What Is Interoceptive Exposure and Why Is My Therapist Asking Me to Breathe Through a Straw?
TL; DR
Interoceptive exposure is a technique used in panic disorder treatment. It involves deliberately triggering the physical sensations of anxiety. This can include a racing heart, dizziness, and shortness of breath. The technique is performed through specific activities like running in place, breathing through a straw, or spinning in a chair. The goal isn't to endure discomfort until it passes. Rather, it’s to repeatedly experience those sensations without catastrophizing them. This teaches the body how to gradually stop treating them as signals of danger. Effectiveness depends on keeping the intensity high enough to actually trigger anxiety. It also requires approaching the discomfort with willingness rather than wishing it away. Over time, clients learn that the sensations themselves aren't the threat. They discover that anxiety can simply be another experience to make room for rather than something they need to escape.
A Powerful Approach to Panic and Anxiety Treatment
Interoceptive exposure is an incredibly powerful tool that most people have never heard of! It is a therapeutic technique involving asking clients to engage in activities that bring up physical sensations. This is helpful for individuals with panic disorder, frequent panic attacks, or those with high sensitivity to anxiety. Anxiety sensitivity can be described as “fear of fear,” or fear or discomfort with the physical symptoms of anxiety.
What is Exposure Therapy?
Exposure therapy is the process of exposing oneself to an anxiety trigger on purpose, without trying to get rid of the anxiety or prevent a feared outcome from occurring. For example, if someone is afraid of spiders, she would expose herself to a (nonvenomous) spider, without doing anything to try to avoid getting bitten. It might start with fake spiders, then dead ones, then live spiders that are small, then a visit to pet a tarantula. Over time, the new experiences add up, and the body learns it doesn’t have to sound the physiological alarm every time any kind of spider appears. The person becomes less anxious as a side effect of this learning. They also learn that they can tolerate the feeling of anxiety.
What Do Interoceptive Exposures Look Like?
It’s the same process with exposure to physical sensations. You identify the physical sensations that scare you, then rank them from least to most challenging, then work through them with repeated exposures until you can experience the discomfort of the sensations without the fear attached to them. It helps people become more tolerant of anxiety in general.
Interoception is your ability to feel sensations from within your body, like your heartbeat, tingling sensations, and the other physical manifestations of anxiety. Interoceptive exposures are exposures to those sensations. How does that work? Well, in sessions at Leap Counseling, we do a bunch of goofy activities to try and cause those feelings to arise. Examples are:
Increased heart rate → going up and down stairs, doing jumping jacks, or running in place
Shortness of breath → breathing through a straw, rapid breathing (do NOT do if epileptic), or holding breath until very uncomfortable
Chest pressure → lie down and place heavy books on chest
Head rush/dizziness → put head between legs and quickly raise head up, shake head back and forth, spin in a chair
Muscle tension → intentionally tense all muscles
Depersonalization (feeling you are not real) → stare at self in mirror for 5 minutes
Derealization (feeling the world is not real) → stare at optical illusion and then look at wall
Choking → wear turtleneck, choker necklace, or place hand around own throat firmly (without squeezing!)
Feeling hot → sit in front of heater
When NOT To Use Interoceptives: Medical Approval Needed
It’s important to rule out any medical problem that would make any of the interoceptive exposure activities unsafe or medically risky. For example, as noted above, intentional rapid breathing (hyperventilation) can cause seizures in some people with epilepsy. Some activities like going up and down stairs might exacerbate pre-existing injuries. If there is any known medical problem, it’s important to consult a medical professional to get approval for the activities before engaging in interoceptive exposures with your anxiety therapist.
Maximizing Effectiveness
Keep the Sensation Strong
When doing interoceptive exposures, it’s important to keep the intensity of the sensation being targeted at a moderate to high level. For example, if doing an exposure to increased heart rate, how fast you should go up and down stairs will depend on how “in shape” you are. The pace of the activity will depend on the individual. It should be fast enough that you experience a rapid heart rate, similar to what a person experiences during typical anxiety or panic. However, it should be slow enough that they can keep it up for as long as needed until the anxiety starts to decrease.
