250 ASSESSMENT AND INTERVENTION STRATEGIES
a feeling of nausea in your stomach you tear open the envelop. Your eyes immedi-
ately fix on the monthly balance. You can’t believe what you see; your investments
have been practically wiped out! A couple of important investments have gone sour
and your hard- earned investments have been decimated. You feel your legs weaken,
your hands are shaking, and you think you are going to be sick. You drop into the
chair, your heart feels like it is going to explode, and you feel sharp chest pains. You
can’t believe what you see and so you keep looking at the numbers. And yet, there
it is; you’ve lost thousands and thousands of dollars. You realize you are finished,
your investment portfolio is ruined. What will you do now?”Another procedure that has been introduced to enhance imaginal exposure is audio
habituation training. A recording of the fear scenario is made on a CD so that the fear
script is presented repeatedly without interruption. The client is instructed to listen to
the CD and to get into the scenario depicted as fully as possible. The CD is allowed to
play repeatedly for 20–30 minute exposure sessions. It is important that clients make
the CD recording themselves so that they are listening to their own voice. A number of
single-case reports have described the effectiveness of audiotaped exposure for obses-
sional fears in which the audiotape not only enhances the imaginal exposure experience
but reduces the opportunity for clients to engage in covert neutralizing responses that
would undermine the exposure experience (e.g., Headland & McDonald, 1987; Salk-
ovskis, 1983; Thyer, 1985).
Clinician Guideline 7.4
Imaginal exposure is particularly useful in the treatment of OCD, GAD, and PTSD where
the source of anxiety is a thought, image, or memory. Abrupt forms of exposure or f looding
are more often used along with narrative scripts or audiorecordings of the imaginal fear to
ensure sufficient fear activation and reduction in cognitive avoidance.Exposure to Bodily Sensations
Certain physical sensations such as chest pain, shortness of breath, dizziness, nausea,
and the like can elicit, or at least further exacerbate, anxiety because they are errone-
ously misinterpreted in a threatening manner. This catastrophic misinterpretation of
bodily sensations is especially characteristic of panic disorder (Beck, 1988; Beck &
Greenberg, 1988; D. M. Clark, 1986a). As with any fear stimulus, it is important that
clients experience repeated exposure to their anxiety- provoking bodily sensations. This
is accomplished by conducting various “panic induction exercises” that involve deliber-
ate activation of bodily sensations such as overbreathing or hyperventilating, breathing
through a straw, running on the spot, and so on. In cognitive therapy the purpose of
these exposure exercises is to activate fear schemas, in this case fear of bodily sensa-
tions, and provide anxious individuals with experiences that correct their erroneous
symptom equation (e.g., that chest pain = elevated risk of heart attack; Beck & Green-
berg, 1987).
Exposure to bodily sensations in cognitive therapy bears some resemblance to
Barlow’s interoceptive exposure that involves repeated reproduction and exposure to