Interoceptive Exercises for Emetophobia: Practical Guide to Tolerating Body Sensations

What Is Interoceptive Exposure?

Interoceptive exposure is a therapeutic technique that involves deliberately inducing feared body sensations to learn that they are not dangerous. In the context of emetophobia, it primarily targets sensations associated with nausea and vomiting.

Why Is This Important in Emetophobia?

People with emetophobia develop a fear of body sensations as much as of vomiting itself:

• Nausea
• Dizziness
• “Knot” in the stomach
• Tight throat
• Intestinal movements
• Sensation of heat

This fear of sensations creates a vicious cycle: the more you fear these sensations, the more attention you pay to them, the more intensely you feel them, the more you fear them.

Goals of Interoceptive Exposure

1. Desensitize to feared physical sensations
2. Learn that these sensations don’t lead to vomiting
3. Develop tolerance to bodily discomfort
4. Reduce hypervigilance to internal signals
5. Break the cycle fear-sensation-fear

Fundamental Principles Before Starting

Recommended Prior Assessment

Before practicing these exercises, it’s recommended to:

• Consult a doctor to rule out any medical condition contraindicating these exercises
• Ideally, be accompanied by a trained CBT therapist
• Assess your baseline anxiety level (SUDs 0-10)
• Identify your most feared sensations

Contraindications

⚠️ Do not practice these exercises if you have:

• Heart problems
• Epilepsy
• Balance problems (inner ear)
• Pregnancy
• Severe respiratory disorders
• Uncontrolled medical conditions

If in doubt, consult your doctor.

Interoceptive Exercises for Emetophobia

Category 1: Dizziness and Vertigo Sensations

Exercise 1: Spinning

Objective: Induce dizziness similar to that felt during nausea

Protocol:

1. Stand with arms spread for balance
2. Spin for 30 seconds to 1 minute
3. Stop and remain standing
4. Observe sensations without fleeing
5. Wait for sensations to naturally diminish

Progression:

• Week 1: 15-20 seconds
• Week 2: 30-45 seconds
• Week 3: 1 minute
• Week 4: 1 minute + standing without support

Expected sensations: Dizziness, slight instability, possible mild nausea

Exercise 2: Rapid Head Movements

Objective: Induce vestibular sensations

Protocol:

1. Seated or standing
2. Turn head from left to right rapidly
3. For 30 seconds
4. Stop and observe

Variation: Looking at ceiling then floor rapidly (neck flexion/extension)

Exercise 3: Head-Down Position

Objective: Pressure sensations and blood flow

Protocol:

1. Bend forward, head toward knees
2. Stay 30 seconds to 1 minute
3. Slowly stand up
4. Observe sensations (dizziness, facial warmth)

Category 2: Respiratory and Chest Sensations

Exercise 4: Straw Breathing

Objective: Sensation of oppression and slight breathing difficulty

Protocol:

1. Take a thin straw
2. Pinch nose closed with fingers
3. Breathe only through the straw for 1 minute
4. Observe restriction sensations
5. Remove straw and breathe normally

Expected sensations: Slight oppression, need for air, possible anxiety

Exercise 5: Controlled Hyperventilation

Objective: Sensations of dizziness, tingling, unreality

Protocol:

1. Seated, breathe rapidly and deeply
2. Through mouth, for 1 minute maximum
3. Stop and observe sensations
4. Slowly return to normal breathing

⚠️ Precautions: This exercise can be intense. Start with 20-30 seconds.

