Academic journal article Journal of Cognitive Psychotherapy

Introduction to the Special Issue on Interoceptive Exposure in the Treatment of Anxiety and Related Disorders: Novel Applications and Mechanisms of Action

Academic journal article Journal of Cognitive Psychotherapy

Introduction to the Special Issue on Interoceptive Exposure in the Treatment of Anxiety and Related Disorders: Novel Applications and Mechanisms of Action

Article excerpt

Interoceptive exposure (IE) involves having an individual repeatedly induce and experience feared arousal-related sensations (e.g., shortness or breath, heart palpitations, dizziness) as a means of reducing the fear of those sensations. IE exercises such as hyperventilation, chair spinning, and breathing through a straw have been demonstrated effective in the treatment of panic attacks and panic disorder, both as part of a broader cognitive-behavioral program and as a stand-alone intervention. This article introduces a special issue of the Journal of Cognitive Psychotherapy focusing on cutting-edge findings on novel applications of IE in the treatment of anxiety and related disorders and research that begins to investigate IE's mechanisms of action. We set the stage for the following series of six original articles by first providing a historical review of the use of IE in cognitive-behavioral treatments of panic. We then provide a brief overview of the various theoretical perspectives that can be applied to understanding the mechanisms of action of IE in reducing fear of fear: conditioning, cognitive restructuring, emotional processing, self-efficacy, and emotional acceptance. Finally, we provide a brief overview of the articles included in the special issue. This special issue should prove helpful to cognitive-behavioral therapists in improving and expanding their use of IE in clinical practice. The issue also should stimulate additional research on the mechanisms of action of IE to ultimately permit refinement of treatments for anxiety and related disorders and, it is hoped, enhance the efficacy of cognitivebehavioral psychotherapy.

Keywords: interoceptive exposure ; mechanism of action; panic disorder; anxiety disorder; conditioning; cognitive restructuring

A commonly used technique in the cognitive-behavioral treatment of panic disorder is interoceptive exposure (IE). IE refers to having patients repeatedly induce and experience their feared physical sensations (e.g., shortness or breath, heart palpitations, dizziness) as a means of reducing their fear of those sensations (Craske, Barlow, & Meadows, 2000; Schmidt et al., 2000). For example, the therapist might have the patient hold his or her breath to elicit feelings of suffocation, spin around rapidly to induce vertigo, or breathe through a narrow straw to elicit the sensation of "air hunger" (Meuret, Ritz, Wilhelm, & Roth, 2005). IE exercises have been demonstrated effective in the treatment of panic attacks and panic disorder, both as part of a broader cognitive-behavioral program (e.g., Barlow, Gorman, Shear, & Woods, 2000) and as a stand-alone intervention (e.g., Craske, Rowe, Lewin, & Noriega-Dimitri, 1997). In the context of panic treatment, IE strategies are intended to direct patients to attend to the feared sensations, to challenge their catastrophic cognitions, and to accept their anxiety experiences so that the sensations of physiological arousal no longer provoke panic and avoidance behavior (Otto, Powers, & Fischmann, 2005).

HISTORY OF IE

IE has been a component of treatments for panic disorder for half a century, although its role in these treatments has not always been appreciated. For example, Wolpe (1958) included CO 2 inhalations in his early anxiety reduction procedures, the original idea being that the inhalations induced relaxation and thereby promoted the reciprocal inhibition of anxiety. Alternatively, Barlow (2002) suggested that these inhalations may have reduced anxiety by exposing the panic patients to their feared anxiety sensations within the safety of the therapist's office. Bonn, Harrison, and Rees (1971) reported on the effects of lactate infusions administered to 33 patients with "intractable, non-situational anxiety" (i.e., what we would consider panic disorder today). Although none of the patients reported an exact reproduction of their "natural" panic attacks, the treatment did result in a significant decline in "morbid anxiety" levels-a decline that was maintained at 6 weeks posttreatment. …

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