Scoping review of interoceptive exposure in physical and mental health conditions

Farris, S. G., Derby, L., & Kibbey, M. M. (2025). Getting comfortable with physical discomfort: A scoping review of interoceptive exposure in physical and mental health conditions.Psychological Bulletin, 151(2), 131–191. https://doi.org/10.1037/bul0000464

Rationale

Interoceptive exposure (IE), a technique involving the intentional induction of physical symptoms to challenge negative cognitions and avoidance behaviors, was initially developed for panic disorder.

This is done through various exercises or activities (e.g. straw breathing, chair-spinning) that elicit specific bodily responses, such as dizziness, breathlessness, or heart palpitations.

The goal of IE is to help individuals confront and habituate to these uncomfortable sensations, ultimately reducing their fear and avoidance behaviors.

By repeatedly experiencing these sensations in a safe and controlled environment, individuals can learn that they are not dangerous and can be tolerated.

This process helps to break the cycle of fear and avoidance that maintains anxiety disorders.

Research has shown that IE can be effective in reducing anxiety sensitivity and fear of bodily sensations in individuals with panic disorder.

However, IE remains underutilized in clinical practice, and its potential applications beyond panic disorder are not fully understood.

The current review addresses a gap in the literature by systematically examining the transdiagnostic use of IE and providing a comprehensive overview of its applications and efficacy in various conditions.  

Method

• The scoping review followed PRISMA guidelines.
• Databases: PsycINFO, PubMed, and Scopus databases were searched from 1992 to 2022.  
• Search Terms: “interoceptive exposure,” “symptom provocation,” “33% carbon dioxide inhalation,” “biological challenge,” “interoceptive exercise,” “somatic exposure,” “interoceptive sensitivity,” “anxiety sensitivity,” “interoceptive awareness,” “interoceptive attention,” “interoception,” “interoceptive,” “anxiety,” “fear,” “panic,” “exposure therapy,” “exposure,” “cognitive behavioral therapy,” “cognitive therapy,” “behavioral therapy,” “acceptance and commitment therapy,” “mindfulness,” “meditation,” “yoga,” “diaphragmatic breathing,” “controlled breathing,” “paced breathing,” “biofeedback,” “pharmacotherapy,” “medication,” “treatment,” “intervention,” “prevention,” “clinical trial,” “randomized controlled trial,” “case study,” “case series,” “open trial,” “pilot study,” “adults,” “adolescents,” “children,” “older adults,” “humans,” “animals”  
• Inclusion Criteria: Published studies on IE in any condition other than panic disorder.  
• Exclusion Criteria: Unpublished studies, dissertations, and studies focused solely on panic disorder.  
• Studies Included: 132 studies published between 1992 and 2022.  
• Data Extraction: Extracted data included study design, sample size, intervention details, and outcomes.

Results

• Conditions Studied: IE has been studied in a wide range of conditions, including anxiety and related disorders, behavioral health conditions, and medical conditions.  
• Efficacy: The strongest evidence for IE’s efficacy was found when it was used as part of multicomponent CBT treatments for PTSD, health anxiety, irritable bowel syndrome, and benzodiazepine discontinuation.  
• Mechanisms: The mechanisms of IE are not fully understood, but it is thought to work by reducing anxiety sensitivity, promoting extinction learning, and increasing tolerance for physical discomfort.  
• Safety: No serious adverse events were reported in any of the studies reviewed.  

Insight

The findings of this scoping review provide valuable insights into the transdiagnostic applications of IE.

The review highlights the potential of IE to address a wide range of mental and physical health challenges, expanding its clinical utility beyond panic disorder.

This information is crucial for clinicians and researchers seeking to implement and study IE in diverse populations.

The review also underscores the need for further research to fully understand the mechanisms of IE and optimize its delivery in various conditions.  

Clinical Implications

The findings suggest that IE can be a valuable addition to the clinical toolkit for a variety of conditions.

Clinicians should consider incorporating IE into their treatment plans, particularly for individuals with PTSD, health anxiety, irritable bowel syndrome, or those seeking benzodiazepine discontinuation.

It is important to note that IE should be tailored to the individual’s specific needs and concerns, and safety precautions should be taken to ensure the procedure is well-tolerated.  

Strengths

• Comprehensive search strategy
• Inclusion of a wide range of conditions
• Detailed examination of IE protocols and outcomes

Limitations

• Heterogeneity of study designs and outcome measures
• Limited evidence for IE’s efficacy as a stand-alone intervention
• Lack of long-term follow-up data in many studies

Socratic Questions

• How might the findings of this review influence the way clinicians approach the treatment of anxiety and related disorders?
• What are the potential benefits and challenges of incorporating IE into a transdiagnostic treatment framework?
• How can research further explore the mechanisms of IE and optimize its delivery for different conditions?
• What ethical considerations should be taken into account when implementing IE in clinical practice?
• How can the findings of this review be translated into practical recommendations for clinicians and policymakers?