The Effectiveness of Interoceptive-Based Interventions to Reduce Adult Anxiety Sensitivity: A Systematic Review

Anxiety sensitivity is defined as the fear of anxiety-related sensations and is linked to the top three preventable causes of disease and death in the US. Interoception is related to anxiety sensitivity and can be addressed by occupational therapists. Interoception encompasses sensing/feeling/noticing, understanding/interpreting, and acting upon one's internal bodily sensations. Interoceptive-based interventions are starting to be used to decrease adult anxiety sensitivity. This review examines the effectiveness of interoceptive-based interventions on adult anxiety sensitivity that can be used by occupational therapists.

Sources: Ovid, CINAHL (EBSCOhost), PsycInfo (Ovid), SCOPUS. Inclusion criteria: interoceptive interventions, persons over age 17 years with anxiety symptoms, level 4 or higher studies, minimum of 14 participants. Exclusion criteria: written before 1999, qualitative, non-peer-reviewed, not available in English, comorbidities or subtypes of anxiety.

Sixteen articles were reviewed, 10 level II studies, one level III-1 study, and four level III-2 studies examining the effect of interoceptive-based interventions on adult anxiety sensitivity. Interventions examined were mindfulness, interoceptive exposure, cognitive behavioral therapy (CBT), and combinations of those. All studies showed significant anxiety sensitivity reduction for participants identified with high anxiety sensitivity. Strong evidence supports the use of mindfulness alone and interoceptive exposure with CBT. Moderate evidence supports interoceptive exposure alone. Insufficient evidence currently supports the use of combinations of interoceptive exposure with mindfulness and of interoceptive exposure with CBT.

Findings support certain interoceptive-based interventions as effective in reducing elevated anxiety sensitivity. More research is needed to examine the less studied combinations, dosages and types of exposures, inclusion of neurophysiological outcome measures, and assessment of long-term effects, and to explore the mechanisms behind this association and its impact on occupational performance and participation.