Interoceptive exposure in panic disorder

The treatment of panic is based on exposure to the physical sensations of it. However, this must be carried out by a specialist psychologist.

Panic or anxiety attacks are part of that list of frequent reasons why people go for consultation. Normally, these patients are seen by primary care doctors and if nothing organic or physical is found in the examination, they are referred to a specialist in clinical psychology.

On other occasions, The majority, due to lack of professionals, are treated with antidepressants or anxiolytics., without this leading to a substantial improvement in the problem. That is why in this article you will find quality information to go to the specialist on your own, so don’t miss anything.

Characterization of panic disorder

Specifically, the DSM5 tells us about an episode of intense fear or discomfort that is accompanied by a feeling of danger or imminent death with an impulse to escape. It starts abruptly and reaches its peak in the first 10 minutes. It must be accompanied by at least 4 or more symptoms of the 13 that appear:

Palpitations or jerks in the heart – the most common symptom – Sweating. Tremors. Feeling of suffocation. Feeling of choking. Chest tightness. Nausea. Instability or dizziness. Derealization or depersonalization. Fear of losing control or going crazy. Fear of dying. Paresthesias (tingling of the skin). Sensations of chills or hot flashes.

These symptoms, which are nothing more than manifestations of anxiety itself, are experienced with very intense discomfort, as they are usually attributed to physical symptoms or imminent death.

Imagine that you suddenly feel like your heart is “feeling out of your mouth”, that you faint, that you sweat uncontrollably or that you feel like you are drowning. The most normal thing is that you think that something bad is happening to you. Will it be a heart attack? I’m going to die? Am I going crazy?

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If your thoughts go in this direction, what will inevitably happen is that those feelings of fear will increase.. This is what is known as a phobia or fear of fear. Therefore, treatment must be aimed at the interpretation and tolerance of these physical sensations, so that they do not escalate in intensity. We delve into it below.

How does interoceptive exposure work?

In any anxiety disorder, the technique of choice is almost always exposure, but we would be guilty of reductionism if we did not say anything else. Although exposure is an easy technique to describe on a theoretical level, it may not be easy to apply.. In addition, it has a multitude of modalities depending on the problem we encounter.

Exposure in a phobia of flying, which is usually done in imagination or through virtual reality, is not the same as in a panic disorder, which is done interoceptively.

Same technique, same objective, but different procedures. Thus, It is extremely important that the treatment be carried out by a specialist psychologist. If it is not done this way, not only may the problem not go away, but it may even worsen, increasing sensitivity.

The objective of the exposure is to achieve habituation to the phobic stimulus. This stimulus can be something in particular, as occurs in specific phobias, a situation, as occurs in social phobia, or a sensation, as in the issue that concerns us. Habituation is a physiological process that occurs when the person experiences for themselves how the phobic stimulus does not entail the consequences that they initially thought could occur.

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In the case of interoceptive exposure, the fact that the patient is exposed to his physical sensations without carrying out any safety behavior that covers up the discomfort (anxiolytics, going with a family member, drinking water, wearing sunglasses…) works. in the sense that The person internalizes that those sensations are simply that, sensations. In this way the panic is eliminated.

They are not given more value than this because we can see how those premonitions that told us that we were going to have a heart attack are unfounded because they never occur.

Therefore, the clinician, in the office and also outside of it, must encourage the patient to voluntarily provoke feelings of panic. Besides, It is extremely important not to engage in any behavior that makes exposure difficult or facilitates avoidance..

Interoceptive exposure exercises

In general, the procedure consists of generate symptoms for about a minute, through exercises that try to mimic the most common and feared symptoms of a panic attack characteristic of the patient. The most common strategies to achieve this are:

Intentional hyperventilation. It causes a feeling of lightheadedness, derealization, blurred vision and dizziness.Spinning in a swivel chair. The goal is to cause dizziness and loss of orientation.Breathe through a cannula. It causes dyspnea and a feeling of suffocation due to air restriction.Hold your breath. Causes a feeling of suffocation.Running at the exhibition site. It causes increased heart rate, breathing and sweating.Tension of muscle areas. It causes the feeling of being tense and hypervigilant.Move your head from side to side. It causes dizziness and neck tension.

The induction of these symptoms should be done between 3 and 5 times a day -the frequency varies depending on the case; On the other hand, it is more important to get the exposure right once than wrong many times – until, thanks to habituation, the patient begins to see how the level of anxiety is reduced to levels in which he is able to control it.

The patient learns that these internal signals should not be feared because they are not associated with any type of threat. In fact, he himself may deliberately provoke them.

In more advanced phases of the treatment, the patient stops practicing these exercises and performs other more “natural” ones. in their daily environment. For example, doing physical exercise, walking quickly, climbing stairs, entering saunas… In this case, the exercises should not last more than three minutes.

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Final considerations

Although interoceptive exposure is a very effective treatment for panic attacks, We must prioritize the case we have and check if it is necessary to add any other technique or carry out other alternative treatments. Some patients reject this type of exposure because they feel unable to endure until that point where habituation begins.

Secondly, psychoeducation is essential. When the patient understands what is happening to him and recognizes the vicious cycle of his anxiety, he is much more inclined to accept the exposure.