Interoceptive Exposure & Panic Attacks: How Facing Physical Sensations Can End the Fear Cycle | Ep. 484

In this episode, I walk you through how panic disorder is maintained and teach you a step-by-step, evidence-based approach using interoceptive exposures to help you change your relationship with anxiety and build true freedom.

In This Episode, I’ll Show You:

• How panic actually works (and why it’s not the first sensation, but your response to it, that keeps the cycle going)
• Why avoiding anxiety symptoms can unintentionally make panic stronger and more persistent
• What interoceptive exposures are and how they target the real fear at the core of panic disorder
• Practical, real-life examples of how to safely practice these exposures at home
• A simple, step-by-step plan to start building confidence in handling uncomfortable sensations
• The mindset shift that helps you move from “I can’t handle this” to “I’ve got this”

How to Practice Interoceptive Exposures for Panic Disorder 

Have you ever felt your heart start to race and then immediately became afraid of your heart racing?

That second moment is often where panic gets locked in.

The first moment is the sensation: a racing heart, dizziness, sweating, tightness in your chest, shortness of breath, or stomach discomfort.

The second moment is the fear of the sensation.

And for many people with panic disorder, that fear becomes the fuel that keeps the panic cycle going.

Today, I want to walk you through a step-by-step plan for practicing interoceptive exposures, which are one of the most effective tools we use to treat panic disorder.

What Happens During a Panic Attack?

Panic often begins with a physical sensation.

Maybe your heart speeds up. Maybe you feel dizzy. Maybe your chest feels tight. Maybe your stomach drops.

That sensation itself is not the problem.

The problem often begins when we interpret that sensation as dangerous.

We might think:

“What if I faint?”

“What if I can’t breathe?”

“What if I’m having a heart attack?”

“What if I lose control?”

Once the brain decides the sensation is dangerous, anxiety rises even higher. Then the panic attack builds. Afterward, you may start worrying about when it will happen again.

That is how panic disorder gets maintained.

The Panic Cycle

The panic cycle often looks like this:

You notice a body sensation.

You interpret that sensation as dangerous.

Your anxiety increases.

The sensations get stronger.

You panic.

Then you become afraid of having another panic attack.

And the next time you feel even a tiny sensation, your brain sounds the alarm again.

Most people with panic disorder are not only afraid of the sensations. They are afraid of panic itself.

Why Avoidance Makes Panic Stronger

Avoidance makes so much sense when you are scared.

If dizziness scares you, you may avoid exercise, spinning, standing too quickly, driving, crowded places, or anything that could make you feel lightheaded.

If a racing heart scares you, you may avoid stairs, workouts, caffeine, intimacy, or stressful conversations.

If shortness of breath scares you, you may avoid anything that makes your breathing feel restricted.

The problem is that avoidance teaches your brain:

“This sensation really is dangerous.”

Every time we avoid, escape, check, seek reassurance, or try to make the sensation go away, we reinforce the belief that panic is something we cannot handle.

And that keeps the cycle alive.

What Are Interoceptive Exposures?

Interoceptive exposures are a structured, evidence-based CBT tool used to treat panic disorder.

“Interoceptive” refers to internal body sensations.

So instead of exposing yourself to an outside situation, like a grocery store or a social event, you practice exposing yourself to the internal sensations you fear.

That might include:

Dizziness.

A racing heart.

Shortness of breath.

Chest tightness.

Disorientation.

Feeling hot.

Feeling shaky.

The goal is not to make the sensations disappear.

The goal is to practice having them on purpose so your brain can learn:

“I can feel this and still be safe.”

“I can feel this and not run away.”

“I can feel this and respond skillfully.”

Examples of Interoceptive Exposures

Every person experiences panic differently, so exposures should be tailored to the sensations that scare you most.

If dizziness is the fear, you might spin in a chair and then practice walking while feeling dizzy.

If shortness of breath is the fear, you might breathe through a thin straw for a short period of time.

