Overcoming the Fear of Fear by Sherry Stewart

Author:Sherry Stewart [Margo C. Watt, Sherry H. Stewart]
Language: eng
Format: epub
ISBN: 9781608825356
Publisher: New Harbinger Publications

Modifying Behavior to Effectively Cope with Anxiety

One of the ways we can learn “to be in anxiety” (that is, reduce our fears of the sensations associated with anxiety) is to expose ourselves to the feared sensations. Interoceptive exposure refers to repeated exposure to feared physical sensations (such as increased respiration and heart rate) as a means of reducing the fear of those sensations. Interoceptive exposure exercises include hyperventilation (overbreathing), spinning around while standing or while sitting in a swivel chair, and breathing through a narrow straw. Such exercises have been demonstrated effective in treating panic attacks and panic disorder, both as part of a broader cognitive behavioral program (for example, Barlow et al. 2000) and as a useful intervention in their own right (for example, Craske et al. 1997). Interoceptive exposure exercises are intended to direct anxiety-sensitive people to attend to their feared sensations, challenge their catastrophic thoughts about the sensations, and accept their anxiety experiences so that the sensations of physiological arousal no longer provoke panic or avoidance behaviors (see Otto, Powers, and Fischmann 2005).

The goal of interoceptive exposure is habituation. Habituation refers to decreased response to a stimulus after repeated presentations. For example, we often find it hard to sleep in a novel environment because we’re sensitive to the new sounds. After a time, however, we become accustomed to the sounds and pay less attention to the noise, and our response diminishes so that we sleep better. This diminished response is an example of habituation.

There are a number of interoceptive exposure techniques that mental health professionals use to help clients habituate to their feared physical sensations. Some examples of these techniques include hyperventilating or overbreathing for 1 minute, shaking your head from side to side for 30 seconds, spinning around (while standing) for 1 minute, holding your breath for 30 seconds, breathing through a drinking straw for 2 minutes, and placing your head between your knees for 30 seconds and then lifting it quickly to the normal position (see the following table). Each of these techniques is intended to have the anxious person face the physical sensations that make him or her anxious (thereby reducing avoidance behavior) and replace mistaken beliefs about the consequences of these sensations.

Martin Antony and colleagues (2006) examined the relationship between fear of particular physical sensations (physical-concerns items on the Anxiety Sensitivity Index) and reported levels of fear and panic following specific exercises that triggered the most intense physical reactions. Participants included people with panic disorder and nonclinical controls. As expected, results showed that people with panic disorder responded more strongly than controls to symptom-induction exercises. The exercises that produced the most fear included spinning, hyperventilation, breathing through a straw, and using a tongue depressor. Closer examination revealed that the ASI items most strongly associated with a fear response while breathing through a straw were “Unusual body sensations scare me” and “It scares me when I feel shaky.” The ASI item most strongly associated with a fear response while running on the spot was “When I notice my heart is beating rapidly, I worry that I might have a heart attack.

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