Academic journal article Journal of Cognitive Psychotherapy

Physical Exercise as Interoceptive Exposure within a Brief Cognitive-Behavioral Treatment for Anxiety-Sensitive Women

Academic journal article Journal of Cognitive Psychotherapy

Physical Exercise as Interoceptive Exposure within a Brief Cognitive-Behavioral Treatment for Anxiety-Sensitive Women

Article excerpt

A brief cognitive-behavioral treatment intervention that included an interoceptive exposure (IE) component was previously demonstrated effective in decreasing fear of anxiety-related sensations in high anxiety-sensitive (AS) women (see Watt, Stewart, Birch, & Bernier, 2006). The present process-based study explored the specific role of the IE component, consisting of 10 minutes of physical exercise (i.e., running) completed on 10 separate occasions, in explaining intervention efficacy. Affective and cognitive reactions and objective physiological reactivity to the running, recorded after each IE trial, were initially higher in the 20 high-AS participants relative to the 28 low-AS participants and decreased over IE trials in high-AS but not in low-AS participants. In contrast, self-reported somatic reactions, which were initially greater in the high-AS participants, decreased equally in both AS groups over IE trials. Findings were consistent with the theorized cognitive and/or habituation pathways to decreased AS.

Keywords: anxiety sensitivity; physical exercise; interoceptive exposure; cognitive behavioral approach

Anxiety sensitivity (AS) is defined as the fear of anxiety-related bodily sensations arising from beliefs that these sensations have harmful physical, psychological, and/or social consequences (Reiss, 1991). AS is implicated in the development and maintenance of anxiety-related psychopathology, particularly panic disorder (Schmidt, Zvolensky, & Maner, 2006). AS is also a risk factor for other mental health disorders, such as posttraumatic stress disorder (Feldner, Lewis, Leen-Feldner, Schnurr, & Zvolensky, 2006), depression (Taylor, Koch, Woody, & McLean, 1996), and hypochondriasis (Watt & Stewart, 2000).

AS is also associated with physical inactivity. High-AS individuals, compared with low-AS individuals, report a lower frequency of strenuous exercise (McWilliams & Asmundson, 2001), more negative attitudes toward exercise, and a lower likelihood of exercising to cope with stress (T. MacDonald & Watt, 2003). McWilliams and Asmundson proposed two explanations that are not necessarily mutually exclusive for the observed association between AS and physical inactivity. First, high-AS individuals might avoid physical exercise because it produces physiological sensations similar to those feared by these individuals (e.g., elevated heart rate). Alternatively, or in addition, infrequent exercise might lead to higher levels of AS by limiting exposure to arousalrelated sensations.


Previous studies suggest that cognitive-behavioral therapy (CBT) interventions that include an interoceptive exposure (IE) component (i.e., exposure to feared anxiety-related bodily sensations by practicing brief and harmless exercises) are successful in decreasing AS levels in patients with panic disorder (Arntz, 2002; Beck & Shipherd, 1997; Penava, Otto, Maki, & Pollack, 1998; Telch, Schmidt, Jaimez, Jacquin, & Harrington, 1995) and in nonclinical samples of high-AS individuals (Harrington, Telch, Abplanalp, Hamilton, & Austin, 1995). Examples of IE exercises used in these trials have included chair spinning to induce dizziness and breathing through a straw to induce breathlessness.

Several studies have also examined the effects of the individual components of CBT plus IE interventions in patients with panic disorder (Bouchard et al., 1996; Hecker, Fink, Vogel tanz, Thorpe, & Sigmon, 1998). In these studies, cognitive restructuring was conducted without behavioral experiments, or, alternatively, IE exercises were performed without cognitive restructuring. In fact, Bouchard et al.'s IE participants were told that cognitive techniques were ineffective in the treatment of panic disorder. Results suggested that the IE component alone produced outcomes that were equally favorable to cognitive restructuring, with no differences in dropout rates. …

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