Anxiety and panic can feel overwhelming, often triggered by sensations within the body that spiral into catastrophic thoughts. For those struggling with panic disorder or anxiety, interoceptive exposure is a groundbreaking technique designed to address and overcome this fear. But what exactly is interoceptive exposure, and why is it so effective? Let’s dive in.

Understanding Interoceptive Exposure

Interoceptive exposure is a form of exposure therapy that specifically targets the internal sensations associated with anxiety and panic. These sensations—such as a racing heart, dizziness, or breathlessness—are common triggers for panic attacks. Rather than avoiding these feelings, interoceptive exposure involves deliberately recreating them in a controlled environment.

The goal is simple but powerful: to teach your brain that these sensations are not dangerous. By repeatedly experiencing them without catastrophic consequences, your brain learns to stop associating these sensations with panic.

How Interoceptive Exposure Works

At its core, interoceptive exposure involves intentionally triggering physical sensations that resemble those experienced during panic. These exercises are done under the guidance of a therapist or as part of a structured self-help plan.

Here are some common interoceptive exposure exercises:

1. Hyperventilation (Respiratory Sensations):
   Breathing rapidly for 30–60 seconds to induce lightheadedness, breathlessness, or dizziness.

2. Spinning in a Chair (Derealization/Disorientation):
   Spinning around to create feelings of dizziness or a sense of unreality.

3. Jumping Jacks or Running in Place (Cardiac Sensations):
   Exercising to elevate the heart rate and mimic the sensation of a racing heart.

4. Straw Breathing (Suffocation Sensations):
   Breathing through a narrow straw to create mild breathlessness.

5. Head Shaking (Vertigo or Disorientation):
   Shaking your head side to side to produce a sensation of lightheadedness or imbalance.

6. Steaming up the Bathroom (Heat and Breathlessness):
   Creating a steamy environment by running hot water in the bathroom, then sitting inside for gradually increasing amounts of time. This exercise replicates feelings of heat, breathlessness, and mild discomfort, providing an opportunity to face and tolerate these sensations.

Each of these exercises targets a specific sensation that may trigger panic, providing an opportunity to face the fear head-on.

Why Interoceptive Exposure is Effective

Anxiety and panic thrive on avoidance and fear of the unknown. When you avoid certain sensations or environments, your brain receives the message that these experiences are dangerous, perpetuating the cycle of fear. Interoceptive exposure disrupts this cycle by:

1. Breaking the Fear-Avoidance Cycle:
   Repeatedly experiencing feared sensations without catastrophic outcomes teaches your brain that these feelings are safe.

2. Building Tolerance for Discomfort:
   By leaning into uncomfortable sensations, you build resilience and reduce sensitivity to them over time.

3. Creating Corrective Experiences:
   Each exposure provides a corrective experience that challenges catastrophic beliefs (e.g., “If my heart races, I’ll have a heart attack”).

4. Enhancing Emotional Regulation:
   As you practice observing sensations without reacting, you develop a calmer response to anxiety-provoking situations.

Addressing Safety Behaviors for Effective Exposure

While interoceptive exposure can be transformative, it’s essential to recognize that it may not work effectively if safety behaviors are not addressed. Safety behaviors are actions or mental strategies used to minimize discomfort during exposure, such as carrying water, sitting near an exit, or continuously monitoring bodily sensations. These behaviors reinforce the belief that the sensations are dangerous and prevent the corrective experience from taking place.

To ensure interoceptive exposure is effective, safety behaviors need to be identified and progressively stripped away. For example:

• If you carry a water bottle to feel safe during exposure, practice leaving it behind as you gain confidence.

• If you repeatedly check your pulse during exercises, work on resisting this behavior to allow the sensations to unfold naturally.

By eliminating safety behaviors, you create an environment where your brain can fully learn that the sensations are harmless.

Combining Interoceptive Exposure with ACT Principles

Interoceptive exposure becomes even more powerful when paired with principles from Acceptance and Commitment Therapy (ACT). ACT encourages you to accept sensations and thoughts as they are, without judgment or resistance. Here’s how ACT complements interoceptive exposure:

1. Acceptance:
   Instead of fighting the sensations during exposure exercises, allow them to be present. For example, if you feel breathless, you might think, “This is uncomfortable, but I can handle it.”

2. Mindfulness:
   Stay present and observe your sensations without attaching meaning to them. Notice the rise and fall of your heart rate or the feeling of lightheadedness as it passes.

3. Defusion:
   If catastrophic thoughts arise (e.g., “I’m going to faint”), label them as thoughts, not facts. Remind yourself, “I’m having the thought that I might faint,” and let it pass.

4. Values-Driven Action:
   Use your values as motivation. For instance, if your goal is to travel more but fear of panic attacks holds you back, interoceptive exposure helps you build the confidence to reclaim that part of your life.

Practical Tips for Interoceptive Exposure

1. Start Small:
   Begin with mild exercises and gradually increase intensity as your tolerance builds.

2. Set a Timer:
   Aim for 30–60 seconds per exercise. This ensures you experience the sensation without overwhelming yourself.

3. Debrief After Each Session:
   Reflect on what you learned. Did your catastrophic fears come true? How did the sensation change over time?

4. Practice Regularly:
   Consistency is key. The more you practice, the faster your brain learns to associate these sensations with safety.

5. Seek Guidance if Needed:
   If you’re unsure where to start or feel overwhelmed, consider working with a therapist experienced in interoceptive exposure.

Final Thoughts

Interoceptive exposure is a transformative tool for overcoming anxiety and panic, targeting the root of the problem: your fear of bodily sensations. By intentionally confronting these sensations in a controlled and compassionate way, you retrain your brain to see them as safe, breaking the cycle of panic.

When paired with ACT principles, interoceptive exposure becomes even more effective, helping you build resilience and live a values-driven life. However, it’s crucial to address and eliminate safety behaviors that can undermine the process. Without these corrective experiences, progress may stall, and the fear may persist.

If you’re ready to take the next step in overcoming anxiety from within, start exploring interoceptive exposure today. With patience, practice, and a willingness to face fear head-on, you can reclaim your freedom and live the life you want.