Interoceptive Exposure for Phobias: Feel Fear and Survive

What is interoceptive exposure and how does it help rid you of phobias?

If you live with fears or phobias, chances are you want to keep yourself as far away from them as possible. Fear can cause high anxiety and can contribute to panic attacks. Living with extreme fears can reduce the quality of your life as you avoid people, places, and situations because of phobias. As anxiety-provoking as the notion of feeling your fear is, doing so is a highly effective way of reducing fear's grip on you. The experience of feeling your fear on purpose in order to reduce the intensity is called interoceptive exposure.

You may have heard of exposure therapy in which you, gradually and in small increments, become exposed to the place or situation where your fear happens--you physically confront your phobia or the object of your fear.

Exposure therapy contrasts with interoceptive exposure, in which you imagine the fear without physically going to the source. You conjure your phobia in your imagination and experience physical, emotional, and cognitive responses. The idea is that as you do this repeatedly, you become desensitized to the physical and emotional sensations you experience when you're dealing with your fear firsthand. You become accustomed to your feelings so they no longer bother you.  Here's how to use interoceptive exposure to survive your fears.

Interoceptive Exposure: Set Yourself Up for Success

Anytime we're dealing with phobias or other fears, we risk increasing anxiety, having a panic attack, or any other experience or feeling that intensifies the fear. Therefore, it's important to be cautious when working with fears. Some things you can do to use interoceptive exposure to reduce your physical and mental reactions to what you're afraid of include:

• Enlist support. Interoceptive exposure is difficult, so it's important to have someone with you as you envision your phobia. They can help you if your fear escalates or you begin to panic, and they can talk about the experience with you afterward. Some people prefer to experience this anxiety treatment with a therapist. 
• Place reminders nearby. Ahead of time, gather objects that ground you, reminding you that right now, the fear isn't real. Right now, you're safe. Your support person can remind you of this and prompt you to hang on to a comfort object. You might use a decorative rock with an inspirational phrase, an item that has special meaning, or anything else that evokes secure, positive thoughts and feelings.
• Use a safe place. You might lie on your bed or on a sofa in your favorite room. The best place is a space that feels secure. 

How to Practice Interoceptive Exposure at Home

This is one example of an interoceptive exposure exercise. Feel free to make adjustments so that interoceptive exposure is custom suited for you. (Note that the amount of time spent on each step varies per person.)

• Get comfortable. Close your eyes and take several slow, deep breaths.
• Visualize a fear. Your support person can also describe or talk about it. Start with something that is only mildly anxiety-provoking. Increase the intensity in subsequent sessions. 
• Stay with your feelings and sensations so you experience them fully. How do you feel physically? What are your emotions? What are your thoughts? Notice your reactions to your fear.
• Use your safety reminders. Grab an object (or your support person can hand you one) and turn your attention to that. Remind yourself that you're safe. 
• Finally, close your eyes again. Return your attention to your breath. Picture yourself in a peaceful place, and meditate on that image while you breathe deeply. 

This example of an interoceptive exposure exercise focused more on emotions than on physical reactions to fear. Other exercises induce the physical symptoms of anxiety and fear (shortness of breath, dizziness, etc.) to help you get used to them so you don't panic when your body reacts to a phobia. 

When you become accustomed to fear, phobias, and anxiety in general, you loosen the grip they have on you and your life. You'll be able to feel your fear and survive until one day, you don't even feel the fear at all. 

Have you tried interoceptive exposure at home or in the therapist's office? How did it work for you?