Exercise 6: Breath Holding

Objective: Sensation of oppression and respiratory urgency

Protocol:

1. Inhale normally
2. Hold breath as long as comfortable
3. Exhale and observe sensations

Category 3: Abdominal and Digestive Sensations

Exercise 7: Abdominal Contractions

Objective: Induce sensations in the abdominal area

Protocol:

1. Lying down or seated
2. Strongly contract abdominal muscles
3. Hold 10-15 seconds
4. Release abruptly
5. Observe sensations in belly

Repetitions: 5-10 times consecutively

Exercise 8: Abdominal Pressure

Objective: Stimulate gastric sensations

Protocol:

1. Seated or standing
2. Press firmly on different areas of abdomen
3. Make circular movements
4. Observe sensations (gurgling, movements, slight discomfort)

Exercise 9: Physical Exercise After Eating

Objective: Sensations of gastric movement

Protocol:

1. Eat a light meal
2. Wait 15-20 minutes
3. Do light exercises: brisk walking, jumping in place, gentle ab work
4. Observe sensations without fleeing

Progression:

• Level 1: Normal walking after eating
• Level 2: Brisk walking
• Level 3: Light jumping in place
• Level 4: More intense exercises

Category 4: Throat and Swallowing Sensations

Exercise 10: Gargling

Objective: Sensation in throat area, close to gag reflex

Protocol:

1. Take a sip of water
2. Slightly tilt head back
3. Gargle for 20-30 seconds
4. Spit and observe

Progression: Gradually increase duration

Exercise 11: Light Gag Reflex Stimulation

⚠️ Advanced exercise - use caution

Objective: Tolerance to gagging sensation

Protocol:

1. Brush teeth normally
2. Progressively go further on tongue
3. Observe sensation without panicking
4. Stop before excessive discomfort

Note: Never induce actual vomiting. The goal is to tolerate the sensation, not to vomit.

Suggested Exercise Program

Weeks 1-2: Familiarization

Objective: Identify exercises that produce sensations similar to your fears

Weeks 3-4: Progressive Intensification

Objective: Increase duration and intensity of most relevant exercises

• Practice daily the 3-4 most effective exercises for you
• Increase duration by 25-50%
• Aim for SUDs of 5-7 during exercise

Week 5+: Consolidation and Generalization

Objective: Maintain gains and transfer to real situations

• Continue exercises regularly (3-4x/week)
• Combine with external stimuli exposure (words, images)
• Apply acquired tolerance in daily life

How to Maximize Effectiveness

Before the Exercise

• Don’t use relaxation techniques (the goal is to tolerate discomfort, not avoid it)
• Assess your starting SUDs
• Recall the objective: learning these sensations aren’t dangerous

During the Exercise

• Stay present to sensations
• Don’t flee mentally (dissociation) or physically
• Observe without judging: “I feel dizziness. It’s uncomfortable but not dangerous.”
• Continue until SUDs decrease (at least 50%)

After the Exercise

• Note observations in a journal
• Identify learnings: “I had intense dizziness and didn’t vomit”
• Celebrate progress, even small ones

Common Mistakes to Avoid

1. Using Safety Behaviors

Avoid:

• Breathing deeply to “calm” sensations
• Sitting immediately after exercise
• Drinking water to “make it pass”
• Reassuring yourself (“it’ll be okay, it’ll be okay”)

Do: Passively observe sensations without intervention

2. Stopping Too Early

Problem: Stopping when anxiety is at its peak reinforces fear Solution: Continue until natural SUDs decrease (often 5-15 minutes)

3. Not Practicing Regularly

Problem: Gains fade without regular practice Solution: Minimum 3-4 sessions per week during first weeks

4. Choosing Exercises That Are Too Easy

Problem: No learning if sensations are too mild Solution: Aim for SUDs of 5-7 during exercise (uncomfortable but manageable)

Conclusion: Concrete Tools to Regain Control

Interoceptive exposure is an essential component of emetophobia treatment. By learning to tolerate feared body sensations, you reduce their anxiety-provoking power and break the fear-sensation-fear vicious cycle.

Key points:

• Interoceptive exercises deliberately induce feared sensations
• The goal is learning these sensations aren’t dangerous
• Regular practice is essential for lasting results
• Start progressively and gradually increase intensity
• Ideally, be accompanied by a CBT therapist

These exercises require courage, but they’re an investment in your future freedom. Each session brings you closer to a life where body sensations no longer dictate your choices.

These exercises are presented for informational purposes. For optimal care, consult a CBT-trained psychologist who can adapt the program to your specific situation.