Abstract

Emotion theories have always focused on the role of bodily cues for understanding our emotional experience, while the relationship between interoceptive awareness and mental health has been less investigated. The aim of this paper is to briefly discuss the importance of being able to recognize and integrate signals originating from within the body, as well as the role of interoception in several mental conditions.

Keyword: Interoception, Interoceptive Awareness, Emotion Regulation, Mental Conditions.

Introduction

Interoception refers to the ability to perceive sensations from inside the body, including the perception of physical sensations such as heartbeat, respiration, and other bodily activities related to emotions (Craig, 2002; Barrett et al., 2001). Generally, these perceptions are unconscious but can become available to conscious awareness (Cameron, 2002).

Interoception plays a role in regulating responses to sensations related to bodily integrity and physical survival, as well as in emotional regulation in terms of mental health. In fact, there is empirical evidence of the connection between interoceptive awareness and emotional regulation (Craig, 2015), as well as the relationship between interoception and stress (Schulz and Vogele, 2015) that can negatively impact interoceptive awareness by altering the intensity of internal bodily signals.

As a measure of interoceptive accuracy, heartbeat awareness may differ between genders (Re et al., 2023) in heart-focused tasks, with men being more accurate than women (Prentice & Murphy, 2022). For a long time, attention to the body has been viewed negatively. Today, the concept of interoceptive awareness has been overturned in the field of clinical research, demonstrating that the cultivation of awareness of one’s internal states can even be fundamental for a positive prognosis in various mental health disorders.

It is upon this new perspective that various meditative techniques are based, such as Mindfulness-Based Cognitive Therapy, which provides a program aimed at reducing suffering through the acquisition of awareness of one’s thoughts, emotions, and physical states (Khoury et al., 2013).

Interoception also plays a crucial role in bodily self-consciousness and the development of the sense of body ownership. The rubber hand illusion paradigm (Botvinick & Cohen, 1998) has shown that it is possible to perceive an artificial hand as part of one’s own body. In this experiment, the participant’s hand is covered by a panel, while a rubber hand is placed within the participant’s field of view.

When the experimenter simultaneously stimulates the rubber hand and the participant’s hand, the participant experiences the rubber hand as their own. However, these results do not take into account the influence of interoception on the sense of ownership of the rubber hand.

In contrast, the experiment conducted in 2011 by Tsakiris, Tajadura-Jiménez, and Costantini, as reported by Tsakiris and De Preester in “The Interoceptive Mind” (2018), demonstrated the existence of a complementarity between interoceptive and exteroceptive processing in the development of a sense of body ownership.

By comparing participants’ levels of interoceptive accuracy with the strength of the illusion, they showed that individuals who experienced a strong sense of ownership over the rubber hand performed poorly on the heartbeat task. Thus, lower levels of interoceptive accuracy were correlated with a stronger sense of body ownership.

Interoception and mental conditions

Interoception alterations have been associated with certain psychiatric conditions, such as alexithymia, anxiety disorders, and depressive disorders, while individuals with high interoceptive abilities may exhibit better emotional regulation.

Individuals with lower interoceptive accuracy may have difficulty perceiving and interpreting bodily signals, which can impact their ability to regulate emotions. Major depressive disorder is characterized by feelings of sadness, pessimism, and loss of interest and pleasure. Additionally, somatic symptoms such as pain, nausea, tachycardia, shortness of breath, constipation, and a general sense of malaise are reported. It has been observed that this disorder is often associated with low interoceptive accuracy when symptoms are not severe (Eggart et al., 2019).

Patients with moderate depression perform worse in detecting heartbeats, while healthy controls and patients with severe depression perform well. The reasons for this trend have been hypothesized by several scientists. Furman et al. (2013) hypothesized that these results depend on the frequent comorbidity between severe depression and anxiety disorders, which instead induce significant interoceptive accuracy.

Essentially, the opposing effects of the two disorders on interoceptive abilities would cancel each other out. The same scientists (2013) conducted an experiment on the interoceptive accuracy of women with acute depression without comorbidity with anxiety disorders. These women showed lower levels of interoceptive accuracy compared to non-depressed participants.

Poor interoceptive accuracy is also correlated with higher levels of alexithymia, which is the inability to understand one’s own emotional states. In a study by Brewer, Cook & Bird (2016), it was found that high levels of alexithymia are positively correlated with deficits in interoceptive accuracy. Furthermore, it has been demonstrated that there is a relationship between interoceptive accuracy and the ability to understand the emotional states of others.

In an experiment, the interoceptive awareness of participants was assessed and subsequently compared with their ability to discriminate emotional expressions of individuals shown in static images. It was found that the recognition rate of emotional expressions is positively correlated with interoceptive awareness (Terasawa et al., 2014).

These findings are consistent with observations made on individuals with autism spectrum disorders, characterized by restricted behaviors, interests, and activities, as well as deficits in communication and social interaction (Bressi & Invernizzi, 2012). These individuals exhibit high alexithymia, which is evident considering the deterioration of their ability to understand their own emotional states.

Interoception also plays a central role in the development of addictions to psychoactive substances. Extremely interesting results concern the concept of “interoceptive agnosia” developed by F. Caruana (2011) and its relationship with addiction. Interoceptive agnosia refers to a deficit in perceiving interoceptive signals. It has been observed that patients with insular lesions are able to recognize the timing of their heartbeats, indicating that they retain a basic level of interoceptive ability.

