Brain-Based Therapy with Adults Evidence-Based Treatment for Everyday Practice by Arden & Linford

Author:Arden & Linford
Format: epub
Published: 0101-01-01T00:00:00+00:00

c07_1 09/29/2008 159

Panic Disorder

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Interoceptive exposure (i.e., exposure to stimuli arising within the body) should be offered after cognitive restructuring has begun (Barlow & Craske, 1994; Craske, Meadows, & Barlow, 1994). The subsequent and simultaneous cognitive restructuring and interoceptive exposure works to challenge cognitions arising from exposure (Zuercher-White, 1997). Psy- choeducation helps patients understand why exposure is necessary. Panic can be thought of as a phobia of internal bodily sensations. Interoceptive exposure helps patients habituate to these sensations. The cognitive com- ponent helps them restructure the self-talk and narratives that arise during interoceptive exposure to the physical sensations. From a brain-based perspective, this involves building or rebuilding neural circuits that sup- port adaptive cognitions and letting the procedural schemas associated with avoidance and insecurity disappear through attrition. By restructur- ing cognitions during interoceptive exposure, patients can establish an increased sense of self-efficacy.

Exposure begins in the office or clinic but soon moves into the patient’s outside world. To foster generalization, the exposure exercises should be practiced at home, work, and other places that panic occurs. Repetition is critical to maximize the potential for neural plasticity. When guiding patients through interoceptive exposure, it is best to lead by modeling. Do not tell the patient what to expect. Some examples of interoceptive exercises include:

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