Internal Exposure: A Strategy to Reduce the Risk of Unexpected Panic Attacks

Panic attacks can feel overwhelming, leaving us feeling trapped, scared, and helpless. One of the most challenging aspects of living with panic disorder is the fear of another attack. The physical symptoms—racing heart, dizziness, shortness of breath—can quickly send you into a spiral of anxiety, especially if you’ve had a panic attack before. The fear of the symptoms themselves can often trigger another attack, creating a vicious cycle.

But what if there was a way to reduce the power that these physical sensations have over you? Internal exposure is a strategy that can help you gradually desensitize yourself to the physical symptoms of a panic attack, reducing the likelihood of unexpected episodes in the future. This approach involves deliberately confronting the sensations that remind you of panic, helping you become more comfortable with them over time.

In this blog, we’ll explore how internal exposure works, how it can help reduce the risk of panic attacks, and why it's such an effective tool for long-term anxiety management.

Understanding Panic Attacks and the Role of Physical Symptoms

A panic attack is a sudden onset of intense fear or discomfort that is often accompanied by physical symptoms. These can include:

Rapid heartbeat or palpitations
Shortness of breath
Dizziness or lightheadedness
Chest pain or tightness
Trembling or shaking
Nausea or abdominal discomfort
A feeling of choking or being unable to breathe

While these symptoms are scary, they are actually the body’s natural response to stress or fear, triggered by the fight-or-flight response. The body is preparing to react to a perceived threat, even if that threat isn’t real.

For those with panic disorder, the fear of these physical sensations can be overwhelming. The next time the heart starts racing or breathing becomes shallow, it may trigger the thought: "Oh no, I’m having another panic attack!" This thought leads to a cycle of anxiety, and before you know it, a full-blown panic attack is occurring. The fear of experiencing these symptoms can, in itself, increase the likelihood of a panic attack.

What Is Internal Exposure?

Internal exposure is a psychological technique that involves intentionally facing the physical sensations associated with panic attacks. The goal is to gradually get more comfortable with these sensations, so they lose their power to trigger fear and panic. The concept comes from exposure therapy, a well-established approach used in cognitive-behavioral therapy (CBT) for treating anxiety disorders, including panic attacks.

In internal exposure, instead of avoiding the physical symptoms that trigger panic attacks (such as a racing heart or dizziness), you deliberately bring them on in a controlled and safe environment. Over time, this helps you become desensitized to the sensations and decreases the fear response. The more you experience the symptoms without a full panic attack, the less likely it is that your body will respond with panic.

How Internal Exposure Works

Identify Your Triggers: The first step in internal exposure is recognizing the physical symptoms that remind you of past panic attacks. This could be anything from a fast heartbeat to lightheadedness or even feeling a sense of tightness in your chest. Understanding your triggers is key to confronting them in a manageable way.
Gradual Exposure: The idea is to start small and gradually increase the intensity of the sensations. For example, if the thought of a racing heart triggers anxiety, you might begin by focusing on your heartbeat in a calm state. Notice how it feels when your heart beats faster, but remain relaxed and remind yourself that these sensations are not harmful.
Controlled Practice: To increase your comfort with the sensations, you can practice triggering them intentionally. This might involve physical exercises that elevate your heart rate, such as brisk walking or light jogging. As you experience these sensations, focus on staying calm, breathing deeply, and reassuring yourself that the feelings are temporary and won’t lead to a panic attack.
Building Tolerance Over Time: Gradually, your tolerance for these sensations will build. As you continue practicing, you’ll start to recognize that these symptoms are not as scary as they once felt. In fact, your body’s natural stress response is a normal reaction, not a signal that something is wrong.
Managing Anxiety During Exposure: During internal exposure, it’s essential to remain grounded. Use relaxation techniques, like deep breathing or mindfulness, to help you manage any anxiety that arises. The goal is to allow the physical symptoms to arise without becoming overwhelmed by them. Over time, this will help reduce the intensity of the fear response.

Benefits of Internal Exposure for Panic Attacks

Reduced Sensitivity to Physical Symptoms: By repeatedly facing the physical symptoms that once triggered panic attacks, you’ll become less sensitive to them. They’ll start to feel less frightening, and you’ll learn to recognize that they don’t necessarily mean a panic attack is on its way.
Increased Confidence: As you grow more accustomed to the sensations associated with panic, you’ll feel more confident in your ability to handle them. You’ll no longer fear the physical symptoms, which reduces the likelihood of spiraling into a panic attack.
Breaking the Cycle of Fear: One of the most powerful aspects of internal exposure is that it breaks the cycle of fear and avoidance. The fear of panic attacks often comes from avoiding situations where you might experience symptoms. By confronting the symptoms, you eliminate the need for avoidance, which gives you more control over your anxiety.
Reduced Frequency of Panic Attacks: Over time, internal exposure helps reduce the frequency of unexpected panic attacks. As your fear decreases, so does the likelihood that a panic attack will be triggered by the physical symptoms. The more you practice, the less likely these symptoms will result in a full-blown attack.
Empowerment: Learning how to manage and control physical sensations associated with panic attacks can empower you. You’ll feel more in control of your body and your anxiety, which can have a significant positive impact on your overall sense of well-being.

Tips for Practicing Internal Exposure

Start Slow: Don’t overwhelm yourself by trying to face all the symptoms at once. Begin with one symptom, like noticing a racing heart, and work your way up to more challenging sensations, like dizziness.
Be Consistent: Exposure therapy requires consistency. Try to practice your internal exposure exercises regularly, but be kind to yourself if you feel anxious. Progress takes time.
Use Support: It can be helpful to work with a therapist, especially one trained in cognitive-behavioral therapy (CBT), to guide you through the process. They can help you structure your exposure exercises and provide support as you navigate difficult moments.
Focus on Breathing: During internal exposure, practice deep breathing exercises to stay calm. Focus on slow, deliberate breaths to prevent your anxiety from escalating.
Challenge Negative Thoughts: As you confront your symptoms, challenge any catastrophic thoughts you may have, such as “If I feel dizzy, I’ll pass out”. Remind yourself that these physical symptoms are temporary and won’t lead to harm.

Conclusion: Reducing the Fear of Panic Attacks

Internal exposure is a powerful tool in managing panic attacks and reducing the fear of physical symptoms. By gradually getting more comfortable with the sensations that remind you of past panic attacks, you can significantly reduce the risk of experiencing an unexpected attack. Over time, this method helps you break the cycle of fear and avoidance, empowering you to take control of your body’s responses and reduce the impact of anxiety on your life.

If you’ve been struggling with panic attacks, internal exposure may provide the relief and confidence you need to regain control. Be patient with yourself, and remember that small, gradual steps lead to lasting change. With practice, you can reduce the power that panic attacks hold over you and take important steps toward greater peace of mind.