Interoception, your body's superpower

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A year or two into teaching yoga, several synchronicities occurred that changed the course of my career and in many ways, my life. I had a small psychotherapy practice, where I integrated restorative yoga and movement directly into sessions. And I taught alignment-based vinyasa yoga as my side hustle.

Early on, students began to approach me before class to disclose physical anomalies or injuries sustained in more physically demanding practices. Others stayed after class to share their struggles with anxiety, depression, chronic pain, or auto-immune disorders. This called me to become a body detective, searching for ways to make the practice more therapeutic for everyone.

One thing soon became clear: The faster the pace of practice, the more alignment fell off the radar—and in turn, the longer people’s injuries lingered. The converse was also true: When people moved more slowly, they began to experience aha! moments that gave us insights into the patterns behind their injuries or pain. We became yoga detectives together, exploring the mysteries of the body.

And yet, alignment wasn’t the only dynamic in play. As the speed of the class continued to slow, something else came to the foreground: the quality and focus of people’s attention. For the first twenty minutes or so, most practitioners had scattered focus: they’d look at the clock, eye one another, adjust their clothing, or move in ways that opened the door to injury. Yet as the instructions continued to draw their attention inward, I noticed a shift. About 25 minutes in, there would be a magical moment of settling, where attention would seem to land solidly in their bodies. Like a rainstorm, awareness would drop into first one person, then another—and then a cascade of people. At times a sublime awareness seemed to fall like a gentle rain over the entire class, blanketing us all.

It was a revelation: this quality of innerness felt to me like the magic element that made the practice more transformative.  This spurred me to experiment with ways to help people “drop in” earlier, such as adding contemplative practices to the beginning of class so that awareness itself became the throughline. The benefits compounded.

My assisting changed, too. Even the gentlest of hands-on assists seemed to draw people’s awareness outward. This inaugurated a yearslong experiment with the impact of language on awareness. My private work and teacher trainings gained a special focus on nourishing what I thought of as embodied awareness.

And then in 2012, at a yoga conference in Toronto, a participant offered me an introduction to Norman Farb, Ph.D. I’d just presented one of Norm’s groundbreaking studies, titled “Minding One’s Emotions: Mindfulness Changes the Neural Expression of Sadness.” We met in person a year later, and Norm shared more about the study. At the end of our lunch, Norm casually mentioned that his research was moving in a new direction to study an aspect of mindfulness called interoception. I couldn’t believe there was a scientific term, let alone an entire field of study, for what I’d been observing.

For the last twelve years, I’ve studied the research on interoception, observed its effects in various forms of clinical practice and teaching, and explored its social context, along with the other inner senses. And I’ve been a research collaborator in the science of interoception; Norm and I, together with several colleagues, published a study in 2022 on interoception and attention, which I’ll unpack in a future column.

Today, my work combines science (more on my complex relationship with science below), psychology, social context, and embodiment.

What Interoception Is + Why It Matters.

The scientific field of interoception has exploded in recent years, yielding a staggering number of papers. But what exactly is interoception, and what does it offer?

In its scientific definition, interoception refers to our ability to receive, interpret, respond to, and regulate the body’s internal signals. You can also think of it as inner perception, or mindfulness of the body.

In many ways, interoception serves as a foundation to our other inner senses, including proprioception, body agency, body ownership, and body resonance.

Interoception is functionally distinct from the five outer senses—vision, audition, taste, touch, and smell—which comprise exteroception, an externally-directed form of attention.

We need both types of attention; research indicates, though, that knowing what to direct our attention to and when, and being able to switch between inner-directed and outer-directed attention, is a key to emotional health—and, it turns out, relevant to social context as well.

My relationship with science includes grounding into the information, but also somewhat irreverently complementing it with a high dose of creative play, so I’m outing my signature tendency here and now.

Here’s some of that play in action:

My Take: Above, I mentioned that scientists define interoception as the ability to receive, interpret, respond to, and regulate the body’s internal signals.

I’ve highlighted these elements intentionally in order to engage in some “creative play” with them.