If a racing heart is the fear, you might do jumping jacks, pushups, or run in place.

If tightness in the chest is the fear, you might hold your breath briefly or create mild pressure through safe exercises.

If disorientation is the fear, you might move your head side to side or watch visual patterns that create an odd sensation.

These exercises are not meant to punish you or overwhelm you.

They are meant to give you practice feeling the sensations you have been avoiding in a safe, intentional, and skillful way.

A Step-by-Step Plan for Interoceptive Exposures

Step 1: Identify the sensations you fear

Start by asking:

“What body sensations do I try to avoid?”

“What sensations make me think something bad is happening?”

“What sensations make me panic about panic?”

This might be dizziness, nausea, breathlessness, a racing heart, sweating, shaking, or feeling unreal.

Step 2: Build a fear hierarchy

Once you know the sensations, rate each one from 0 to 10.

A 2 or 3 might feel uncomfortable but manageable.

A 9 or 10 might feel very intense.

We usually start with lower-level exposures and work our way up gradually.

Step 3: Practice creating the sensation

Next, choose an exercise that brings on the sensation.

This could be spinning, running in place, breathing through a straw, or another safe practice that mimics the body sensation you fear.

The goal is not to prove you will never panic.

The goal is to practice allowing the sensation without escaping it.

Step 4: Reduce safety behaviors

This part is so important.

During the exposure, we work on reducing the behaviors that keep panic alive.

That means practicing not checking your pulse.

Not seeking reassurance.

Not Googling symptoms.

Not avoiding.

Not ruminating.

Not mentally reviewing whether you are okay.

Instead, we practice saying:

“This is uncomfortable, and I can allow it.”

“I know this sensation.”

“I do not have to do anything about it.”

Step 5: Repeat, repeat, repeat

Interoceptive exposure is not a one-and-done practice.

It works through repetition.

The more you practice, the more your brain learns a new pathway. This is called inhibitory learning.

We are not trying to erase discomfort.

We are building a new relationship with discomfort.

Over time, your brain begins to understand:

“I have felt this before.”

“I know what this is.”

“I can handle this.”

Why This Work Feels Hard

Let’s be honest: interoceptive exposures can feel very uncomfortable.

Your brain may say:

“Nope. Absolutely not.”

“This is dangerous.”

“Make it stop.”

That is part of the process.

Panic disorder wants you to run, avoid, escape, and remove discomfort. But recovery asks us to do something different.

Recovery asks us to lean in with willingness.

Not aggressively. Not harshly. Not without self-compassion.

But with the understanding that freedom often comes from learning we can feel hard things and still be okay.

The Goal Is Freedom, Not Perfect Calm

The goal of interoceptive exposures is not to never feel panic sensations again.

The goal is freedom.

Freedom to exercise.

Freedom to leave the house.

Freedom to feel your heart race without spiraling.

Freedom to feel dizzy without assuming catastrophe.

Freedom to live your life without constantly monitoring your body.

When you practice these sensations on purpose, you teach your brain that they are not emergencies.

They are uncomfortable.

They are intense.

But they are not dangerous in the way panic says they are.

Final Thoughts

If you are struggling with panic disorder, please know this: panic is treatable.

You do not have to spend your life avoiding sensations, places, people, or experiences.

With practice, repetition, compassion, and the right tools, you can learn to respond to panic differently.

This work is hard, but it is also incredibly empowering.

As I always say, it is a beautiful day to do hard things.

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Transcription: Interoceptive Exposure & Panic Attacks: How Facing Physical Sensations Can End the Fear Cycle

You felt your heart start to race, and then you started to notice the fear of your heart racing in that exact moment. That second moment is where you get locked into panic understanding. This is the first step, but today I’m actually going to show you a step by step plan on how to practice interceptive exposures or panic and panic disorder.

