Interoceptive Exposure Therapy Combined with Trauma‐related Exposure Therapy for Post‐traumatic Stress Disorder: a Case Report

Abstract

Trauma-related exposure therapy is a useful but not universally effective treatment for post-traumatic stress disorder. Anxiety sensitivity may play an important role in this disorder, as it does in panic disorder. Studies have shown that interoceptive exposure therapy reduces anxiety sensitivity in panic disorder. The present case study was a preliminary investigation of the merits of including interoceptive exposure therapy in the treatment of post-traumatic stress disorder, in order to improve treatment outcome for a patient who had no history of panic disorder or panic attacks. Interoceptive exposure therapy (4 sessions) was one component of treatment, combined with trauma-related exposure therapy (4 sessions of imaginal exposure followed by 4 sessions of in vivo exposure). Treatment outcome was assessed with the Clinician-Administered Post-traumatic Stress Disorder Scale, a self-report measure of post-traumatic stress disorder symptoms, and measures of symptoms and cognitions commonly associated with post-traumatic stress disorder. Scores on all outcome measures decreased over the course of treatment, with gains maintained at 1- and 3-month follow-up. Symptoms of anxiety sensitivity and post-traumatic stress disorder decreased during interoceptive exposure therapy. The results indicate that interoceptive exposure therapy is a promising adjunctive intervention for post-traumatic stress disorder. Further research is needed into the merits of combining interoceptive exposure therapy and trauma-related exposure therapy as a means of boosting treatment efficacy.

Enhanced Early Emotional Intrusion Effects and Proportional Habituation of Threat Response for Symptom and Illness Words in College Students with Elevated Health Anxiety

“…It might be possible that strong attentional biases to external threat in HA occur only in interaction with increased arousal (e.g., as a function of acute stressors) and/or a break down of inhibitory abilities in controlled attention, for instance as a consequence of severe depressive states which again increase arousal and decrease working memory resources. The interaction hypothesis of HA and elevated arousal leading to attentional biases could be directly tested in further studies with the help of systematic arousal inductions (e.g., through stress induction procedures or via interoceptive exposure procedures as proposed by Wald and Taylor 2005). Further studies enlightening the details of how health anxious people cognitively react in the face of health threatening information and under what conditions such stimuli interfere with ongoing information processing would bear important implications for choosing appropriate therapeutic interventions such as distraction from or confrontation with anxiety triggers.…”

Heart rate response after emotional picture presentation is modulated by interoceptive awareness

“…Data exists showing that interoceptive awareness is positively related to anxiety measures in healthy subjects (Critchley et al, 2004;Pollatos et al, 2005b). Significant differences in heartbeat perception ability were also observed in different clinical samples: Several studies (Ehlers, 1995;Ehlers et al, 2000;Van der Does et al, 2000;Pineles and Mineka, 2005;Roth et al, 1992;Wald and Taylor, 2005;White et al, 2006;Zoellner and Craske, 1999) have shown that interoceptive awareness is closely associated with many anxiety disorders. For example, Ehlers et al (2000) reported a higher degree of interoceptive awareness in panic patients, and in a similar study with children increased panic symptoms were associated with an enhanced ability to perceive internal physiological cues as measured by a heartbeat perception task (Eley et al, 2004).…”

Interoceptive awareness, anxiety and cardiovascular reactivity to isometric exercise

“…There is some evidence that heartbeat perception correlates with the ability to detect changes in other autonomically innervated organs (Whitehead and Drescher, 1980) and should therefore reflect a general sensitivity for visceral processes. There is confirming data on clinical populations known to have alterations in somatization and body perception like anxiety disorders, depression and eating disorders: Concerning anxiety disorders some studies showed an increased heartbeat perception Pineles and Mineka, 2005;Van der Does et al, 2000;Wald and Taylor, 2005;White et al, 2006;Zoellner and Craske, 1999) while decreased heartbeat perception was found in depressive subjects (Dunn et al, in press).…”

“…Further evidence for a possible relation between cardiovascular reactivity and interoceptive awareness stems from research on the pathophysiology of anxiety disorders (Cameron and Minoshima, 2002). Several studies (Ehlers, 1995;Ehlers et al, 2000;Pineles and Mineka, 2005;Roth et al, 1992;Van der Does et al, 2000;Wald and Taylor, 2005;White et al, 2006;Zoellner and Craske, 1999) have shown that interoceptive awareness is closely associated with anxiety disorders such as panic disorders or social phobia. Concerning panic disorders, Ehlers et al reported a higher degree of interoceptive awareness in panic patients.…”