they are experiencing as a panic attack, another person may correctly attribute what they’re experiencing as a “normal response” to working out. In the case of running five miles, both participants are experiencing the same symptoms but the anxiety or panic sufferer is adding on negative or catastrophic meaning to their experience.
The good news… interoceptive exposure is part of an arsenal of effective techniques for reducing and, eventually, gaining mastery over anxiety and panic. With the guidance and support of a mental health professional trained in evidence-based treatment of anxiety disorders, you can acquire skills that will enable you to gain mastery over and freedom from whatever is holding you back from living with joy, purpose and meaning.