Panel Discussion 7 - Bottom-up Informational Mechanisms in Exposure-based Interventions: The Role of Interoception and Expectancy Violation

Most exposure-based interventions have traditionally focused on exposure to external stimuli, under the assumption that fear reduction primarily depends on repeated contact with aversive exteroceptive events. However, this emphasis overlooks the fact that, for a subgroup of individuals, interoceptive processes play a predominant role in the maintenance of fear responses (Paulus et al., 2019). In such cases, the critical process sustaining fear is not external but internal and predictive, suggesting that interoception should constitute a primary target of intervention.
From this perspective, the central question for experimental and clinical work is not whether individuals should approach an aversive event, but what type of information is made available to facilitate extinction learning. Interoception-based interventions such as interoceptive awareness, mindfulness and interoceptive exposure can be understood as procedures that alter how bodily signals are interpreted and used to generate predictions. Importantly, their shared mechanism is likely the updating of Pavlovian contingencies (Rescorla & Wagner, 1972) in which interoceptive cues function as predictors of threat.
This formulation implies that the informational process, rather than the act of exposure itself, should be the focus of intervention. The emphasis of exposure should therefore not be on the mere presence of aversive stimulation, but on violations of interoceptive expectations that allow new learning to occur. Evidence indicates that fear reduction can occur even when instrumental behaviors do not modify the aversive outcome, but instead provide information that adjusts predictability (Restrepo-Castro et al., 2023).
Within this framework, the panel will discuss how interoception operates through informational processes during exposure-based treatments, bridging basic learning theory and clinical practice. This perspective provides a common conceptual ground for applied programs that integrate interoceptive processes, such as the Mind-Action-Mood Programme, and for contemporary theoretical formulations of exposure, including the Inhibitory Learning Approach (Craske et al., 2014) and the reward process view of extinction (Rosenberg et al., 2024).