Interocep-what? Exposure Therapy for Panic Disorder

You probably already know the symptoms of a panic attack: hyperventilation, heart palpitations, dizziness, tingly hands, sweating, chills, shaking, chest pain. For many people, it’s easy to identify what they’re panicking about, whether that’s something outside of them (eg, getting on an airplane) or inside of them (for instance, the thought that your boss is going to fire you). And many times, people have panic attacks without knowing why at all.

Panic attacks can happen anytime, and anywhere. For those that experience them unexpectedly, this can be disorienting and scary. Often, people will pay particular attention to their physical symptoms to try to predict if a panic attack is coming, and your enjoyment of the world goes down by quite a bit. If you’re monitoring your breathing closely, for instance, it’s likely you’re going to start feeling anxious, which would increase your respiration rate… which would make you more anxious, and might induce a panic attack. You weren’t necessarily worried about something, but the worry of panic built and built, and now you’re panicking. People with panic disorder will also often avoid places where they fear they will have a panic attack, and their world gets smaller and smaller.

A lot of approaches to help with panic attacks focus on preventing or managing triggers, relaxation training, and reminding yourself that you’re safe during the panic attack. These are particularly effective if there is a known fear leading to the panic attack.

It gets trickier if you don’t know why you’re panicking. That’s where Interoceptive Exposure comes in: you and your therapist systematically (and slowly, collaboratively, and with your consent), expose you to the unpleasant sensations of a panic attack. For instance, if one of your distressing symptoms is that your heart races, your therapist might have you do some physical activity to expose you to the feared sensation, then notice that you are able to withstand the sensation. If you’re avoiding a particular place, you might also do some physical activity while imaging that place (and work up to doing some jumping jacks while you’re at that place). This is to help your brain learn that perhaps it doesn’t need to interpret your heart racing as dangerous.

Anxiety loves avoidance, while exposure helps you learn that you are able to sit with all the difficult feelings while pursuing the things that important to you. In other words, experience is the best teacher.