What is Interoception? Most of us are aware of our outward looking senses – sight, smell, hearing, taste, touch. Sensation that occurs through these senses is known as exteroception. However, we also have inward looking senses which detect signals originating from within the body, leading to our brain’s awareness of the physiological state of our body e.g., clenching of the stomach, sensations in muscles, beating of the heart, hunger, thirst, air hunger, pain, temperature. This sensing of our internal body state is known as interoception.
Why is interoception important in mental health? Interoceptive receptors located throughout our body communicate to our brain to tell us how we are feeling and what we need to stay in a state of balance e.g., if we’re feeling hungry, that feedback prompts us to eat, if we’re hot, that feedback prompts us to take off some layers or go outside to cool down. As emotions are linked to body sensations, our interoceptive body signals also help us to make sense of and regulate our emotions. Think about when you feel excited, angry, panicked, sad – all of these emotions have associated sensations e.g., butterflies in the stomach, racing heart rate, hot cheeks, heaviness in the chest – interoception allows us to recognise those sensations so that we can respond accordingly. Neuroscientists have discovered particular brain regions that are involved in interoception, in particular the insula, and neuroanatomist Bud Craig proposed that the insula gives substance to human feelings from the body that relate to our state and our subjective feelings – creating our sense of self.
Recent research by Camila Nord, a neuroscientist at the University of Cambridge found that during different interoceptive activities, one particular brain region, the mid-insula showed a different pattern of activity in people across a range of mental health difficulties including depression, bipolar disorder, anxiety, anorexia and schizophrenia, when compared to healthy individuals. What is so interesting about the mid-insula is that it communicates with the more emotion-related frontal insula and the more body-sensing related posterior insula. Nord suggests that the mid-insula, as it is affected across a range of mental health disorders, may have a ‘special role in a person’s subjective feelings, integrating input from the body with expectations and emotions related to internal body state’. For many years, research has suggested that our perception of the world, including our internal word, is heavily influenced by our expectations – that when we experience something we are experiencing a combination of external input mixed with our expectations. Nord cites visual illusions as an example of this: we see things that we expect to see rather than what is actually there. Nord speculates that the mid-insula seems to be potentially one region where the difference between what we are expecting and what our body is experiencing is being ‘computed’ and given that this region is disrupted across a range of mental health difficulties, it may be a target to improve symptoms through interoceptive practises, and she is keen to explore this within different therapeutic approaches.
Atypical interoception has been identified as a common risk factor across a range of mental health disorders. Intuitively, this makes sense. Individuals with depression often report feeling numb and it may be that reduced interoceptive awareness and reduced ability to feel body signals may lie behind the sense of lethargy and emotional numbness. Individuals with anxiety are attentive to interoceptive signals however don’t necessarily read them accurately. So, in panic disorder for example, a small change in heart rate may be misinterpreted as much bigger than it is which can lead to catastrophic thoughts and emotional responses that amplify feelings of panic. In PTSD, it would make sense to want to be less aware of feelings from the body given the feelings of terror both at the time of trauma and during re-experiencing would have been expressed via the body, so interoceptive awareness may be muted due to understandable attempts to ‘not feel’ the body.
A recent study by Norman Farb, an Associate Professor of Psychology at the University of Toronto Mississauga, and Zindel Segal, Professor of Psychology in mood disorders at University of Toronto Scarborough has found that suppressing or blocking out physical sensations related to emotions such as sadness can hinder recovery from depression symptoms and may cause a relapse into depression. They found that sensory shutdown (understandable that we would want to shutdown feelings of sadness) determined depression levels. Farb states that when our brains shut down sensory information in negative mood, we are left only with our thoughts to make sense of what is happening, and being thought-led alone doesn’t give us the full picture, we need our sensory information if we are to make sense of ourselves in a holistic way.
How can we improve Interoception? Activities that direct our attention to internal sensation helps us to improve interoceptive awareness and yoga and mindfulness, practises that continue to grow in popularity, inherently involve attention to internal sensation. In fact, one of the fundamental aspects of yoga is the practise of ‘Pratyahara’ or ‘withdrawal of the senses’ understood to direct the yoga practitioner to turn their senses inward to connect with their inner landscape.
Yoga therapy encompasses yoga and breathing practises with an integral mindfulness component and in my work, I’ve been able to integrate basic yoga therapy approaches into psychotherapy work and I’ve seen how a focus on improving interoception has helped clients with depression, generalised anxiety and anxiety related to health and social situations, panic disorder and PTSD, develop a different relationship to their body sensations which has been helpful in their recovery.
If you’re interested to explore this for yourself and experiment with how a focus on interoception might change your experience, feel free to get in touch to discuss how yoga therapy or an integration of some basic yoga therapy skills and psychotherapy may be helpful for you. Over the course of my career, I find I’m drawing on this integration more and more as a way to facilitate interoceptive practise to support a move toward improved emotional health. Whilst trauma-related difficulties are better worked with in a one-to-one individualised way, those looking to improve feelings of stress, anxiety and depression may wish to attend the 8-week Yoga Therapy for the Mind course. You can read more about one-to-one work and the 8-week course here. In the meantime, see how it is to turn your attention inward for a few moments, and get to know your inner world.
References Farb, N. A., Desormeau, P., Anderson, A. K., & Segal, Z. V. (2022). Static and treatment-responsive brain biomarkers of depression relapse vulnerability following prophylactic psychotherapy: Evidence from a randomized control trial. NeuroImage: Clinical, 34, 102969. https://www.sciencedirect.com/science/article/pii/S2213158222000341
Nord, C. L., Lawson, R. P., & Dalgleish, T. (2021). Disrupted Dorsal Mid-Insula Activation During Interoception Across Psychiatric Disorders. The American journal of psychiatry, 178(8), 761–770. https://pubmed.ncbi.nlm.nih.gov/34154372/
Brewer, R., Murphy, J., & Bird, G. (2021). Atypical interoception as a common risk factor for psychopathology: A review. Neuroscience and biobehavioral reviews, 130, 470–508. Atypical interoception as a common risk factor for psychopathology: A review - PMC (nih.gov)
Craig, A. D. (2002). How do you feel? Interoception: the sense of the physiological condition of the body. Nature reviews neuroscience, 3(8), 655-666. https://www.nature.com/articles/nrn8