Specified to the second and measured out of a hundred
- The Centre for Clinical Interventions, a public clinical psychology service of the North Metropolitan Health Service in Perth, Western Australia, publishes the workbook "When Panic Attacks" (Sng, Howell, Burgess, Pannekoek and Campbell, 2023; ISBN 978 0 9757995 3 6; the last page of each module prints "Created: February 2023"). Seven modules run to 73 pages, and seven panic information sheets, five worksheets and a video of a clinician running the procedure sit beside them. Every file downloads from the CCI site without registration, an email address or payment.
- Interoceptive exposure occupies module 4, "Coping with Physical Alarms", eleven pages. Page 5 lists ten induction tasks, each with a time: hyperventilation 1 min, shaking the head 30 sec, head between the legs 30 sec, running in place or up steps 1 min, holding muscle tension 1 min, holding the breath 30 sec, spinning 1 min, breathing through a narrow straw 1 min, chest breathing 1 min, staring at a spot 1.5 min.
- The module sets numeric thresholds rather than leaving the decisions to judgement. Every task is rated on three 0–100 scales, for anxiety, for how similar the sensation is to the person's own panic, and for intensity. A task joins the ongoing programme when its similarity rating passes 25. It is repeated until anxiety falls below 30, then extended by 30 to 60 seconds, or performed standing, or performed away from easy sources of help. Two different tasks are scheduled each day. Six medical conditions send the reader to a doctor first: epilepsy or seizures, pregnancy, a heart condition, a history of fainting or low blood pressure, physical injuries such as a neck problem, asthma or other lung problems.
- The reference list on page 11 names the component network meta-analysis of Pompoli and colleagues (Psychological Medicine, 2018, 48(12):1945–1953). The method estimates what one component adds to a package instead of what the package achieves whole, and reports it as an incremental odds ratio. The outcome is remission of panic disorder, taken as close to three months as the trials allowed and defined in each of them by its own investigators. Interoceptive exposure came out at 1.49 (95% credible interval 0.94–2.36), a face-to-face setting at 1.27 (0.57–2.66), breathing retraining at 0.84 (0.54–1.26), muscle relaxation at 0.59 (0.40–0.90).
- Access is free and the licence is not open. The CCI copyright page permits "downloading any material or information solely for personal use, or any use permitted by the Copyright Act 1968 (Cth)" and reserves other reproduction to express permission; rights rest with the State of Western Australia, and no Creative Commons terms are stated. Practice under supervision is the paid part: CCI runs the one-day workshop "Exposure to Exposure" in Perth for 210 AUD including GST, two-day workshops for 350 AUD.
Page 11 of module 4 carries a reference list of four works, and one of them is the study the workbook leans on when it puts physical sensations at the centre of panic treatment. Pompoli and colleagues screened 2,526 references and pooled 72 randomised trials with 4,064 participants; interoceptive exposure was in 54 of the arms, 40.3% of them. Its number says two things at once. Among the four components named here it carries the highest estimate and it is the only one of the four above 1.0, with muscle relaxation at 0.59 on an interval of 0.40–0.90 that excludes 1.0 from the other side. One figure in the full table stands higher, 1.97 for third-wave components, resting on a single arm out of 134. At the same time its own bounds, 0.94 and 2.36, take in 1.0, so the component is ranked above the alternatives inside the package and is not separated from a package built without it. The abstract puts it as an association with better efficacy and acceptability. Remission is the outcome behind both readings, in trials that had control conditions. The workbook cites that literature and then measures something else.
The scales the procedure runs on
Every decision the procedure makes is taken on one of its three ratings. Whether a task joins the ongoing programme is settled by the similarity score, and by nothing else. Whether the task repeats is settled by the anxiety score. When it lengthens, or moves to a standing position, or moves somewhere unfamiliar, the same anxiety score has fallen under 30 and released it. The stopwatch governs the induction, the person's estimate of their own fear governs the course, and nothing inside that loop reads the disorder the loop is pointed at. The end of the course is set in the same currency: the module recommends going on "until even the idea of it is no longer anxiety-provoking, but rather boring", which is a state the reader is the only one in a position to declare.
Beside the three numbers the worksheet on page 6 leaves a fourth column headed Physical Sensations, and page 4 asks the reader to write down the sensations and the anxious thoughts in words. A tally of attacks module 4 does not carry, and that lives elsewhere: the form "Monitoring your panic attacks" sits on page 9 of module 2, is reprinted on page 9 of module 6, and asks for the date, the time, an intensity out of 100, whether the attack was expected, the trigger and a tick against thirteen symptoms. Module 7 then invites the reader to "compare the frequency of your panic attacks from when you started these modules up until now". That comparison has one person in it and nothing to compare against except an earlier week of the same person.
A separate video shows a clinician running the procedure in session, and CCI marks it for professional development rather than for use with a client. Rehearsal with feedback carries a price of 210 AUD for a day.
The seconds are printed, the thresholds are printed, and the number that comes back at the end of a task is a rating of fear out of 100.
This is a clinical service's teaching material, not a trial, so it carries no control condition and no effect estimate of its own. The figures of 1.49, 0.59 and 0.84 belong to Pompoli and colleagues and describe components across 72 trials, not this workbook. Statements here about what a document does not contain are bounded by what was read: module 4 in full, modules 2, 5, 6 and 7 in full or by contents and the pages named above, the CCI copyright and disclaimer page, the training calendar and the workshop description, and the CCI publications page as updated 24 November 2025. A published evaluation of "When Panic Attacks" itself was not found on those pages, which is a statement about those pages and not about the literature at large. The video was identified by title, channel and an upload date of 11 October 2021, and was not watched; the CCI page that links it prints no running time, so none is quoted here. Rights are held by the State of Western Australia and downloading is permitted for personal use, so distributing printed copies is a question for CCI rather than a settled permission.