Sensation Exposures
Sensation Exposures (also known as “I feel it” exposures), are like Sentence Exposures, except that you repeat the sentence “I feel it” over-and-over again in your head: “I feel it. I feel it. I feel it...” While you are repeating that sentence, you focus on any part of your body that feels uncomfortable.
I use this technique most often for pain. I do it when my back hurts, when my knee hurts, when I have a headache. For me, personally, when I feel anxious it usually comes in the form of thoughts, so I do a Sentence Exposure. But, sometimes, it comes in the form of feelings - tightness in my chest, butterflies in my stomach. On those occasions, I do a Sensation Exposure.
Sensation Exposures are very useful for people who primarily feel anxiety through physical sensations. Most people feel anxiety in the form of anxious thoughts and sensations. But some people just feel it in their bodies. In some cases, people don’t even know that they are anxious. They go to the emergency room because they feel like they are dying, and when they are told that was due to a panic attack they protest “but I don’t even feel anxious!?” That’s because they are experiencing anxiety mainly through their body, rather than in the form of thoughts.
How does it work?
Sensation exposures usually work in one of two ways: Either the sensation goes away completely, or the sensation goes down slightly and then you get distracted from it/you start thinking about something else (because it gets boring).
For example, when my knee hurts, I’ll focus on the pain and really try to feel exactly what part of my knee is hurting. “I feel it, I feel it, I feel it…” The pain gets worse initially, but then, after a few minutes, it melts away and I literally can’t feel it anymore.
It’s a little bit different when my back hurts or I have a headache. The pain doesn’t go away. Instead, it does down a little, like my maybe 30%, but then I get distracted. I start thinking about my day. If you asked “Hey Dr. K, does your back still hurt?”, I’d say “Yeah, it does, but it’s not on my mind anymore, so same difference.”
The discomfort goes away completely, or you get distracted from it. Either way, ironically, by focusing on it, it is no longer on your mind.
But what if the physical discomfort is caused by something real?
Sensation Exposures work regardless of whether or not the sensation is caused by something “real”. Even when pain or discomfort is caused by an actual medical condition (i.e. arthritis, a pinched nerve, a migraine etc.), focusing on the sensation is one of the ways to help get it off of your mind. That’s why this is one of the techniques used by pain clinics, regardless of the medical cause of the pain.
To find out whether or not Sensation Exposures work for you, try the following experiment:
Sensation Exposure Experiment
For the next three minutes, close you eyes and try not to move at all. I’m hoping. at some point, you’ll want to move. Your scalp will itch or you’ll want to move your ankle or you’ll want to shift your position. When that happens, don’t move. Instead, do a Sensation Exposure. Focus directly on the urge to move. If you want to scratch your arm, say “I feel it. I feel it. I feel it.” and focus on the itchiness. The itchiness should get really intense, but after a while, it will break and your mind will wander somewhere else. Then maybe your scalp will itch, then maybe you’ll want to move your feet, then your wrist, and so on. Keep following the urge to move as it migrates through your body. If enough time passes, your mind will start to wander and you’ll start thinking about something else.
For three minutes, close your eyes and try not to move at all. Do Sensation Exposure for any part of your body that you want to move.
OK. I tried it!
What happened?
If you noticed at least some physical discomfort and/or an urge to move and that sensation later moved or went away completely, then this technique worked for you.
If this experiment produced too much anxiety to continue it, then this is probably the wrong fit for you. Try another one instead.
If you felt no urge to move at all, then try this experiment for longer, and/or try it the next time you are already feeling physical discomfort.
If you felt an urge to move but it did not go away at all, then try this technique for ten minutes. If the sensation still does not go away, then this technique is probably the wrong fit for you. Try another one instead.
When should I use Sensation Exposures?
The next time you are feeling anxious, if there are no particular sentences associated with the anxiety and/or your physical sensations are the most prominent, try a Sensation Exposure.
I have many patients who alternate between a Sentence Exposure and a Sensation Exposure depending on what is most prominent at a given time. So, you might first focus on the sentence “They can tell I’m anxious” and then switch to focusing on your shoulder tightness once the sentence gets boring. Keep doing this process, alternating between sentences and sensations until you are feeling calmer.
If the Sensation Exposure experiment worked for you, try doing Sensation Exposures for five minutes a day for the next three days (to get the hang of it). After that, just use Sensation Exposures when you are already feeling uncomfortable.
The normal treatment algorithm is to try the Yoga Style or Logic Style techniques first when you are anxious (because they work faster), and then switch to some form of exposure if those aren’t working. Practically speaking, most people get a sense of which technique works best for them in which situation, and they will jump correctly to the best technique.
Sensation Exposures are also particularly useful to use during Real-Life Exposures. It helps ensure that the anxiety itself is voluntary, helps you get the most out of each Real-Life Exposure, and, ironically, can help you calm down the fastest as you push outside your comfort zone.