Behavioral Interventions 251
uncomfortable arousal- related bodily sensations (White & Barlow, 2002; Taylor, 2000).
The purpose of interoceptive exposure is fear reduction of specific bodily cues through
repeated exposure (Craske & Barlow, 2001). However, in cognitive therapy these exer-
cises are used differently to activate the fear schemas associated with bodily sensations
and provide corrective evidence against the catastrophic misinterpretations of physical
symptoms. Although interoceptive exposure is most often used in cognitive therapy for
panic disorder, it is relevant for any anxious individual who fears a particular body sen-
sation (Antony & Swinson, 2000a). A more detailed account of this type of exposure
can be found in the next chapter on panic disorder.
Clinician Guideline 7.5
Use exposure to bodily sensations to activate the client’s fear schema by intentionally pro-
ducing the body sensations associated with anxiety in order to provide corrective evidence
against the catastrophic misinterpretation of the sensation. The procedure is used most fre-
quently in the treatment of panic disorder.response preventionResponse prevention involves the deliberate suppression of any coping strategy, such as
a compulsion, neutralization, or other control response performed to alleviate anxiety
or discomfort (D.A. Clark, 2004). As a behavioral intervention, response prevention
is most often used in conjunction with exposure interventions, especially in the treat-
ment of OCD. However, when viewed more broadly as the prevention of maladaptive
coping responses that contribute to the persistence of anxiety, response prevention can
be an important treatment component for any of the anxiety disorders. For instance,
with Maria it was important to reduce her reliance on “controlled” breathing when she
became anxious because it actually intensified her anxious state.
Response prevention is most relevant for addressing the deliberate safety- seeking
strategies that anxious individuals employ during the elaborative phase of anxiety (see
Chapter 2, Figure 2.1). In Chapter 5 we listed 34 behavioral and emotional coping
responses that might be used to neutralize anxiety (see Appendix 5.7). Moreover, highly
anxious individuals often engage in effortful cognitive strategies aimed at alleviating
discomfort such as deliberate thought suppression, rationalization, and the like (see
Appendix 5.9). Response prevention, then, is a robust intervention strategy designed to
eliminate problematic behavioral, that is, emotional and cognitive responses that lead to
premature termination of exposure to a fear stimulus.
In essence any therapeutic intervention that seeks to suppress the expression of
safety- seeking responses in the context of anxiety arousal is a form of response pre-
vention. The goal is to help clients become more aware of their maladaptive coping
responses, suppress these responses, and engage in more adaptive responses to ensure
continued exposure to the fear- eliciting situation. Initially the therapist can model
response prevention in the therapy session and then proceed to coaching the client in
similar coping strategies. The eventual goal is for the client to engage in self- directed
response prevention in the naturally occurring anxious situation.