Maximizing Efficacy of CBT Therapy for Anxiety: Research Brief
Maximizing Efficacy of Interoceptive Exposure by Optimizing Inhibitory Learning
Behaviour Research and Therapy, 51(9), 2013, 588-596
Panic Attacks occur in over 11% of adults in the United States. Panic Attacks are characterized by a sudden onset of fear or intense discomfort (e.g., accelerated heart rate, sweating, chest pain, dizziness, fear of going crazy or dying). Interoceptive Exposure is an integral part of treatment for Panic Disorder. The treatment simulates the physical sensations of a panic attack, exposing them to their fear and reducing sensitivity to the sensations.
Unfortunately, many practitioners hesitate to use Interoceptive Exposure due to their own fears of harming or overwhelming the patient (Deacon, et. al, 2013). Practitioners often deliver smaller doses of the treatment or avoid it all together.
The results of this study show that more intensive doses of Interoceptive Exposure are more effective. Lower doses, involving reduced frequency and more breaks between exercises, were less effective at reducing anxiety sensitivity. The authors propose that more intensive exposure works by increasing inhibitory learning (e.g., the patient learns they can tolerate the fear and that no actual harm occurs).
Highlights from the Study
“The researchers compared “Basic Interoceptive Exposure” (i.e., 3 sixty-second trials of hyperventilation with 15 seconds to rest between trials) to “Intensive Interoceptive Exposure” (i.e., 8 trials or more of hyperventilation; continued until prediction of feared outcome ratings dropped substantially).
“As hypothesized, the superior efficacy of intensive Interoceptive Exposure…was fully mediated by greater improvement in fear toleration and violation of danger expectancies during the exposure trials.” p. 594
Participants rated the degree to which they found the exposure exercises aversive, acceptable, and likeable. Findings “suggest that fearful individuals are able to accept, tolerate, and benefit from intensive exposure therapy despite perceiving it as moderately aversive.” P. 594
At Feeling Good Institute, we use a model of Cognitive Behavioral Therapy (CBT) that provides warmth and support to clients, but challenges them to face the exposures needed to reach recovery.
Learn about the essential skills for effective cognitive behavior therapy and how we set therapists up for success.
Citation: Deacon B, Kemp JJ, Dixon LJ, Sy JT, Farrell NR, Zhang AR. Maximizing the efficacy of interoceptive exposure by optimizing inhibitory learning: a randomized controlled trial. Behav Res Ther. 2013 Sep;51(9):588-96. doi: 10.1016/j.brat.2013.06.006. Epub 2013 Jul 6. PMID: 23872701.