Here’s my take on why these elements are important: After years of pouring over the research, working with people therapeutically, and training yoga teachers and yoga therapists, I’ve noticed that emotionally-mediated illnesses like anxiety, depression, chronic pain, eating disorders and other addictions have anomalies in one of these four nodes of interoception.

People with depression and chronic pain, for example, often have difficulty receiving bodily signals.

People with anxiety receive them clearly, but often interpret them in catastrophic ways.

In addictions, the signals that come with craving or using a substance can be so amplified that it’s hard to sense other information. (This seems like an issue with regulating signals.)

However you think of anxiety, depression, chronic pain, and addictions, you can also re-imagine them as diseases of disembodiment.

And while most of us experience a combination of these variations, we all tend to be challenged by regulating the body’s signals. (Stay tuned for future columns, in which I’ll put flesh on the bones of this theory more directly.)

The Mechanics of Interoception

How, exactly, does interoception work? Receptors in our cells, tissues, and organs—collect information about the inner state of our bodies. These “interoceptors” specialize in distinct sensations. (Scientists continue to discover new receptors, so the list below is not an exhaustive one.)  

Some receptors are in free nerve endings, and pick up sensations related to pain and temperature. Some are circulatory, and monitor such aspects as the speed of your heart. Some are respiratory, and track the pace and depth of your breath. Others are gastrointestinal, and oversee hunger, fullness, distention, or indigestion. Hormonal receptors oversee blood volume, immune metabolites, and electrolyte balance, as well as hormones such as blood glucose, neuropeptides, neuromodulators. And some interoceptors are tactile; they detect sensual touch, also known as social or “affective” touch, the kind we foster when we groom or caress one another. (For others, see the chart directly below.)

The Sensations of Interoception:

• cardiovascular, such as heartbeat

• gastrointestinal, including from the esophagus, stomach, small intestine, and colon (these are also part of our enteric nervous system, also known as our “second brain”)

• distention of the abdomen, bladder, or rectum

• hunger, thirst, and fullness

• sensations of breath, including shortness of breath, or “air hunger”

• temperature (warmth or coolness)

• pricking pain or burning pain

• itch, shudder, or tickle

• vasomotor flushing (aka hot flashes)

• muscular sensations, e.g. tension, soreness, and isometric or dynamic exercise

• bone bruising, fracture, joint ache

• nausea or cramps or illness

• headache + migraine

• fatigue, including chronic fatigue

• sensual touch, also referred to as social or affective (emotional) touch

• sexual arousal, touch, and orgasm

• wine-tasting (in sommeliers)

• acute or systemic inflammation and inflammatory metabolites

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The Social Context of Interoception

Interoception might seem like an individual endeavor, but it has a social context. In fact, there’s a growing field called social interoception.

To begin to consider the social context of interoception, it’s helpful to understand that the capacity to direct attention inward requires a modicum of physical and emotional safety.

A 2022 hypothesis paper by Sahib Khalsa and Negar Fani, published in the journal Nature, explored the impact of racial discrimination on interoception. The authors examined dissociation, a movement away from the body’s direct experience. Dissociation is an adaptive (and reactive) response to acute stress that allows people to survive traumatic, often life-threatening experiences. It’s a form of homeostasis, and vital to survival.

Over time, however, the need for chronic dissociation can disrupt interoception and interfere with the ability to control where we place our attention. This can make it difficult to sense the ebb and flow of internal bodily signals (interoception)—which, as we’ll see in future explorations, is a key part of emotional regulation. Large-scale studies have found that the frequency of racial discrimination correlates with the severity of dissociation. Furthermore, repeated exposure to racial discrimination heightens sympathetic nervous system arousal (fight, flight, or functional freeze) and cardiovascular stress responses, further contributing to dysregulated interoception.

Khalsa and Fani call for interventions that decrease the cardiovascular stress and increase interoception. Perhaps more importantly, they point out the importance of addressing the root causes of racial discrimination and implementing preventive measures on a social level.