 

My name is Kimberly Quinlan. I’m an anxiety and OCD specialist, and I am on a mission to help 10 million people with anxiety. I know in my heart that we can suffer less. The world is hard enough, and I want to make sure that you can manage your anxiety and go and live your life. Spread the love around.

 

There is so much crap on the internet these days about anxiety. So my hope is to give you evidence-based skills where you can help reduce your own suffering with anxiety. So let’s get started. So what actually is happening during a panic attack? Now I wanna explain it by using a graph that we use all the time with our students, and it’s going to start here in the sensations of anxiety.

 

What often happens is something happens and you feel an intense. Increase in sensations of anxiety. It might be a heart rate. It might be you start to sweat, your tummy might start hurting when you have that anxiety. That is the first moment. But then what happens is we catastrophize or we misinterpret those sensations as dangerous.

 

And then the cycle is off and it’s running. And so what happens here is you’ve had this sensation you’ve interpreted as dangerous or problematic, or that it means something, and then you have an even higher increase in anxiety. It’s kind of like you’re telling your brain like, yes, yes, in fact this is dangerous.

 

Then you have an increase in anxiety and then. You move on to have an actual panic attack. Now what happens is once the panic attack has risen and fallen, then you start to have anticipatory anxiety about when you will have the anxiety again, and now the cycle is in full swing. Then next time you have any sensations of anxiety, you do again, catastrophize that and make it mean that something dangerous is about to happen, and then you have even more anxiety.

 

You have an even bigger panic attack. Which again forces you to be even more afraid of the next panic attack. This is the cycle of panic disorder. Most people with panic disorder are afraid of panic. That’s what they’re mostly struggling with. Now, if we look at that cycle, the thing to remember is the sensation wasn’t the problem.

 

The problem is our response and how we interpreted that sensation. And here’s the most critical part. Every time you have that sensation and you avoid it, or at least try to avoid it, you’re actually reinforcing that cycle. The act of avoidance teaches your brain that we actually do need to be afraid of panic, and then your brain reminds you next time you have any kind of anxiety, that danger is on its way and that.

 

Is how panic disorder is maintained. And if you’re stuck in this situation, you’re not alone and it’s not your fault. We just need to make some pivots in how you respond to those physiological sensations that you experience. So let’s go a little deeper and look at why avoidance doesn’t work. Let’s say that you have a sensation of dizziness and you interpret the dizziness as dangerous.

 

You might say, oh my gosh, if I’m dizzy, that might mean I faint. And if I. Faint. I pass out and if I pass out, then bad things will happen and I’ll have to go to the, uh, the hospital or I’ll make a fool of myself. Now, you’ve created an entire narrative that is going to reinforce this idea that anytime you even feel the slightest sensation of dizziness, even degrees that are within normal range.

 

You are going to start to avoid it and reinforce that cycle. Now, there are other ways that we might try to avoid it. We might avoid places and people and locations where you’ve had panic attacks before. You might avoid going to the doctor, going out with friends. You might avoid certain situations that occur at work or school.

 

That avoidance is a subtle nudge to your brain that panic is dangerous and that we shouldn’t have any sensation beyond. Normal. What we end up doing is becoming hypervigilant to any physical sensations in our body and doing whatever we can to avoid those sensations. But once again, avoidance does not reduce panic.

 

It actually fuels it and reinforces it. So what is Interceptive exposures now? Interceptive exposures is a structured, evidence-based cognitive behavioral technique that we use to target this exact problem, this cycle that we get stuck in. The word interceptive refers to your own internal. Bodily sensations.

 

So think about it like when we’re talking about exposure and response prevention, we might expose you to going to the supermarket. We might expose you to reading a story that makes you anxious. Interceptive exposures is where we practice deliberately exposing ourselves to internal sensations. Of discomfort or whatever the panic symptoms are that you are trying to avoid, or the panic sensations that you misinterpret as dangerous and problematic.

