Hybrid Cognitive Behavioral Therapy With Interoceptive Exposure for Irritable Bowel Syndrome: A Feasibility Study

Reframing Refractory Chronic Cough: The Role of Interoception

Refractory chronic cough (RCC) remains a persistent clinical challenge, often resistant to traditional treatments. Emerging evidence now positions RCC as a disorder rooted in hypersensitivity, driven primarily by central neural processes rather than external physiological causes. Central to this understanding is the concept of interoception-the brain's ability to perceive and interpret internal bodily signals. Neuroimaging research has identified abnormalities in brain regions associated with interoception and inhibitory control among RCC patients. Interestingly, RCC shares neurophysiological characteristics with other disorders like overactive bladder and urinary urge incontinence (OAB/UUI), which also involve dysregulated interoceptive and inhibitory mechanisms. Behavioral treatments for OAB/UUI are highly effective and are regarded as the first-line treatment in many consensus guidelines. OAB/UUI behavioral treatments have been shown to induce central neuroplastic changes, further underscoring their efficacy and potential parallel for RCC interventions. Behavioral cough suppression therapy (BCST), an efficacious treatment for RCC, may leverage similar neuroplastic adaptations, enhancing interoceptive processing and inhibitory control. Given the multi-dimensional nature of interoception, which encompasses sensory perception shaped by learning, memory, and emotional context, BCST's engagement of multiple neural pathways offers an alternative therapeutic option compared to single-mechanism pharmacological treatments. Future research should prioritize exploring the mechanistic underpinnings of BCST and other interoception-based therapies for developing more comprehensive and effective treatment options. Such research holds promise for improving patient outcomes, alleviating the significant healthcare burden associated with RCC, and advancing our understanding of central hypersensitivity disorders.

Getting comfortable with physical discomfort: A scoping review of interoceptive exposure in physical and mental health conditions

Interoceptive exposure (IE) involves the use of exercises, activities, or tasks to intentionally induce (or exacerbate) physical symptoms in the body, to challenge misconceptions about the harmful nature of the physical symptoms that maintain fear and problematic avoidance. IE was originally developed for the cognitive behavioral treatment and prevention of panic disorder. Bodily sensations and concern about physical symptoms are common features in many conditions, not limited to panic disorder. For this reason, IE could be theoretically relevant to cognitive behavioral intervention for many psychological, behavioral, and medical conditions. Yet, IE remains relatively underrecognized and underused as an intervention. Exposure involves feeling discomfort before experiencing relief; thus, it is often perceived as an aversive, unsafe, and illogical intervention because of the seemingly paradoxical approach. We conducted a systematic literature search for a scoping review with the aim of locating published studies on IE to understand how it has been studied beyond panic disorder. Studies focused solely on panic disorder were excluded. We were able to identify and extract data from 132 studies (published between 1992 and 2022), though this published literature is difficult to find. The use of IE has been widely investigated in conditions beyond panic disorder, although evidence for its efficacy is difficult to isolate from other forms of exposure and cognitive behavioral features. There is the strongest evidence for the efficacy of IE as a part of multicomponent cognitive behavioral treatments for posttraumatic stress disorder, health anxiety, irritable bowel syndrome, and to aid in benzodiazepine discontinuation. Interventions that were primarily or exclusively IE-based did not consistently or directly influence claustrophobia fear, separation anxiety, suicidality, insomnia symptoms, cigarette or drug abstinence, or pain-related fear. No serious adverse events were reported in any study. Studies of IE require larger sample sizes, detailed descriptions and rationale of IE exercises, higher IE dosing, extended follow-up assessment, and documentation of safety. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Interoceptive Processing in Functional Gastrointestinal Disorders

Functional gastrointestinal disorders (FGIDs) are characterized by chronic gastrointestinal symptoms in the absence of overt pathology and affect a significant percentage of the worldwide population. They are commonly accompanied by co-morbid psychiatric symptomatology and are associated with significant suffering and great healthcare services utilization. There is growing evidence that dysregulation of the gut-brain axis and disturbances in the processing of afferent interoceptive signals lie at the heart of these disorders. In this context, the aim of the current review was to detect and critically review original articles focusing on the role of interoception in the pathophysiology of FGIDs. Our search yielded 38 relevant studies. FGID patients displayed increased visceral sensitivity, enhanced attention to gastrointestinal interoceptive cues, and greater emotional arousal when coping with gut-derived sensations. Neuroimaging studies have shown significant structural and functional changes in regions of the interoceptive network, while molecular and genetic studies have revealed significant associations between interoceptive signaling and deficits in excitatory neurotransmission, altered endocrine and immune physiological pathways, and aberrant expression of transient receptor potential channel genes. Finally, there were emerging data suggesting that interoception-based interventions may reduce physical symptoms and improve quality of life and should be integrated into FGID clinical management practices.