Mechanisms underlying interoceptive exposure: belief disconfirmation or extinction? A preliminary study

• Published in: Cognitive behaviour therapy Vol. 52; no. 2; pp. 132 - 145
• Main Authors: Ginat-Frolich, Rivkah, Kara-Ivanov, Anna, Strauss, Asher Y., Myers, Ayelet, Huppert, Jonathan D.
• Format: Journal Article
• Language: English
• Published: England Routledge 04-03-2023; Taylor & Francis Ltd
• Subjects: Anxiety; Anxiety - psychology; Anxiety - therapy; Anxiety Disorders - psychology; anxiety sensitivity; Behavior modification; Behavior Therapy; behavioral; Catastrophization - psychology; Catastrophization - therapy; cognitive; Cognitive Behavioral Therapy - methods; Exposure; Extinction (Learning); Humans; Intervention; mechanisms of change; anxiety sensitivity; Exposure; cognitive; mechanisms of change; behavioral
• DOI: 10.1080/16506073.2022.2109511
• EISSN: 1651-2316
• ISSN: 1650-6073

Interoceptive exposure, or exposure to one's feared physical sensations, has been shown to be an important technique in cognitive behavioral therapies for anxiety disorders and related constructs, such as anxiety sensitivity (AS). The current study sought to further clarify the underlying cognitive-behavioral mechanisms of interoceptive exposure in a lab-based, analog study with individuals high in AS. Participants (n = 59) were randomized into three groups: a cognitive-behavioral intervention emphasizing belief disconfirmation (CbI), a behavioral intervention emphasizing exposure (BI), and a control condition. Self-report measures assessing AS, catastrophizing of bodily sensations, and subjective units of distress (SUDS) were collected before, during and after the intervention. Participants also completed online questionnaires at a one-month follow-up. Following the CbI but not BI, a decrease was observed in both AS and catastrophizing interpretations. Furthermore, only the CbI group exhibited a decrease in SUDS ratings, whereas the BI group exhibited a significant increase. Notably, these effects were not maintained at a one-month follow-up. Findings suggest that cognitive interventions without repeated behavioral exposure may be sufficient in reducing self-reported anxiety-related symptoms and catastrophic misinterpretations, though not at maintaining them. This raises questions regarding the role of pure behavioral mechanisms in exposure.