Interoceptive exposure
The session most therapists dilute. You are going to ask a frightened woman to deliberately produce the sensations she has organised her life around avoiding — and to do it first yourself.
What you are practising
- 1Deliver a rationale the patient genuinely accepts, rather than one you have recited
- 2Screen medically before interoceptive provocation
- 3Model the procedure before asking for it
- 4Run repeated trials optimised for expectancy violation rather than for comfort
- 5Notice your own avoidance as it happens
Briefing
Where you are
Session 6. The cognitive work has established that the sensations come first and the catastrophic interpretation second. Her supermarket experiment last week went well: she stayed, did not faint, and rated her belief in "I will faint" down from 85 to 40. She is now ready for the component that does the heaviest lifting in panic treatment.
Before you start
- Cardiac workup: complete and normal, per the referral. Confirm.
- Ask about asthma, epilepsy, pregnancy, and any recent cardiac symptoms.
- Have you done this to yourself? If not, do it before the session.
The case
Maya Ellison
29, she/her, veterinary nurse, lives with her partner
Panic attacks with increasing avoidance of driving, supermarkets and the underground.
Read the full case firstThe phases
- 1
The rationale
Genuine agreement, not compliance.
- 2
The exposure
Model it, then run repeated trials.
- 3
Debrief and generalisation
Extract the learning, and get it out of the room.