 

Now, by doing these interceptive exposures, we actually learn that we can tolerate those feelings, and often we also can learn that those feelings don’t. Always mean that you will go into a full-blown panic attack. Now we’re not really pushing to prove that that’s not the goal. Our main goal is to practice having that sensation on repeat so that we can build mastery over it.

 

So just to be clear, interceptive exposures is a form of exposure and response prevention, but it’s applied to the internal experience. So it’s the same mechanisms. Same practice. It’s just something you do internally to sensations instead of doing it to external experiences. One thing I wanna really highlight here is often by the time clients come to us or students have come over and taken some of our courses they have been to through multiple different types of treatment, maybe more general cognitive behavioral therapy where they’ve been taught to calm down and try to maybe reduce your anxiety, maybe restructure your thinking.

 

There’s nothing wrong with. Those techniques, but what often happens is they’ve missed the actual thing. We are trying to expose them to, they’re going and they’re doing the things in their daily life, but they’re still having this fear response to the physiological experience.

 

Now, as you know, I have a private practice. I have six amazing therapists in Calabasas, California. However, we do not take insurance now, if you are looking for insurance covered OCD or BFRB treatment, I wanna let you know about no cd. No CD provides face-to-face live video sessions with specialized.

 

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I am honored to partner with no cd. I want to remind you that recovery is possible. Please do not forget that now, big hugs, and let’s get back to the show. And so what we wanna do in this case is practice those interceptive exposures so we get at the actual core fear or the actual experience that you’re actually most anxious about.

 

Now, here is some interceptive exposure examples that we use with clients all the time in my private practice. And again, I want you to understand that. Each person is going to be different if every person experiences panic differently, but when we identify the specific experience that they’re having or sensations that they’re having, we can then craft exposures specific to the sensation.

 

That bothers them the most. So an example might be if you have dizziness and it really scares you to have the sensation of dizziness, you might actually sit in a chair just like the one I’m sitting in and spin around and around. And what we’re doing there is we are inducing the sensation of dizziness.

 

Then what we might do is say, okay, we’re gonna practice tolerating that feeling of dizziness. What we might also do is because we want this to be. In real world examples is we might spin around and then I might have my clients leave my office and we might walk the halls and they might practice walking the halls with the sensation of dizziness so that they can learn that they can actually tolerate that feeling.

 

Another one might. Is you’re having a lot of anxiety about kind of that tight chest feeling, feeling like you can’t breathe. We might get some straws, any straw that you would get from the gas station, and we would breathe through that thin straw to induce that experience of shortness of breath. Now, we’re not doing this to actually inflict pain on the person.

 

We’re doing it in a very skillful way. Where we’re saying, okay, how can we simulate this sensation? Not in the actual experience where you’re having panic, but outside of that in your day to day so that you can start to have a better relationship with those sensations and have a better reaction to those sensations.

 

Another one is hyperventilation. In this case, we might actually encourage them to breathe short, rapid breath just for a short period of time. Again, we’re not here to try and induce some. Pain on the person, but we’re trying to give them an opportunity in small short births to experience that feeling in a safe, very, very skillful way.

 

Another one might be, if you’re afraid of that rapid heart rate that happens when you’re anxious. We might do a lot of jumping jacks. We might do some pushups, we might do some sprints, whatever it is that helps you to induce that sensation. Another one might be. Holding your breath if you’re, that’s something that a tightness and the holding of breath, tight chest feeling might be a great and interceptive exposure for you.

 

Another one is if you’re really someone who struggles with disorientation, maybe some dissociation, we might spin your head from side to side. We might watch YouTube videos of bizarre movements that create this sort of weird, spacious, weird sensation for the person. These are all in very creative in Terrace.

 

Perceptive ways that we can expose someone to the specific sensations of panic that they struggle with. If you’re looking for a step-by-step program on how to do these interceptive, let me give you a very brief understanding. First, what we’re gonna do is we’re going to build a fear hierarchy. We’re gonna get very clear about what are the sensations.

