Facing feared body sensations: step ideas
Step ideas to choose from with your therapist for facing feared body sensations, from everyday activities to agreed exercises, grouped by sensation. Based on Clark (1986), Antony et al. (2006) and Craske et al. (2014): a list of graded practice ideas for feared body sensations, with safety behaviours to drop and steps to carry to the exposure hierarchy.
Written by Tarun Vermani, Trainee Clinical Psychologist Updated
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Facing feared body sensations: step ideas
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How facing the fear helps
When body sensations like a racing heart, dizziness or feeling hot frighten you, it makes sense to steer clear of anything that brings them on, or to stop them as soon as they start. But that means you never find out what really happens when you let them be.
Each step on this sheet is a chance to test what you fear, for example that a racing heart means a heart attack, or that dizziness means you will collapse. Before a step, you and your therapist write down what you expect to happen. Afterwards, you write down what did happen. Your anxiety does not have to go down before you start or before you stop: what matters is finding out.
Practise each step more than once, and vary it: a different time, place or length.
Only practise steps you have agreed with your therapist, and leave out anything that would put your health or safety at real risk.
Only try exercises you have agreed with your therapist. Check with your GP first if you have a heart or breathing condition or epilepsy, or are pregnant. Stop if you feel unwell in a way that is different from your usual panic feelings.
Also check with your GP first if you have problems with your balance, neck, back or joints, or a history of fainting.
A racing heart and faster breathing
These everyday activities speed up your heart and breathing. They run roughly from easier to harder, but what is hard differs from person to person.
Feeling hot and sweaty
These ideas bring on warmth, flushing and sweating. Tick any you avoid; what is hard differs from person to person.
Dizziness, feeling unreal and tightness
Some of these are everyday, and some bring the feeling on deliberately, for a short time you agree in advance. Your therapist will usually try the deliberate ones with you in a session first, and can share a sheet for recording them.
Things you may have stopped doing
Many people quietly give up activities because of the sensations they bring. Tick any you would like to get back to.
Safety behaviours to drop
Safety behaviours are things you do to feel safer, like checking your pulse or sitting down as soon as you feel dizzy. They can stop you finding out what really happens, so dropping them is part of each test. Tick the ones you use.
Choose which safety behaviours to drop with your therapist. Keep precautions that protect your real health or safety. Do not stop or change any prescribed medication on your own; talk to your prescriber first.
Steps to add to my ladder
With your therapist, write down the steps you would like to try and what you fear will happen in each. Then rate how anxious you expect to feel, from 0 (no anxiety) to 100 (the most anxious you can imagine).
You and your therapist will add these steps to your graded exposure hierarchy, where you rank them and plan your practice.
| # | Step I could try | What I fear will happen | Expected anxiety (0 to 100) | Actions |
|---|---|---|---|---|
| 1 | ||||
| 2 | ||||
| 3 |
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When to use ‘Facing feared body sensations: step ideas’
‘Facing feared body sensations: step ideas’ is an interactive cognitive behavioural therapy (CBT) worksheet, most often used in CBT for panic. It is also commonly drawn on when working with health anxiety.
It is designed to be used within therapy rather than as a standalone self-help tool: a therapist introduces it, works through it collaboratively, and helps make sense of what it surfaces. You can preview the full worksheet above, then assign it digitally for clients to complete between sessions on any device or download it as a print-ready PDF.
How it works
Most people work through it in around 15 minutes. It moves through six short steps:
- How facing the fear helps: When body sensations like a racing heart, dizziness or feeling hot frighten you, it makes sense to steer clear of anything that brings them…
- A racing heart and faster breathing: These everyday activities speed up your heart and breathing. They run roughly from easier to harder, but what is hard differs from person…
- Feeling hot and sweaty: These ideas bring on warmth, flushing and sweating. Tick any you avoid; what is hard differs from person to person.
- Dizziness, feeling unreal and tightness: Some of these are everyday, and some bring the feeling on deliberately, for a short time you agree in advance. Your therapist will usually…
- Things you may have stopped doing: Many people quietly give up activities because of the sensations they bring. Tick any you would like to get back to.
- Safety behaviours to drop: Safety behaviours are things you do to feel safer, like checking your pulse or sitting down as soon as you feel dizzy. They can stop you…
Completed on the Formulate platform, your client's answers are saved automatically and shared straight back to you, so you can review them before the next session rather than waiting for a paper copy to come back.
The CBT approach behind it
In common with other CBT methods, ‘Facing feared body sensations: step ideas’ works by gradually and safely facing avoided situations so anxiety can subside (exposure). The aim is not positive thinking but a clearer, shared understanding of what keeps a difficulty going and practical, testable ways to change it.
Because it is a CBT tool it stays focused on the here-and-now links between thoughts, feelings, the body and behaviour, and it works best as one part of a wider course of therapy rather than as advice or a diagnosis.
Evidence & sources
This worksheet is grounded in established cognitive behavioural therapy theory and practice. Key sources include:
- Craske, M.G., Treanor, M., Conway, C.C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10-23. doi:10.1016/j.brat.2014.04.006
- Clark, D.M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24(4), 461-470. doi:10.1016/0005-7967(86)90011-2
- Antony, M.M., Ledley, D.R., Liss, A., & Swinson, R.P. (2006). Responses to symptom induction exercises in panic disorder. Behaviour Research and Therapy, 44(1), 85-98. doi:10.1016/j.brat.2004.12.005
For use alongside professional support
Formulate provides educational CBT resources for use with a qualified therapist. They are not a substitute for professional assessment, diagnosis, or crisis care.
If you need urgent help now:
- Emergency services: 999 — if you or someone else is in immediate danger
- NHS 111 (NHS 24 in Scotland): 111 — choose the mental health option for urgent help, in England, Scotland and Wales (in Wales, press 2)
- Lifeline: 0808 808 8000 — for urgent help in Northern Ireland, free, day or night
- Samaritans: 116 123 — free, day or night, 365 days a year
- Shout: 85258 — text SHOUT, free, day or night
- SANEline: 0300 304 7000 — 4pm–10pm, every day
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