My Take:

The term “dissociation” can have negative connotations in popular culture. But for the sake of the study above, you can consider dissociation as a counterpoint to interoception; it makes interoception difficult.

Thanks to the amazing Dionne on Substack, I’m going to emphasize the point above:

In situations that are unsafe, including racial- and gender-based and other forms of trauma, dissociation is an adaptive and healthy response, particularly when we do so deliberately and on a temporary basis. Here, it helps to leave “emotional and sensory breadcrumbs” (as in the tale of Hansel + Gretel) so we can re-access the experience when we wish. This form of mindful dissociation, if you will, can preserve our sense of agency and self-determination.

Here are some other thoughts that might flesh out the notion of adaptive responses to racialized or gender-based trauma:

Interoceptive attention is also distinct from exteroceptive attention, which we engage through our five outer senses, e.g. vision, audition, smell, taste, or touch).

These forms of attention counter one another (although they’re not completely mutually exclusive).

Interoception requires a baseline of safety. And dominant culture levies a constant threat of assault, continual surveillance, and myriad forms of body endangerment toward Black, Indigenous, and People of Color (BIPOC) and other (LGBTQ+, female, disabled) bodies it marginalizes. The demand for hypervigilance to ensure a minimal level of body safety makes interoception (and internally focused perception) more difficult.

This calls to mind one of my favorite authors on the topic of embodiment. In Between the World and Me, Ta-Nehisi Coates says, “Disembodiment is a kind of terrorism, and the threat of it alters the orbit of our lives and, like terrorism, the distortion is intentional.”

In my opinion (since I can’t ask him directly), Coates speaks here not of voluntary dissociation, the tendency many of us have to avoid difficult sensations and experiences and live in our heads. He’s talking about forced disembodiment, a primary mechanism through which dominant social groups acquire and maintain power over others for social, political, and financial gain.

One of the most insidious weapons dominant social groups employ is the oppression, regulation, and surveillance of bodies.

In this context, embodiment (which includes interoception and the other inner senses, but also dance, movement, music, expressive joy, and being in nature) becomes an act of reclamation and resistance.

A recent study supports the notion of adaptive responses to racialized trauma. In 2021, Negar Fani and her colleagues conducted a study of 55 Black women in the U.S. with a mean age of 37.7. They found that a higher number of experiences of racial discrimination were associated with a markedly greater response in brain networks associated with emotional regulation, fear inhibition, and visual attention. And the mediating factor in emotional regulation is interoception. Frequent experiences of racial discrimination, they suggest, may activate survival-based responses to trauma and stress that require a modulation of resources and contribute to health disparities caused by racism.

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Summary:

Interoception refers to our ability to perceive the inner world of our bodies. It’s not just an individual function; it is also socially determined. Here are the main points that underlie this insight:

• In its scientific definition, interoception refers to our ability to receive, interpret, respond to, and regulate the body’s internal signals.

• You can also think of interoception as inner perception, or mindfulness of the body

• emotionally-mediated illnesses—anxiety, depression, chronic pain, eating disorders and other addictions, and more—have anomalies in one or more of these four nodes of interoception

• Receptors in our cells, tissues, and organs—collect information about the inner state of our bodies, then send this information to the brain, where it is processed in three stages (for details on the process in the brain and how it relates to emotional health, view this column)

• We’re taught to view interoception as an individual endeavor, but it’s actually a social construct

• Oppression directly targets interoception by creating unsafe environments, which force its targets to scan the environment for threats, and which uses extra resources for emotional regulation and threat detection.

• This means that there are social determinants (influences on) interoception.

• This is true also for gender: People in female, LGBTQ+ bodies, and disabled people experience greater social challenges to their interoception.

• To put this information into practice, or help others do so, visit the Practice Section directly below

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Book Recommendations: I highly recommend Dr. Joy DeGruy’s outstanding book Post-Traumatic Slave Syndrome, which explores the direct and epigenetic “legacy” of enslavement and oppression of African and African American people.

