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Lee, K., Noda, Y., Nakano, Y., Ogawa, S., Kinoshita, Y., Funayama, T., & Furukawa, T. A. (2006). Interoceptive hypersensitivity and interoceptive exposure in patients with panic disorder: specificity and effectiveness. BMC psychiatry, 6, 32. https://doi.org/10.1186/1471-244X-6-32 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1559685/
the nine exercises were designed to elicit a range of physical sensations (1. hyperventilation, 2. shaking head, 3. putting the head between the legs, 4. step-ups, 5. holding breath, 6. body tension, 7. spinning, 8. breathing through a straw, and 9. chest breathing).
The factor analyses revealed four factors, which we named "pseudoneurological fears", "gastrointestinal fears", "cardiorespiratory fears" and "fears of dissociative feelings."
The items that loaded on Factor I were 'numbness in limbs' (item 3), 'fingertip tingling' (item 4), 'other numbness' (item 5), and 'wobbly legs' (item 13). Therefore, Factor I was named "pseudoneurological fears."
The items that loaded on Factor II were 'nausea' (item 9), 'butterflies in stomach' (item 10), 'knots in stomach' (item 11), and 'dry throat' (item 15). Therefore, Factor II was named "gastrointestinal fears."
The items that loaded on Factor III were 'heart palpitations' (item 1), 'pressure in chest' (item 2), 'shortness of breath' (item 6), 'dizziness' (item 7) and 'lump in throat' (item 12). Therefore, Factor III was named "cardiorespiratory fears."
The items that loaded on Factor IV were 'disorientation' (item 16) and 'disconnected from body' (item 17). Therefore, Factor IV was named "fears of dissociative feelings."
For Factor I (pseudoneurological fears), statistically significant correlations were obtained for several interoceptive tasks: 'hyperventilation', 'shaking head', 'holding breath', 'spinning' and 'chest breathing.' For Factor II (gastrointestinal fears), a statistically significant correlation was obtained for 'breathing through a straw.' For Factor III (cardiorespiratory fears), no statistically significant correlations were obtained. For Factor IV (fears of dissociative feelings), a statistically significant correlation was obtained for 'spinning.' 'Hyperventilation', 'shaking head', 'holding breath' and 'chest breathing' were therefore considered to reproduce pseudoneurological symptoms. 'Breathing through a straw' was considered to reproduce gastrointestinal symptoms. 'Spinning' was considered to reproduce both pseudoneurological and dissociative symptoms. None of the interoceptive exercises were considered to reproduce cardiorespiratory symptoms, such as palpitations and shortness of breath.
Among the patients for whom 'hyperventilation' was effective, significant changes in all factors were observed. Among the patients for whom 'holding breath' was effective, a significant change in pseudoneurological fears was observed. Among the patients for whom 'spinning' was effective, significant changes in pseudoneurological, gastrointestinal and cardiorespiratory fears were observed. Among the patients for whom 'chest breathing' was effective significant changes in pseudoneurological, gastrointestinal and cardiorespiratory fears were observed.
'Shaking head', 'spinning' and 'breathing through a straw' were considered to represent pseudoneurological, dissociative and gastrointestinal symptoms, respectively. However, among the patients who performed the 'shaking head' and 'breathing through a straw' exercises, no significant changes between the baseline and endpoint scores were seen for any of the factors. In patients who performed the 'spinning' exercise, no significant change in the baseline and endpoint scores was seen for the 'fears of dissociative feelings' factor.
Respiratory system: shortness of breath, tightness of throat, “I can’t breathe” “I will pass out”. Suggested interoceptive exposure exercise: deliberate hyperventilation, such as breathing rapidly for one minute.
Cardiovascular/circulatory system: heart racing, sweating “I’m going to have a heart attack”. Suggested interoceptive exposure exercise: intense physical exercise, such as running on the spot.
Vestibular system: dizziness, imbalance “I will fall over”. Suggested interoceptive exposure exercise: spinning, such as spinning in an office chair (with eyes open or closed).
Muscle tone: muscle tension, tightness, shaking, imbalance. Suggested interoceptive exposure exercise: muscle tension / applied tension.
Psychological system: feelings of unreality “I’m going mad” “I’m losing my mind”. Suggested interoceptive exposure exercise: staring into a mirror for an extended period.
Temperature / homeostatis system: feeling too hot, sweating “I’m going to pass out”. Suggested interoceptive exposure exercise: staying in a hot room.
Nociceptive system: pain “This is causing permanent damage”. Suggested interoceptive exposure exercise: performing bending and lifting movements.
Various / mixed systems: heart racing, mind racing “I’m going to lose control”. Suggested interoceptive exposure exercise: drinking caffeinated drinks.
Newer understandings of exposure therapy based upon inhibitory learning theory (ILT) place more emphasis upon what exposure to a stimulus can help patients to learn. Exercises can be introduced in an exploratory fashion to assess a patient’s feelings and appraisals, or exercises can be introduced in the context of a behavioral experiment where a patient is invited to test a specific prediction or appraisal. Recent experimental data indicates that there is a dose-effect response with more intensive interoceptive exposure being more effective in reducing anxiety.
A more efficient way of conducting interoceptive exposure is to identify the body sensations of concern to a patient, and to identify their unique appraisals. A therapist might ask “What do you think would happen if you didn’t avoid that feeling?” or “What do you think would happen if that feeling was allowed to continue indefinitely?”. In this way a prediction is generated which can be tested using a behavioral experiment / hypothesis-testing approach.