Panic disorder is not really a disorder of panic attacks. It is a disorder of being afraid of them — of monitoring for the next one, and of reading an ordinary racing heart as evidence something is wrong. Treatment that only addresses the thoughts leaves that link intact.
Interoceptive exposure goes at it directly. You produce the sensation on purpose, notice that the catastrophe does not follow, and do it again. Over repetitions the sensation stops meaning what it used to mean. It is unglamorous, it is uncomfortable by design, and it is one of the better-evidenced things in this entire field.
The exercises
Before you start
These exercises deliberately produce real physical sensations. For most people that is safe and it is the active ingredient. For some people it is not. Do not do them if any of these apply to you:
- A heart condition, or chest pain a doctor has not explained
- Asthma, COPD, or another breathing condition
- Epilepsy or a seizure disorder
- Pregnancy
- Uncontrolled high blood pressure
- A recent head, neck or back injury
- Any advice from a doctor to avoid exertion or breath-holding
If you are not sure, ask a doctor first. This is not urgent and it will keep.
How to actually use this
Short and often beats long and rare. A few exercises several times a week does more than one heroic session. Pick the one that produces your feared sensation rather than working through all six — if your panic is about your heart, running on the spot matters more than spinning.
Stay with it until the fear drops rather than until the sensation stops. Ending the moment it gets uncomfortable teaches the opposite of what you want, which is the same reason avoidance keeps panic alive.
When this is the wrong thing
If you are in an acute crisis, this is not the moment — this is practice for ordinary days, not a technique for a bad one. If you have never had a medical workup for symptoms that are new or have changed, get that first. And if a clinician is available to you, doing this with one works considerably better; they will pace it, and pacing is most of the skill.
Sources
Interoceptive exposure is a standard component of cognitive behavioural treatment for panic disorder rather than anything novel to this site. If a therapist you are seeing for panic has not mentioned it, that is a reasonable thing to ask about.
- Anxiety & Depression Association of America — Patient resources and a therapist directory from the main US professional body for anxiety disorders.