11. Interoceptive Exposures – Kids

Interoceptive exposures are created by triggering sensations in the body. With many anxiety disorders, feelings are a prominent trigger. This is especially true for emetophobia. Common sensations that may be triggers are stomach and/or throat discomfort, dizziness, lightheadedness, feeling hot, feeling full, any anxiety, etc. I am going to list several ways these sensations might be created. An important difference between these and the previous exposures is that these should be done in a much shorter period of time. Many of them only 30-60 seconds. I will try to note that with the description. You only need to do it long enough to trigger anxiety. Similar to all exposures, these will need repeating until a person can easily tolerate them or the anxiety is significantly reduced.

Usually, I can ask my client if they think it will make them nervous or not. If they are confident it won’t, I typically will move on. However, if there is any chance it might bug them, it is worth a try. Some of these are really easy to create and some might be a bit more complicated. I will list the ones that are very connected to emetophobia first and then follow with those that are likely to trigger anxiety in general.

I usually do these exercises first. Seeing what happens to someone else makes it a bit less risky to try. By the way, don’t overdo these. The last thing you want to do is get dizzy and fall. If you think you might be alarmed, practice before doing it before doing it with your client.

Someone created a video using the sesame street character, Grover, doing several of these. It adds a bit of charm to them (assuming you like Grover). The video is directed toward panic attacks, but it will give you an idea of how they might be done. Some of them may not be relevant for your client.

Interoceptive exposures that might be effective are listed below:

  • Spin around and around for up to one minute. If you have a chair that swivels, such as a desk chair, this is ideal. Otherwise, stand up and turn around quickly (about one turn every three seconds) to make yourself dizzy. Be near a soft chair or couch to sit on after one minute is up. This will produce dizziness and, perhaps, light nausea as well. Twisting up and then spinning and/or swinging if a swing is available is another option (1 minute approximately). Many of these may cause a bit of nausea. Greet that like an old friend. “Oh, hello nausea, I see you are here. I can take this. I have lots of practice.”
  • Wrap something snuggly (like an ace bandage or belt) around the area of the stomach that might bother you. Alternatively, wrap a scarf or tie until it creates some distress. Use one or both if they trigger anxiety. Make it only tight enough to trigger some anxiety. (1-2 minutes to start. Gradually increase the time.)
  • Use your finger or popsicle stick to cause a gag feeling. Just barely cause the feeling. Don’t overdo it. (few seconds)
  • Eat until you feel really full. If you really want to lean into it, watch some challenging videos.
  • Over-breathe for up to one minute—that is, breathe deeply and fast, using a lot of force, as if you were blowing up a balloon. Sit as you do this. This exercise produces unreality, shortness of breath, tingling, cold or hot feelings, dizziness or headache, and other symptoms. (Do not do this exercise if you have epilepsy, seizures, or cardiopulmonary diseases.) (30-60 seconds)
  • Get hot or heat up. You might dress in clothes that will feel hot. Heat up something that you can put on your forehead. You can also exercise vigorously. The type of heat may be very specific. For example, exercise might not trigger anything but feeling you forehead get hot might. Try to reproduce the kind of hot that makes you worry.
  • Smell something that would cause a natural gag reflex like spoiled milk. You can create something that looks or smells like vomit. There are recipes online or you can order the smell on eBay or a similar website. Butyric Acid is what causes the smell and that can be ordered. (few seconds)
  • Swallow rapidly (30-60 seconds)
  • Breathe through a drinking straw for up to 2 minutes. This will produce the feeling of not getting enough air. (1-2 minutes)
  • Place your head between your legs for 30-60 seconds, and then sit up quickly to produce feelings of lightheadedness.
  • Do handstands or hang upside down from a swing or playset. (1-2 minutes)
  • Run in place, lifting your knees up as high as they can to produce racing heart and shortness of breath. (1-3 minutes) You can also run up and down stairs to produce these sensations.

Next step is life situations