Is Anxiety Sensitivity Getting in the Way of Your Anxiety Treatment?

It is easy for us to become overwhelmed by the physical sensations of anxiety. Fortunately this is a very treatable challenge.

By Ferdinando Palumbo, MSW, LCSW

What is Anxiety Sensitivity?

Franklin D. Roosevelt famously said in his inaugural address, “The only thing we have to fear is fear itself.” Although this axiom was very poignant in a country faced with an economic depression and impending war, as a therapist who treats Anxiety, Phobias, OCD, and Panic Disorder, I often encounter people who fear their fear—or more specifically, their sensations of fear. This is referred to as Anxiety Sensitivity, a construct named by psychologists Steven Reiss and Richard McNally in 1985, which refers to the fear and catastrophic interpretations of anxious sensations. In other words, people with Anxiety Sensitivity not only experience their anxiety as uncomfortable but the fear that it is dangerous, will last forever, or might cause them to “lose their minds.”

Anxiety Sensitivity  exists across anxiety diagnoses, although I would venture to say that most people with Panic Disorder and Agoraphobia suffer from Anxiety Sensitivity which, in those disorders particularly, fuels the problematic avoidance of triggers. If we look at someone who experiences panic attacks with the sensation of a racing heart rate, they may mistakenly think that this sensation means they are in danger of experiencing a cardiac emergency so they avoid triggers that will cause anxiety or increased heart rate and slowly their world shrinks. Unfortunately, this also reinforce the notion that these sensations are dangerous when this is not actually the case.

This can also exist in other disorders. Someone living with OCD , social anxiety, a particular phobia, Posttraumatic Stress Disorder, or any anxiety disorder can also experience Anxiety Sensitivity. Someone with social anxiety, for example,  can find themselves in a position where they not only fear speaking in public for fear of ridicule or judgment, but also because they fear the sensations of anxiety will cause them to “go crazy,” have a heart attack, or some other catastrophe.

How Anxiety Sensitivity Gets in the Way of Getting Better

When we become afraid of the sensations of Anxiety, it makes it much harder to face our fears because not only are we afraid of whatever we are worried about, but we’re also afraid to experience that fear. This is challenging because any competent anxiety therapist will be challenging you to face your fears in a gradual manner which we call Exposure Therapy. However, if in addition to being afraid of public speaking, I’m also convinced that I will have a heart attack from anxiety,  then how much harder will it be to face our fears and go speak in public ? This is how anxiety sensitivity can keep people stuck not progressing in anxiety treatment.

How Do We Treat Anxiety Sensitivity?

Carl Robbins, LCPC, a highly accomplished Anxiety and OCD Therapist based out of  Baltimore, Maryland has described Anxiety Sensitivity as “A sensation plus a story.” I start this paragraph with his description because I think therapists assisting people suffering with Anxiety Sensitivity, have the goal of helping the clients separate the sensation from the catastrophic story of what that sensation means. We do this through primarily two means which I will elaborate on later: interoceptive exposure therapy and cognitive therapy.

Interoceptive Exposure Therapy for Anxiety Sensitivity

Note: It is generally good practice to check with a primary care provider that these sensations are not medically significant before we engage in interoceptive exposures.

If you have read any of my blog posts or know me in real life, you have probably heard me talk about  Exposure Therapy. Exposure Therapy, facing one’s fears in a sustained and consistent manner, is, for me, the True North for anxiety therapists. Research has shown that this is a highly effective treatment for anxiety disorders. Interoceptive Exposure Therapy is when we are focusing exposure treatment on the internal sensations of anxiety rather than imagining a stressful experience (imaginal exposure) or facing avoided stimuli (in vivo exposure).

 In interoceptive exposures, the therapist and client work together collaboratively to identify the specific sensations of anxiety, with a particular focus on the most distressing sensations of anxiety. Then, we practice gradually engaging in exposures that are geared toward replicating the distressing sensations. We do this with the main goals of: 1) testing to see if the belief these sensations are actually dangerous and 2) learning that we can tolerate the discomfort of these unpleasant sensations.

Cognitive Therapy for Anxiety Sensitivity

Cognitive Therapy supposes that when someone is anxious, there are inaccurate inferences and beliefs that lead someone toward dysfunctional, unpleasant emotional states. I think if any of us were to believe that a racing heart meant we were at imminent risk of death we would likely be very anxious and avoidant of stimuli that raise our heart rate or induce anxiety. However, this belief isn’t accurate. We can engage clients in Socratic questioning and cognitive challenging to replace inaccurate beliefs with more accurate and functional beliefs.

In the example of being convinced that a racing heart rate must mean an impending heart attack or death, we would really want to challenge these beliefs. I ask almost all of my anxiety sensitive clients to estimate the number of times they have felt the feared stimuli in question. If someone has experienced this sensation, say, 100 times and this sensation is supposed to be predictive of impending heart attacks and death it’s important to ask how many times this sensation has induced the client to have a heart attack or death. Invariably, when I ask this the answer is always that it has never resulted in heart attack or death.

So as cognitive behavioral therapists, we here at Northern NJ CBT, would ask if you have experienced this sensation 100 times and, so far, it has not induced heart attack or death, is it helpful to tell ourselves that each time we are faced with racing heartrate that we are at death’s door? I would argue this doesn’t seem to be a belief with a lot of evidence, it rather seems like a story based mostly in possibility. A more accurate belief might be something like “this sensation is uncomfortable” rather than “my heart racing is dangerous and I need to stop it immediately.” Now is a rehearsed more accurate belief a magic bullet that cures anxiety sensitivity? No. It is however part of the battle to becoming more comfortable with uncomfortable sensations.

Pulling it All Together

When we combine Cognitive Therapy and Interoceptive Exposure for Anxiety Sensitivity, we have two very powerful tools in learning that the sensations of anxiety are not dangerous. We can purposely recreate any of the feared sensations—racing heart, sweaty palms, chest tightness, dizziness, lightheadedness, and others—scores of times in various scenarios and then evaluate if experiencing these sensations is truly dangerous. When we test our beliefs and hold onto accurate beliefs and dismiss inaccurate beliefs, we can free ourselves from the fear of discomfort and be empowered to face other worries as well.

If you are suffering from Panic Disorder, Agoraphobia, or Anxiety Sensitivity and reside in New Jersey please consider joining my SAFE Group. Email Ferd@NorthernNJCBT.com

If you are a therapist interested in learning more about anxiety treatment, please consider joining my case consultation group every other Wednesday and email me at ferd@NorthernNJCBT.com