I also recommend undertaking an experiential exploration of Somatic Abolitionism, the work of Resmaa Menakem, for its brilliance in applying embodied insight to racial justice in a sustained way.PRACTICE SECTION.

Becoming Your Own Body Detective

Pick any sensation (of course, you can pick more than one) such as your breathing, your heartbeat, gastrointestinal sensations, and track it for the next several months.

It’s super cool to use several tracking “modalities,” such as contemplative practices, check-ins throughout the day, or movement. (Feel free to be creative; it’s your sensation, after all, and it’s fun to find myriad ways to follow it!)

Say, for example, that you decide to follow and become more aware of your breathing, and in particular, the sensations of breathing. You can track these sensations in a meditation, becoming aware of the fullness, shape, and location of your breath. You can do the same in an embodied check-in for a minute or two as you’re going about your day. And you can do it during any form of movement.

When you’ve chosen the sensation you’d like to track, you can record your observations in your Body Journal.

Tip: All of us have sensations that are more “elusive” or quiet than others. If you’re not receiving data on a sensation over a long period of time, feel free to choose another one.

“When I feel, truly feel, I leave the room for my identity to be unset, for how I grasp for and obtain power to be unset. And unsettled. Feeling is different than conjuring a set of sensations that reinforce who we would like to be. It is allowance and discovery. Listening. A dance with the unknown.”

~ Prentis Hemphill

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Sources:

I’d just presented one of Norm’s groundbreaking studies: Farb, N. A., Anderson, A. K., Mayberg, H., Bean, J., McKeon, D., & Segal, Z. V. (2010). Minding one's emotions: mindfulness training alters the neural expression of sadness. Emotion (Washington, D.C.), 10(1), 25–33. https://doi.org/10.1037/a0017151

Norm and I, together with several colleagues, published a study in 2022 on interoception and attention: Eusebio, J., Forbes, B., Sahyoun, C., Vago, D. R., Lazar, S. W., & Farb, N. (2022). Contemplating movement: A randomized control trial of yoga training for mental health. Mental Health and Physical Activity, 23, 100483. https://doi.org/10.1016/j.mhpa.2022.100483

The scientific field of interoception has exploded in recent years, yielding a staggering number of papers: Khalsa, S. S., Adolphs, R., Cameron, O. G., Critchley, H. D., Davenport, P. W., Feinstein, J. S., Feusner, J. D., Garfinkel, S. N., Lane, R. D., Mehling, W. E., Meuret, A. E., Nemeroff, C. B., Oppenheimer, S., Petzschner, F. H., Pollatos, O., Rhudy, J. L., Schramm, L. P., Simmons, W. K., Stein, M. B., Stephan, K. E., … Interoception Summit 2016 participants (2018). Interoception and Mental Health: A Roadmap. Biological psychiatry. Cognitive neuroscience and neuroimaging, 3(6), 501–513. https://doi.org/10.1016/j.bpsc.2017.12.004

In its scientific definition, interoception refers to our ability to: Farb, N., Daubenmeier, J., Price, C. J., Gard, T., Kerr, C., Dunn, B. D., Klein, A. C., Paulus, M. P., & Mehling, W. E. (2015). Interoception, contemplative practice, and health. Frontiers in psychology, 6, 763. https://doi.org/10.3389/fpsyg.2015.00763

A 2022 hypothesis paper by Sahib Khalsa and Negar Fani, published in the journal Nature, explored the impact of racial discrimination on interoception: Fani, N., & Khalsa, S. S. (2023). The role of racial discrimination in dissociation and interoceptive dysfunction. Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology, 48(1), 225–227. https://doi.org/10.1038/s41386-022-01402-5

Negar Fani and her colleagues conducted a study of 55 Black women in the U.S.: Fani, N., Carter, S. E., Harnett, N. G., Ressler, K. J., & Bradley, B. (2021). Association of Racial Discrimination With Neural Response to Threat in Black Women in the US Exposed to Trauma. JAMA psychiatry, 78(9), 1005–1012. https://doi.org/10.1001/jamapsychiatry.2021.1480