Running as Interoceptive Exposure for Decreasing Anxiety Sensitivity: Replication and Extension

Empirically supported psychosocial treatments for posttraumatic stress disorder (PTSD) all entail some form of trauma-related exposure therapy. Although these treatments are often useful, none are effective for all patients. Even those who respond are often left with residual symptoms. A better understanding of the causes of PTSD may lead to more effective treatments. The present article reviews the nascent but steadily growing research on the role of anxiety sensitivity (fear of arousal-related sensations) in PTSD. Available research suggests that anxiety sensitivity may play an important role and that treatments that directly target anxiety sensitivity (such as interoceptive exposure) may improve outcome, particularly if these treatments are implemented before commencing trauma-related exposure therapy.

Download Full-text

Do Cognitive Reappraisal and Diaphragmatic Breathing Augment Interoceptive Exposure for Anxiety Sensitivity?

Journal of Cognitive Psychotherapy ◽

10.1891/0889-8391.26.3.257 ◽

2012 ◽

Vol 26 (3) ◽

pp. 257-269 ◽

Cited By ~ 20

Author(s):

Brett J. Deacon ◽

James J. Lickel ◽

Elizabeth A. Possis ◽

Jonathan S. Abramowitz ◽

Brittain Mahaffey ◽

...

Keyword(s):

Anxiety Sensitivity ◽

Expressive Writing ◽

Cognitive Reappraisal ◽

Clinical Implications ◽

Single Session ◽

Diaphragmatic Breathing ◽

Interoceptive Exposure ◽

Concurrent Use ◽

The Common

Interoceptive exposure (IE) is an effective procedure for reducing anxiety sensitivity (AS) and the symptoms of panic disorder. However, considerable variance exists in how IE is delivered among clinicians, and the extent to which IE is enhanced by the concurrent use of cognitive reappraisal (CR) and diaphragmatic breathing (DB) is unclear. Participants (N = 58) with high AS were randomly assigned to one of four single-session interventions: (a) IE only, (b) IE 1 CR, (c) IE 1 CR 1 DB, or (d) expressive writing control. IE was superior to expressive writing in reducing AS and associated anxiety symptoms. The addition of CR and DB did not enhance the benefits of IE at either posttreatment or 1-week follow-up. These findings highlight the specific efficacy of IE in reducing AS and call into question the common practice of combining IE with cognitive and breathing strategies. Theoretical and clinical implications are discussed.

Download Full-text

Anxiety Sensitivity, Emotional Intolerance, and Expansion of the Application of Interoceptive Exposure: Commentary on the Special Issue

Journal of Cognitive Psychotherapy ◽

10.1891/0889-8391.22.4.379 ◽

2008 ◽

Vol 22 (4) ◽

pp. 379-384 ◽

Cited By ~ 7

Author(s):

Michael W. Otto

Keyword(s):

Panic Disorder ◽

Anxiety Sensitivity ◽

Special Issue ◽

Interoceptive Exposure ◽

Future Directions ◽

The Core ◽

Wide Range ◽

Novel Applications ◽

Emotional Intolerance

Starting with the success of interoceptive exposure in the treatment of panic disorder and encouraged by the importance of anxiety sensitivity and emotional intolerance for understanding a wide range of conditions, interoceptive exposure techniques have been applied in a variety of new and useful ways. This commentary provides a review of a number of the core themes evident in this special issue on novel applications of interoceptive exposure. Targets and strategies for dissemination are discussed along with research achievements and future directions for inquiry.

Download Full-text

Interoceptive Exposure-Based Cessation Intervention for Smokers High in Anxiety Sensitivity: A Case Series

Journal of Cognitive Psychotherapy ◽

10.1891/0889-8391.22.4.346 ◽

2008 ◽

Vol 22 (4) ◽

pp. 346-365 ◽

Cited By ~ 58

Author(s):

Michael J. Zvolensky ◽

Andrew R. Yartz ◽

Kristin Gregor ◽

Adam Gonzalez ◽

Amit Bernstein

Keyword(s):

Smoking Cessation ◽

Anxiety Sensitivity ◽

Large Scale ◽

Case Series ◽

Series Data ◽

Controlled Clinical Trial ◽

Affective States ◽

Interoceptive Exposure ◽

Smoking Cessation Treatment ◽

Cessation Treatment

The current report presents the underlying rationale and components of an interoceptive exposure-based smoking cessation treatment for anxiety-sensitive smokers. The intervention was pilot-tested on three (female) daily smokers with moderate to high levels of nicotine dependence and high levels of anxiety sensitivity. Results indicated meaningful therapeutic gains in smoking outcome and theoretically expected changes in anxiety sensitivity, distress tolerance, and negative as well as positive affective states. Overall, the present case series highlights a potentially promising way to integrate interoceptive exposure-based treatment with standard smoking cessation treatment for smokers high in anxiety sensitivity. From a treatment development perspective, these case-series data suggest that future study of this intervention in a large-scale (controlled) clinical trial is indicated.