 

You don’t like feeling, then we’re going to rate them on out of 10 of how much discomfort or how much fear you have around experiencing those sensations. And we’re probably gonna start in the very low and work our way up to the higher. Then step three is we’re going to practice that in interceptive exposure.

 

We are going to be creative and come up with ways to induce that sensation. And step number four, just like any exposure and response prevention plan. We are going to practice the reduction of safety behaviors. That means that we are not gonna be seeking reassurance. We’re not gonna be avoiding, we’re not gonna be ruminating, we’re not beating ourselves up.

 

We’re not doing any internal checking behaviors. We’re gonna work at just allowing that discomfort. And step number five, and you’ve heard me say this before, is. Repeat. Repeat. It’s not a one and done. It’s something we do over and over and over again so that you can build mastery. Now, what’s actually happening here is a scientific term called inhibitory learning.

 

What’s happening here is. You’re not taking away the discomfort. You’re just getting new neuro pathways. You’re learning new ways that you can handle this discomfort or this sensation. I always think of it like the Rubik’s Cube. When you first start doing it, you’re like, I have no idea. Like I ha I can’t do this.

 

But then after you practice it, you start to build a sense of mastery over your ability to handle this Rubik’s cube and these interceptive are no different. They might seem really complex and almost impossible to start with, but with practice, practice, practice, you will start to feel confident and you’re like, you actually get the hang of it.

 

Like, oh, okay, I can actually handle this Now. The major shift, like I just said, is instead of going, oh my gosh, I can’t handle it. How can I make it go away? We move to, this is uncomfortable. I felt it before. I know what it is. I don’t have to do anything about it. Well, how it translates is if you’re getting really good at doing interceptive in your day to day, when you’re out and about and you do start to experience those sensations, you’ll be able to go, okay, I know this feeling.

 

I know how to, how to handle it. I know how to tolerate it. I’ve had. Practice doing it. Okay, so I know what you’re thinking. Before we move on, I wanna really get to the honesty here. Doing interceptive exposures is genuinely uncomfortable. It is not easy. There will be moments where your brain is like, absolutely like, don’t wanna do this.

 

This is terrible. This. Sucks. How can I run away? How can I avoid? And I totally get it. That is a part of the process. That is the function of panic disorder. It wants you to run away. It wants you to reduce or remove that discomfort, but the best way out of this disordered cycle. Is to lean in, is to willingly have the discomfort, willingly have the sensations that create discomfort for you.

 

As I always say, it is a beautiful day to do hard things. This work is hard, but I promise you that you will not regret your ability to have a sensation and learn to respond in a skillful. Kind, compassionate, and empowered way. The goal of interceptive is not to calm, is not to reduce or remove those sensations forever.

 

It’s really actually more about freedom. It’s about you knowing that you can have any sensation and you’ve already practiced having them on purpose. It’s sort of like. Homework. You know, I know everyone hates homework when you’re in high school or you’re in elementary school, but the reason they give it to you is it reinforces what you’ve learned the first time you do it.

 

Over and over and through that there is this sort of rote. Practice where you’re like, oh, yeah, yeah, yeah, yeah. Like it’s in my head now I know what to do. And by practicing having those sensations, you will have the same experience. Now when you’re ready to go deeper, I would really encourage you to head over to your anxiety and panic toolkit.

 

It is a complete course step-by-step, showing you exactly what I teach my clients with generalized anxiety and panic. It is there for you at CBT score, or you can connect by clicking the link in the show notes now. As always, I wanna thank you for being here. Please do share this with anyone you think this would be helpful for.

 

It is my goal to help as many people as possible, so just know that I’m sending you so much love and I hope you have a beautiful day.

 

Please note that this podcast or any other resources from cbt school.com should not replace professional mental health care. If you feel you would benefit, please reach out to a provider in your area. Have a wonderful day, and thank you for supporting cbt school.com.