316 TREATMENT OF SPECIFIC ANXIETY DISORDERS
homework with clients instructed to practice intentionally producing their feared physi-
cal sensations first in neutral and then in anxiety- provoking situations.
Before introducing symptom induction it is important to determine if the client has
any medical contraindications for engaging in the exercise. Of course clients must be
physically able to do the exercise and willing to endure a moderate level of discomfort.
Any medical problems that could be worsened by an induction exercise must be taken
into account by possibly consulting with the client’s family physician. Taylor (2006)
lists various health conditions that would warrant extreme caution when using certain
induction exercises (e.g., lower back pain, pregnancy, postural hypotension, chronic
obstructive lung disease, severe asthma, or cardiac disease).
Table 8.8 presents a list of the most common symptom induction exercises, the
physical sensations evoked by the exercise, and an example of a typical threat misin-
terpretation associated with the symptom. See also Taylor (2000, 2006) and Antony,
Rowa, Liss, Swallow, and Swinson (2005) for a similar list of symptom induction and
exposure exercises.
As can be seen from this table, most of these exercises are very brief and must be
repeated frequently both as within- session demonstrations and as homework assign-
ments. Antony et al. (2005) found that breathlessness/smothering sensations, dizziness
or feeling faint, and pounding/racing heart were the most common physical sensations
elicited by the exercises. Although two- thirds of the panic disorder group in their study
reported at least moderate fear to one or more of the symptom induction exercises, most
exercises produced only a low intensity of symptoms with spinning, hyperventilation,
breathing through a straw, and use of a tongue depressor the most potent exercises.
Other exercises such as quickly raising the head, staring at a light, tensing muscles, run-
ning on the spot, or sitting close to a heater were relatively ineffective.
Hyperventilation and breath holding were the two main symptom induction exer-
cises used with Helen. These proved highly effective because of her fear of suffocation.
Breath holding, in which Helen was encouraged to hold her breath until she felt abso-
lutely compelled to breathe, was a particularly effective intervention that was first dem-
onstrated in session and then assigned whenever she felt anxious about her breathing.
By holding her breath, Helen was challenging her catastrophic view “I can’t breathe”
and by exaggerating the sense of breathlessness the sensation became less frightening.
The intense urge to breathe after a period of holding her breath was powerful evidence
that “not breathing” was extremely difficult to do even when it was intentional. Her
panicogenic belief that “I might just stop breathing and die” was weakened by realizing
that she possessed an intense automatic physiological urge to breathe.
Clinician Guideline 8.11
Within- session symptom induction is a critical therapeutic ingredient for activating panic-
relevant fear schemas and directly challenging the catastrophic misinterpretation of physi-
cal sensations. A solid rationale for symptom induction must be provided. The exercises
are utilized repeatedly throughout treatment and eventually assigned as homework. Some
exercises are more effective than others in provoking physical sensations that are somewhat
similar to naturally occurring panic attacks.