Let's Talk About Interoceptive Exposure

What is interoceptive awareness and can it play a role in the development of eating disorders?

What is interoceptive exposure and how can it be used in the treatment of eating disorders?

In this podcast episode, Kate Fisch speaks with Dr. Melanie Smith about interoceptive exposure and awareness. She discusses how interoceptive exposure can help assist our clients and develop more effective treatments.

MEET DR. MELANIE SMITH

Melanie Smith, PhD, LMHC, CEDS-S, is the Director of Training for The Renfrew Center. In this role, she provides ongoing training, supervision and consultation to clinicians across disciplines for the purpose of continually assessing and improving competence in the treatment of eating disorders. Dr. Smith is co-author of The Renfrew Unified Treatment for Eating Disorders and Comorbidity Therapist Guide and Workbook (Oxford University Press), is a Certified Eating Disorders Specialist and Approved Supervisor, and is a Certified Therapist & Trainer for the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP). 

Visit Melanie Smith to find out more.

 

IN THIS PODCAST

• What is interoception?

• What is interoceptive awareness?

• How can we use interoceptive exposure to help clients?

• The brain and body image.

 

Where do we start in terms of interoception?

“Let’s start with interoception in and of itself. This is just our body’s internal perception, so our bodily senses of what is happening inside our body.”

Dr. Melanie Smith

Our clients are always looking for as many tools as they can to treat their eating disorder clients. It is important for us, as therapists, to understand all the factors that can influence eating disorders…

“When we think about eating disorder application; our ability to sense if I'm hungry, if I'm full, if my stomach doesn't feel good; all of that is what we're talking about when we're talking about interoception.”

Dr. Melanie Smith

 

What then is interoceptive awareness?

“Interoceptive awareness is the level to which we are consciously aware of the things happening inside our bodies.”

Dr. Melanie Smith

 

It is important to understand what level of interoceptive awareness a client has and how they react to what is happening inside the body, because most of us, most of the time, shouldn’t be (or aren’t) noticing things such as our heart beating or ourselves breathing.

“Heightened levels of interoceptive awareness also results in heightened anxiety about what is happening inside our body. So we might start to overthink it or overinterpret what it means.”

Dr. Melanie Smith

 

How can we use interoceptive exposure to help clients?

 

“The ultimate goal with interoceptive exposure is to intentionally evoke those same unpleasant, uncomfortable sensations. So, we're going to allow ourselves to experience that emotion, allow it to rise, BUT allow it to fall and learn that this is actually something we can tolerate.”

Dr. Melanie Smith

 

Interoceptive exposure seems to align with other methods and skills that we already understand as therapists or clinicians. If we were to think about Mentalizing, Acceptance and Commitment Therapy or Dialectic Behavioral Therapy.

“Those same principles are absolutely at work here, which is why I would suggest it as a wonderful adjunctive that could nicely coincide with any of those treatment approaches.”

Dr. Melanie Smith

 

When was this developed and is there any current research into the method?

 

“The first places you'll see it in the literature as a proposed intervention, from an experimental standpoint, was back in the late 80s, maybe early 90s. But I think in the 80s specifically, it was proposed as a Cognitive behavioral exposure-based intervention for panic disorders.”

“There's also a lot of really interesting evidence out there and people doing more trials with this with individuals with PTSD because when you think about trauma response and the way that trauma is held within the body, and that bodily reaction, you're not going to talk someone out of that. There have been really successful applications with other chronic illnesses and chronic pain.”

Dr Melanie Smith

 

When talking to a family or talking to a client and trying to explain what is happening to us or to your brain start by explaining;

You have your brain which is the organ which Neurologists take care of, and then you have your mind which is a little bit less tangible and it's what us therapists take care of.

One of the issues that we have is that our civilization, which is backed by our minds, has actually evolved faster than our brains have so our brains get activated by perceived threat and still think tigers are chasing us.

It's still our brain, that primitive Caveman Limbic system, deep in the depths of our primitive brain that is not aware that it's not a tiger. That's that overinterpretation of threat. When our brain is not aware that it is not a tiger.

So it is still dropping all of those neurochemicals associated with running for your life. Now our minds are thinking; “there's not a tiger - so why is my heart beating this fast?”.

My heart's beating that fast because my brain told it to because it thinks I'm running from a tiger. 

There's something about that idea of separating the brain from the mind that really helps people understand that they're not defective. They're not doing something wrong, or their loved one isn't doing something wrong or isn't broken.

In fact, you're the opposite of broken. Your brain is working magnificently, it's doing exactly what it's designed to do. Now our mind needs to override that brain part and that feels like such a good starting point.

 

“Those teaching examples and metaphors I think are so brilliant. I literally start with that one, usually the tiger. That's one of my teaching examples.”

Dr. Melanie Smith

 

Let’s talk about what this all looks like in a therapy room and any examples you may have.

“All of the education kind of stuff we just talked about, you have to bring in the room with a client using language that is appropriate developmentally and, again, relationally; like it's not a science class but we are teaching them about science.”

Dr Melanie Smith

 

It is clear that introspective exposure is a tool that therapists and clinicians can incorporate, but as a method of treatment, this is not something you're going to start off with. We need to get past certain stages in therapy and have foundational blocks before we move onto using interoceptive exposure with clients.

This is a fascinating topic and Dr. Melanie Smith provides valuable insights, information and examples throughout the podcast.

To read the article or find the book mentioned in the podcast, follow the links below.

 

RESOURCES MENTIONED AND USEFUL LINKS

Visit National Library of Medicine to read the article mentioned in the podcast.

Visit this  Amazon Link to get the book mentioned in the podcast.

 

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