Anxiety sensitivity and interoceptive exposure: A transdiagnostic construct and change strategy
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Recent findings support the relevance of anxiety sensitivity (AS) and interoceptive exposure (IE) across emotional disorders. This study (a) evaluated levels of AS across different anxiety disorders, (b) examined change in AS over the course of transdiagnostic psychological intervention, and its relationship with outcome, and (c) described the implementation of IE to address AS with patients with different anxiety disorders. Participants (N=54) were patients who received treatment with the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) in two consecutive treatment trials. Participants completed a measure of AS at pre- and posttreatment, and multiple occasions during treatment. Symptom severity was assessed at pre- and posttreatment, and clinical information related to physical symptoms and IE were collected as part of routine clinical practice. Elevated AS was observed at pretreatment across diagnoses and decreases in AS were observed from pre- to posttreatment. Similar changes occurred across the diagnostic categories, notably coinciding with the introduction of IE. Change in AS was correlated with reduced symptom levels at posttreatment and 6-month follow-up. Patients with different anxiety disorders endorsed similar physical symptoms and practiced similar IE exercises with similar effects. Results provide preliminary support for the usefulness of IE as a treatment strategy across the spectrum of anxiety disorders, and additional support for the transdiagnostic relevance of AS.
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Interoceptive interventions showed positive effects on fear and anxiety-related disorders, psychosomatic disorders such as irritable bowel syndrome, and phobias.
“Interoceptive interventions showed positive effects on fear and anxiety-related disorders (e.g., [101,102]), psychosomatic disorders such as irritable bowel syndrome [103,104], and phobias [105].”
From Interoceptive Ability and Emotion Regulation in Mind–Body Interventions: An Integrative Review (2024) · cites this paper as [101]
The Abstract (page unavailable) reports preliminary support for interoceptive exposure across anxiety disorders and describes its established use in panic disorder. It does not address irritable bowel syndrome, and it says studies of interoceptive exposure in social phobia were lacking. The claim therefore extends beyond the positive effects this source supports. (LLM, conf=0.86)
Experimental — accuracy not yet measuredInteroceptive exposure therapy is often used clinically to reduce attention to interoceptive cues in those with anxiety and panic disorders.
“Indeed, interoceptive exposure therapy is often used clinically to reduce attention to interoceptive cues in those with anxiety and panic disorders (Boettcher et al., 2016; Boswell et al., 2013).”
From Atypical interoception as a common risk factor for psychopathology: A review (2021) · cites this paper as Boswell et al., 2013
The Abstract says interoceptive exposure is an established CBT strategy for panic disorder, and the Discussion describes its use for patients with and without panic (page numbers unavailable). But the paper describes its aim as increasing tolerance of physical sensations and reducing distress or sensitivity, not reducing attention to interoceptive cues. (LLM, conf=0.88)
Experimental — accuracy not yet measuredReductions in anxiety sensitivity from pre- to post-treatment were associated with lower anxiety at post-treatment and 6-month follow-up.
“and reductions in anxiety sensitivity from pre-to post-treatment were associated with lower anxiety at post-treatment and 6-month followup (Boswell et al., 2013).”
From Within-person changes in aversive reactivity predict session-to-session reductions in anxiety and depression in the unified protocol. (2024) · cites this paper as Boswell et al., 2013
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“Single case experimental design studies found that mindfulness, cognitive flexibility, and anxiety sensitivity were associated with outcome (Boswell, 2013; Boswell et al., 2014; Brake et al., 2016).”
BackgroundCross-Cultural and Gender Invariance of Transdiagnostic Processes in the United States and Singapore
Zainal, N. H., Newman, M. G., & Hong, R. Y. (2021) · Assessment · doi:10.1177/1073191119869832 · Cited by 25 · see citing works
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Dixon, L. J., Lee, A. A., Gratz, K. L., & Tull, M. T. (2018) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2017.10.009 · Cited by 23 · see citing works
Paulus, D. J., Brandt, C. P., Lemaire, C., & Zvolensky, M. J. (2020) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2019.1621929 · Cited by 19 · see citing works
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Shaw, A. M., Halliday, E. R., Tonarely, N. A., & Ehrenreich-May, J. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.10.048 · Cited by 14 · see citing works
The contribution of transdiagnostic vulnerability factors in patients with chronic insomnia
Habibi Asgarabad, M., Doos Ali Vand, H., Salehi Yegaei, P., Hooman, F., Ahmadi, R., Baglioni, C., & Moradi, S. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1162729 · Cited by 10 · see citing works
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“…of uncertainty, and experiential avoidance predicted reductions in anxiety and depression at post-treatment (Khakpoor et al., 2019), and reductions in anxiety sensitivity from pre-to post-treatment were associated with lower anxiety at post-treatment and 6-month follow-up (Boswell et al., 2013).”
BackgroundSelf-citationDas Unified Protocol zur Behandlung emotionaler Störungen
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“, self-induced dizziness, accelerated heart rate and hyperventilation or physical exercises) [79].”
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Interoception and Psychopathology
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- Authors
- Boswell, J. F., Farchione, T. J., Sauer-Zavala, S., Murray, H. W., Fortune, M. R., & Barlow, D. H.
- Affiliations
- Boston University (US)
- Corresponding author
- Boswell, James F.
- Venue
- Behavior Therapy
- Publisher
- Elsevier BV
- Published
- 2013-09
- Volume
- 44
- Issue
- 3
- Pages
- 417-431
- ISSN
- 0005-7894 (ISSN-L)
- PMC
- PMC3727659
- OpenAlex
- W1983317080
- Cited by
- 232
- References
- 64
- Citations by year
- 2026: 10 · 2025: 12 · 2024: 14 · 2023: 16 · 2022: 18 · 2021: 22 · 2020: 18 · 2019: 25 · 2018: 29 · 2017: 15 · 2016: 16 · 2015: 22 · 2014: 12 · 2013: 2
- FWCI
- 23.43
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Behavior Therapy (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R34MH070693, R01MH090053)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- anxiety sensitivity, interoceptive exposure, transdiagnostic treatment, Unified Protocol for Transdiagnostic Treatment of Emotional Disorders, anxiety disorders, somatic symptoms, treatment outcomes, symptom severity
- MeSH terms
- Adult, Anxiety, Anxiety Disorders, Female, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Surveys and Questionnaires, Severity of Illness Index, Cognitive Behavioral Therapy, Treatment Outcome, Self Report
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