Interoceptive exposure exercise

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Interoceptive exposure is a part of Cognitive Behavioural Therapy (CBT). The purpose of interoceptive exposure is to replicate the physical sensations of a panic attack, so that you can learn to tolerate them. This will provide you with new associations (such as “palpitations are harmless”), which will compete with the old associations (such as “palpitations are dangerous”) through practice. It is important to emphasize these new associations after each exercise by asking yourself “What did I learn from this exercise?”.

 

Interoceptive exposure: the foundation

There are a number of interoceptive exposure exercises you can try. When an exercise no longer evokes anxiety for a week, you can stop doing the exercise. Take note of the following each time you do an exercise:

  • Write down how anxious you were during the exercise, from 0 (= not at all) to 10 (= very much).
  • Write down to what extent these anxious feelings correspond to the anxiety you feel during a real panic attack, from 0 (= no resemblance) to 10 (= very strong resemblance).
  • Write down what you would expect to happen if you had those same feelings during a real panic attack. For example, what do you expect to happen when your heart rate accelerates, similar to what happens if you do the ‘running on the spot’ exercise?
  • Take note of whether your anxious expectation came true.
  • Ask yourself “what did I learn from this exercise?”.

 

Exercise 1

The aim of this exercise is to stand up for 90 seconds while breathing fast and shallow (hyperventilate). It is an exercise, not a test. Indicate what you feel.

Exercise 2

Shake your head from side to side, gently shaking ‘no’ without forcing your neck. Do this for 30 seconds.

Exercise 3

While seated, keep your head between your knees for 30 seconds and then stand up quickly.

Exercise 4

Run on the spot for 90 seconds.

Exercise 5

Hold your breath for 30 seconds or longer.

Exercise 6

While standing, keep your body in a push-up position against a wall, with bent arms at shoulder height. Maintain this position for 60 seconds. If you have a lot of strength in your upper body and the wall exercise is too easy for you, you can push your body up from the floor and hold the plank position.

Exercise 7

Spin around on an office chair (with your eyes open) for 60 seconds. If there is no chair available, you can also do the exercise by spinning around while standing up.

Exercise 8

Stand up facing a white wall with your face about 6 inches (15 centimetre) away from the wall. Stare at one specific spot on the wall for 90 seconds.

Exercise 9

Breathe through a straw (with your nose closed) for 90 seconds.

The exercises that you find induce physical sensations that resemble a real panic attack or that evoke anxiety will become homework assignments. This means that you will practise these exercises at two or three set times every day. Exercise 1 (hyperventilating) is always a homework assignment, regardless of your anxiety level.

 

Source: Keijsers, G. P. J., Van Minnen, A., Verbraak, M., Hoogduin, C. A. L. & Emmelkamp, P., (2017). Protocollaire behandelingen voor volwassenen met psychische klachten.

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