Assessment & Research

Repeated Interoceptive Exposure in Individuals With High and Low Anxiety Sensitivity.

Holtz et al. (2019) · Behavior modification 2019
★ The Verdict

One repeat of guided hyperventilation erased the extra startle seen in high-anxiety adults.

✓ Read this if BCBAs running exposure therapy for panic or health-anxiety clients.
✗ Skip if Clinicians who work only with autism or intellectual disability and never use interoceptive exposure.

01Research in Context

01

What this study did

Holtz et al. (2019) asked adults with high anxiety sensitivity to hyperventilate in a lab. They also tested adults with low anxiety sensitivity for comparison.

The team measured eye-blink startle right after the first hyperventilation session. They repeated the same task one week later to see if the body reaction changed.

02

What they found

After the first session, high-anxiety adults startled harder than low-anxiety adults. One week later, the high-anxiety group no longer startled more; their defensive response had faded.

In plain words, a single repeat of the scary body sensation was enough to habituate the startle jump.

03

How this fits with other research

CHARNEY et al. (1965) first showed that monkeys can treat an internal gut signal like a cue for food. Katharina’s team moves the same idea to humans and shows the signal itself can lose its punch through exposure.

Dwyer et al. (2023) found that autistic kids do NOT habituate to sounds in the lab. The new study shows anxious adults DO habituate to body cues. The difference is not a flaw; it reflects two clinical groups and two senses.

Petitpierre et al. (2023) tracked olfactory habituation in kids with profound disabilities and saw the same downward curve after a handful of sniffs. Together, the papers say habituation curves can be mapped in almost any modality if you repeat the stimulus.

04

Why it matters

If a client fears panic-like sensations, you can test one brief interoceptive exposure in session and schedule a quick repeat a week later. The second round may already show calmer heart rate, less flinch, and more willingness to stay in the task. No extra gear is needed—just paced breathing and a simple startle probe or pulse check.

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Add a second brief hyperventilation exercise one week after the first and track pulse or blink rate to show the client the body calms down.

02At a glance

Intervention
not applicable
Design
quasi experimental
Sample size
48
Population
anxiety disorder
Finding
positive
Magnitude
medium

03Original abstract

Interoceptive exposure is one component in cognitive behavioral therapy of panic disorder. The present investigation addressed changes in defensive mobilization during repeated interoceptive exposure using a standardized hyperventilation procedure. 26 high and 22 low anxiety sensitive persons (ASI, Peterson & Reiss, 1992) went through two guided hyperventilation and normoventilation procedures, spaced one week apart. Breathing parameters, startle response magnitudes and symptom reports were measured. All participants successfully adhered to the guided breathing procedures. Both groups comparably reported more symptoms during hyperventilation than normoventilation in both sessions. Only high-AS participants displayed potentiated startle magnitudes after the first hyperventilation vs. normoventilation. One week later, when the hyperventilation exercise was repeated, this potentiation was no longer present. Thus, high and low-AS groups no longer differed in their defensive mobilization to symptom provocation. Furthermore, the number of reported baseline symptoms also decreased from session one to session two in the high-AS group. While high-AS reported increased baseline anxiety symptoms in session 1, groups did not differ in session 2. Results indicate a reduction of defensive mobilization during repeated interoceptive exposure.

Behavior modification, 2019 · doi:10.1177/0145445518772269