Download Full-text

Mindfulness and Interoceptive Exposure Therapy for Anxiety Sensitivity in Atrial Fibrillation: A Pilot Study

Behavior Modification ◽

10.1177/0145445519877619 ◽

2019 ◽

pp. 014544551987761 ◽

Cited By ~ 2

Author(s):

Megan Oser ◽

Amanda Khan ◽

Meghan Kolodziej ◽

Gabriel Gruner ◽

Arthur J. Barsky ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pilot Study ◽

Behavioral Medicine ◽

Brief Intervention ◽

Anxiety Sensitivity ◽

Exposure Therapy ◽

Proof Of Concept ◽

Interoceptive Exposure ◽

Cardiology Department ◽

Inhibitory Learning

Atrial fibrillation is the most common cardiac arrhythmia and symptoms overlap with physiological sensations of anxiety. Patients with atrial fibrillation can demonstrate anxiety sensitivity even in the absence of actual atrial fibrillation symptoms. Interoceptive exposure is effective in treating anxiety sensitivity, and recently, mindfulness has been proposed as an enhancement strategy to facilitating inhibitory learning in exposure therapy. This pragmatic study piloted a brief mindfulness and interoceptive exposure treatment for anxiety sensitivity in atrial fibrillation. Eight participants with atrial fibrillation and elevated anxiety sensitivity from a hospital cardiology department participated in the treatment. Anxiety sensitivity significantly decreased during the course of the intervention. These initial findings show proof of concept for this brief intervention in a cardiac-specific behavioral medicine setting.

Download Full-text

Repeated Interoceptive Exposure in Individuals With High and Low Anxiety Sensitivity

Behavior Modification ◽

10.1177/0145445518772269 ◽

2018 ◽

Vol 43 (4) ◽

pp. 467-489 ◽

Cited By ~ 4

Author(s):

Katharina Holtz ◽

Alfons O. Hamm ◽

Christiane A. Pané-Farré

Keyword(s):

Anxiety Sensitivity ◽

Interoceptive Exposure

Download Full-text

Two Interventions Decrease Anxiety Sensitivity Among High Anxiety Sensitive Women: Could Physical Exercise Be the Key?

Journal of Cognitive Psychotherapy ◽

10.1891/0889-8391.30.2.131 ◽

2016 ◽

Vol 30 (2) ◽

pp. 131-146 ◽

Cited By ~ 7

Author(s):

Brigitte C. Sabourin ◽

Margo C. Watt ◽

Olav E. Krigolson ◽

Sherry H. Stewart

Keyword(s):

Anxiety Sensitivity ◽

Behavioral Therapy ◽

Clinical Implications ◽

Depression And Anxiety ◽

High Anxiety ◽

Post Intervention ◽

Interoceptive Exposure ◽

Undergraduate Women ◽

Stress Symptoms

A brief group-based cognitive behavioral therapy (CBT), with running as an interoceptive exposure (IE) component, was effective in reducing anxiety sensitivity (AS) levels in undergraduate women (Watt, Stewart, Lefaivre, & Uman, 2006). This study investigated whether the CBT/IE intervention would result in decreases in AS and emotional distress that would be maintained over 14 weeks. Female undergraduates, high (n = 81) or low (n = 73) in AS, were randomized to 3-day CBT plus forty-two 10-min running IE trials (n = 83) or 3-day health education control (HEC) with interactive discussions and problem solving on exercise, nutrition, and sleep (n = 71). The CBT/IE intervention led to decreases in AS, depression, and stress symptoms for high AS participants, which were maintained at 14 weeks. Unexpectedly, HEC participants experienced similar and lasting decreases in AS, depression, and anxiety symptoms. Furthermore, there were no post-intervention differences between CBT/IE and HEC participants in any of the outcomes. Low AS participants experienced few sustained changes. Clinical implications and the possible role of aerobic exercise in explaining outcomes of both interventions are discussed.

Download Full-text

New Evidence on the Construct Validity of the ASI-3 and the Dimensional Conceptualization of Trait Anxiety Sensitivity From IRT Modeling

European Journal of Psychological Assessment ◽

10.1027/1015-5759/a000284 ◽

2017 ◽

Vol 33 (3) ◽

pp. 181-189 ◽

Cited By ~ 2

Author(s):

Christoph J. Kemper ◽

Michael Hock

Keyword(s):

Construct Validity ◽

Anxiety Sensitivity ◽

Latent Class ◽

Dimensional Structure ◽

Sensitivity Index ◽

Response Scale ◽

Established Risk Factor ◽

Irt Models ◽

Level Data ◽

Extreme Response

Abstract. Anxiety Sensitivity (AS) denotes the tendency to fear anxiety-related sensations. Trait AS is an established risk factor for anxiety pathology. The Anxiety Sensitivity Index-3 (ASI-3) is a widely used measure of AS and its three most robust dimensions with well-established construct validity. At present, the dimensional conceptualization of AS, and thus, the construct validity of the ASI-3 is challenged. A latent class structure with two distinct and qualitatively different forms, an adaptive form (normative AS) and a maladaptive form (AS taxon, predisposing for anxiety pathology) was postulated. Item Response Theory (IRT) models were applied to item-level data of the ASI-3 in an attempt to replicate previous findings in a large nonclinical sample (N = 2,603) and to examine possible interpretations for the latent discontinuity observed. Two latent classes with a pattern of distinct responses to ASI-3 items were found. However, classes were indicative of participant’s differential use of the response scale (midpoint and extreme response style) rather than differing in AS content (adaptive and maladaptive AS forms). A dimensional structure of AS and the construct validity of the ASI-3 was supported.

Download Full-text