Interoception is a concept I’ve been thinking about, fascinated by and focused on this year … Specifically, I want to help translate this incredible new body of science into psychotherapeutic care and intervention. Most people and even most mental health professionals don’t really know what interoception is or why it matters … So, I’m happy to begin to share my thoughts, as well as resources I’ve created, around what I believe may be a new direction in mental health care.
The easiest way to define interoception is body awareness. It’s actually a perceptual ability we have like hearing, seeing or touch; the way in which it’s unique from the usual senses we focus on is that interoception is internally focused.
Here’s how it works: our bodies have multitudinous functions occurring at all times. Some of those functions, like the lengths of our telomeres changing, we have no ability to sense. Others, like our heartbeat, what’s going on in our gut, muscle activity and how we are breathing are within the reach of our awareness. The extent to which you are aware of what’s going on in your body, your interoceptive health, seems to predict mental illness and mental health (Domschke et al., 2010; Khalsa et al., 2018; Watson et al., 2019).
One really important thing to know about interoception is that it is a constructed sense - just like vision or hearing. That means, like there are visual illusions, there are interoceptive illusions. For example, in the classic Rubber Hand Illusion (see below), our visual system tricks our interoceptive system into ‘taking ownership‘ of a rubber hand even though “we“ know it’s not ours.
In addition to influence from the visual and tactile systems, the interoceptive system is profoundly influenced by the emotional and cognitive centers of the brain. For the neuroanatomy nerds out there, all interoceptive goes up through the body (afferent transmission) through the vagus nerve and spinal cord, into the brain stem and goes to the hub of interoception: the insula. There, our brain creates a map of what is happening in our body; however, it’s directly connected to and influenced by the amygdala and parts of the pre-frontal cortex. This is the neurophysiological reason that interoception is connected to mental health - our basic emotions and thoughts influence our interoception, so when have emotional distress it becomes neurally harder to connect to our body in a healthy way … which in turn makes it much harder to receive the helpful information (some people call it wisdom, I see it simply as information) coming from the body that is meant to help in recovery from anxiety, depression or trauma.
There are a few less-than-optimal interoceptive patterns that interfere with recovery from anxiety, depression or trauma:
The first pattern that some of us engage in is what I call overly-attentive interoception … body sensations (often the heart, pain sensations or gut sensations) are seen as representing some known or unknown threat, we over-focus on them and the quality of the attention is a worried one. The problem this pattern creates is that over-focus / worried attention actually magnifies sensations because the brain on anxiety does not accurately or helpful perceive what’s happening in the body. Another component of this interoceptive style is that bodily sensations are interpreted as scary at a basic, sub-cortical level and unhelpful beliefs about bodily sensations often form. While this overly-attentive style can present in folks without diagnoses of mental health concerns, it’s most common in those with anxiety in general (nearly any type) and certain presentations of trauma.
The other most common pattern is the opposite: disconnected. For those of us with this pattern, we ignore, suppress, “push through“ and “power through“ bodily sensations. Bodily sensations are information, a data stream, that’s meant to be integrated with the rest of our experience to help us regulate and stay in homeostasis … in this pattern, those messages just aren’t fully received or adequately acted upon. The brain learns that bodily sensations will be ignored, creating a real disconnect with the body. This pattern is quite common in those with certain personality styles but is also seen in more extreme forms with depression (e.g. ignoring bodily sensations to go to the bathroom), dissociation or dissociation-based trauma.
So what is Healthy Interoception? Healthy Interoception, as I see it, is having awareness and accuracy to what is happening in the body, an ability to sustain attention in certain parts of the body with mindful, non-judgmental attention. The other critical aspect of Healthy Interoception is that bodily sensations are interpreted in a neutral way - just as information or as I like to call it: ‘body data.‘
If you’re curious about your interoceptive health (there are structured measures, but they are more used in research than in real-life settings) … think about the following in terms of your attention to your own bodily sensations …
In terms of how you interpret or appraise that information, you can reflect on how you basically interpret that information - just a basic, instinctive (sub-cortical) reaction to bodily sensations as information or something that’s threatening … as well as how helpful or not your beliefs are about your body.
For each of these components of interoception, we are beginning to see interventions and strategies to improve them … this is definitely a system that can be improved and can either help you recover from mental health issues or protect you from them!
I’ve combed the (extremely) recent psychological literature as well as meditative interventions and come up with a series of recorded interventions you are welcome to use: Free Therapeutic Resources — Bay Area Biofeedback & Therapy (drnateewigman.com).
Each intervention is targeted towards one of these processes above; so depending on what you need help with, I hope one of these might be a good fit. For example, to improve interoceptive awareness and accuracy, you might consider biofeedback treatment or try out the cardiac interoception trainings and / or the Bracing Response (and unbracing) recordings; to improve your ability to mindfully sustain attention to different body parts, I would recommend the breath- and body-scan meditations. To improve your basic reaction to bodily sensations, you might try the Equanimity, RAIN and / or RAFT meditations. If you have beliefs that have calcified around bodily sensations, these meditations above may be helpful, but it may also be helpful to use reframing techniques focused on interoceptive beliefs (I have a sheet I created, feel free to reach out if you’d like it).
I hope that you benefit from these resources and this information about interoception … I would strongly encourage you to incorporate it within your therapeutic work, whether that’s with me or with your therapist. Be well, and happy interocepting!