The graph of the sensation intensity and anxiety intensity should look something like this:
Willingness & Acceptance: Changing Your Relationship to Anxiety
It’s often not enough to just endure the physical sensations while still wishing they would just go away. One way this can show up is by “awfulizing” the exposures - focusing on how much it sucked and telling yourself, “That was so awful, I never want to do that again” or, “I hate this, I wish the feelings would just go away.”
An important part of exposure therapy is learning to tolerate, and even welcome, the uncomfortable experiences that come along with anxiety. This is how you change your relationship to the anxiety often associated with panic disorder. Instead of something to be avoided at all costs, it becomes another guest at your table, whose voice you can listen to, or not. Either way, you pull out a chair for it and allow it to just be there.
Ready to Stop Fearing What Your Body Feels? Panic Disorder Treatment in Wauwatosa, WI, Can Help
Panic disorder treatment that includes interoceptive exposure can help you stop dreading your own physical sensations and start relating to them as something you can handle, not something you need to escape. Leap Counseling and Consultation is a Wisconsin-based solo therapy practice led by Dr. Johanna Wood, who specializes in OCD and anxiety disorders, including panic disorder. Dr. Wood uses personalized, evidence-based CBT treatment to help clients deliberately face the sensations that have been driving their panic, build genuine tolerance for discomfort, and change their relationship with anxiety from the inside out. Taking that first step is more manageable than it might feel right now:
Reach out to schedule a free 15-minute consultation to talk through what you've been experiencing
Work one-on-one with an experienced panic disorder therapist in Wauwatosa who knows how to guide interoceptive exposure effectively
Begin facing the physical sensations driving your panic and learn to make room for anxiety instead of running from it
Other Services Dr. Wood Provides Online In Wauwatosa, Wisconsin, and All PSYPACT States
Learning about interoceptive exposure is a powerful first step. Putting it into practice with a skilled therapist is where real change happens. Many people who commit to this kind of work are genuinely surprised by how quickly their relationship with physical sensations can shift, and how much less power anxiety has once they stop treating it as the enemy.
Panic disorder is one of several conditions I treat at my Wisconsin-based online therapy practice. Anxiety sensitivity and panic don't always show up in isolation, and if other concerns are part of your experience, those deserve attention too. I provide therapy for a broad range of anxiety-related conditions, including OCD, Agoraphobia, Generalized Anxiety Disorder, Social Anxiety Disorder, and Phobias. As a licensed psychologist in Wisconsin and all PSYPACT states, I offer specialized online care to clients across many locations.
No matter how long physical sensations have been driving your anxiety and avoidance, that pattern can change. Browse my mental health blog to learn more about panic disorder and reach out whenever you're ready to get started.
About the Author
Dr. Johanna Wood completed her doctoral internship at Rogers Behavioral Health in the OCD and Anxiety Adult Residential Program. This is one of the most intensive anxiety treatment environments in the country. She later became supervisor of the OCD, Anxiety, and Depression Adult Residential Program. That immersive clinical background gave her deep, hands-on experience with the full spectrum of anxiety disorders, including the kind of panic and anxiety sensitivity that interoceptive exposure is designed to address. She earned her PhD in Clinical Psychology from Northern Illinois University and is licensed in Wisconsin and all PSYPACT states. She’s also an active member of the International OCD Foundation, contributing to national education efforts on scrupulosity OCD.
What her credentials don't capture is what it actually feels like to be on the other side of an overactive anxiety system. Having personally navigated the intrusive thoughts and anxiety spiral of relationship OCD, Dr. Wood knows firsthand what it's like when your own body's signals feel threatening rather than neutral. Her own ERP treatment taught her to stop fighting those signals and start making room for them. That lived understanding shapes the way she guides clients through the same uncomfortable but transformative process. Dr. Wood is a Wisconsin-based clinical psychologist whose combination of specialized training and personal insight informs every aspect of the compassionate, evidence-based anxiety care she provides at her online practice.
