Interoception
Feeling the body states. Interoception, emotion and mental health: a guide for therapeutic synergy.
People don’t believe me when I say this, but it is true. When practicing some pretty hard core breathwork stuff, like power breathing - essentially tummo or the prolonged breath of fire kind of practices - at some point, I will start feeling a curious sensation around the small of my back. It is a strange sensation. It is neither fully painful nor pleasurable, it is somewhere there in the uncanny valley of sensations. Somewhere in between the pleasant and the unpleasant. But is is one that is hard to ignore, and as the practice continues, it typically only ever becomes stronger and stronger until it becomes the main sensation that I can feel in my body and the sole focus of my perception. Kind of radiating spillover from my kidneys into the space around them that diffuses into other sensations. Really hard to describe.
I have no idea what it is - really, no idea at all - but I know I feel it. I feel it through my sense of interoception. The capacity to feel the internal body states.
There is a lot going on under the hood in the body, as we go about our day, while we are mostly stuck in our head and thoughts. Most of it happens outside of awareness and on autopilot. The heart is beating, the chemicals are constantly being released into the bloodstream, the blood pressure adjusted, the gases being exchanged and all remaining within some fairly narrow parameters that are conducive to life.
The only conscious signal we get from those processes is through our interoceptive awareness.
The opposite of interoception is exteroception, and it feels as though we are generally more, at least declaratively, focused on exteroception. Right? It is somehow easier to describe what we see, taste or hear than what we feel inside. I will talk about that a little bit more later.
Body & Mind
There is a growing body of research today around the relationship between the mind, the body and what and how we feel. There proves to be more interconnection and interdependence than meets the cartesian eye.
The picture emerges where the whole shebang seems to be intertwined more than the science has initially assumed. In some respects, the boundary between the mental and the physical is becoming increasingly blurred. The body is taking on more and more important role in understanding of the mental states. In fact, the body is taking a big role in understanding of the purpose of the brain itself.
Now, the brain is a part of the body, alright - but quite a particular one. The central notion that links the two that is in the nexus of all of the things above seems to be interoception.
The aim of this post is to take stock of some elements of what emerging neuroscience tells us, cross that with some lived experience and see whether we can see working on interoception as a synergetic addition to whatever therapy direction we are using with the clients.
If you are NOT a therapist, that does not matter, because the same thing is valid for you too - I assume you are a psychonaut wanting to understand the inner workings of your mind, conclusion I make on the ground that you are reading this piece in the first place.
My goal is to give you some introductory notions about what interoception is and how it links to our mental states, mental health and overall health and what we can do about it. It covers the following:
What is interoception and some of its neural underpinnings
Talk about the roles of interoception in emotions
Touch on the relationship between interoception and the concept of allostasis
Links interoception to mental health (very superficial overview - deeper dive into this later)
Suggestions for some clinical implications and ideas as to how to improve interoception
I will write a separate post where I will be sharing some of my essential references when it comes to thinking about interoception, in relation to psychotherapy.
Let’s dig in.
What is Interoception: Definitions & Basics
Interoception is the process of sensing and becoming aware of the internal states of the body. Examples range from feeling hunger, feeling our own heartbeat, (cardioception), feelings of fatigue, feeling perked up, activated and energetic, sleepy, experiencing the breathing sensations and their pace and the list goes on and on. Even wanting to go for a wee.
As mentioned already, the opposite of interoception is exteroception - the sensing and perception of external stimuli. Interestingly, neuroscience is much more advanced in understanding exteroception than interoception, and as therapists we might ask ourselves why - if we are inclined to analyse the scientific psyche. Which i am not, at this specific moment, but would love to hear your thoughts.
Other, maybe more philosophical questions arise, once we start thinking about this more deeply. For example: how does the brain know where the ‘us’ ends and ‘outside’ of us begins? Does interoception affect exteroception? And what about the vice versa?
Like for any other sense, when it comes to interoception, we are not all equal - some people end up being better at it than others.
Through this piece, I hope to make it self-evident why exploring client’s interoception might be an important piece of information in therapy, why we might want to improve it and how it can be done.
Interoception, as a sense, is thought to have three different aspects:
interoceptive accuracy
interoceptive sensibility
interoceptive attention
Interoception Neural Correlates
Our old friend, the vagus nerve is one of the main conduits of the interoceptive signals. Around 80% of vagal fibers are afferent - meaning that they send the signal from the body to the brain. But, once the signal has been transmitted, how is this signal processed and interoceptive awareness formed?
To give an idea of the journey of the information from its point of origin in the body until it reaches the awareness, I will give you a simplified itinerary.