However, their interoceptive agnosia has been demonstrated through various experiments conducted on nicotine-dependent patients who have suffered a stroke. In fact, after the traumatic event, they were immediately able to quit nicotine use without difficulty (Naqvi et al., 2007).

This not only demonstrates that these patients have lost the ability to “read” interoceptive cues from their bodies but also confirms numerous studies suggesting that insular activity is directly involved in the craving phenomenon in individuals using psychoactive substances such as nicotine, alcohol, cocaine, and heroin (Naqvi & Bechara, 2009).

Conclusion

According to Craig (2002), interoception can be defined as “the sense of the physiological condition of the whole body, not just of the viscera,” and it is associated with better emotional regulation (Pollatos et al., 2007). The concept of interoceptive accuracy, on the other hand, refers to the ability to perceive and interpret internal signals and is correlated with a better understanding of one’s own emotional state.

Interoception plays an important role in various mental disorders such as anxiety, depression, and eating disorders, in which individuals may have difficulties perceiving or interpreting internal bodily sensations. A large number of disorders are associated with altered interoception.

For example, individuals with anxiety disorders may experience heightened awareness of bodily sensations and interpret them as signs of danger, leading to increased anxiety and avoidance behaviors. Similarly, individuals with depression may have reduced interoceptive accuracy, which may contribute to a lack of motivation and reduced physical activity. Individuals with eating disorders may also have altered interoception, with distorted perceptions of hunger and fullness cues leading to dysfunctional eating behaviors.

For all these reasons, disorders that affect interoceptive accuracy can have a significant impact on individuals’ physical and mental health, and individuals with poor interoceptive awareness may be more likely to develop mental health conditions. Therefore, promoting emotional regulation and interoceptive awareness could be an effective way to improve mental health.

Furthermore, the fact that interoceptive accuracy is an important factor in a range of mental and physical health conditions leads us to consider the possibility of developing more effective interventions and treatments in the future.

Lavinia Maria Tiziano
Department of Cognitive Science, Psychology, Education and Cultural Studies University of Messina

Anna Re
Istituto per le Tecnologie Didattiche, CNR (Palermo)
Department of Cognitive Science, Psychology, Education and Cultural Studies University of Messina

References

1. Barrett, L.F., Gross, J., Christensen, T.C., & Benvenuto, M. (2001). Knowing what you’re feeling and knowing what to do about it: mapping the relation between emotion differentiation and emotion regulation. Cognition and Emotion, 15(6), 713-724. https://doi.org/10.1080/02699930143000239.
2. Bressi C., Invernizzi G., (2012) Manuale di Psichiatria e Psicologia Clinica, McGraw Hill
3. Botvinick, M., & Cohen, J. (1998). Rubber hands ‘feel’ touch that eyes see. Nature, 391(6669), 756. https://doi.org/10.1038/35784
4. Brewer, R., Cook, R., & Bird, G. (2016). Alexithymia: a general deficit of interoception. Royal Society open science
5. Cameron, O. G. (2002). Visceral Sensory Neuroscience: Interoception. Oxford: Oxford University Press.
6. Caruana, F. Esiste una agnosia enterocettiva? L’insula e l’interruzione della dipendenza, in “Giornale italiano di psicologia, Rivista trimestrale” 4/2011, pp. 877-898
7. Craig, A. D. (2002) How do you feel? Interoception: The sense of the physiological condition of the body. N1ature Reviews Neuroscience, 3(8), pp.655–66.
8. Craig, A.D. (2015). How Do You Feel? An Interoceptive Moment with Your Neurobiological Self. Princeton, New York: Princeton University Press.
9. D.J. Furman, Christian E. Waugh b , Kalpa Bhattacharjee b , Renee J. Thompson a , Ian H. Gotlib. Journal of Affective Disorders 151 (2013) 780–785.
10. M. Eggart, A. Lange, M.J. Binser, S. Queri, B. Müller-Oerlinghausen Major depressive disorder is associated with impaired interoceptive accuracy: a systematic review
11. Brain Sci., 9 (2019), p. 131, 10.3390/brainsci9060131.
12. Khoury, B., Lecomte, T., Fortin, G., Masse, M., Therien, P., Bouchard, V., . . . Hofmann, S. G. (2013). Mindfulness-based therapy: A comprehensive meta-analysis. Clinical Psychology Review, 33, 763-771.
13. Naqvi, N. H., & Bechara, A. (2009). The hidden island of addiction: the insula. Trends in neurosciences, 32(1), 56-67. Naqvi, N. H., Rudrauf, D., Damasio, H., & Bechara, A. (2007). Damage to the insula disrupts addiction to cigarette smoking. Science, 315(5811), 531- 534.
14. Pollatos O, Herbert BM, Matthias E, Schandry R. Heart rate response after emotional picture presentation is modulated by interoceptive awareness. Int J Psychophysiol. 2007 Jan;63(1):117-24. doi: 10.1016/j.ijpsycho.2006.09.003. Epub 2006 Nov 29.
15. Pollatos O, Traut-Mattausch E, Schandry R. Differential effects of anxiety and depression on interoceptive accuracy. Depress Anxiety. 2009;26(2):167-73.
16. Prentice, F., & Murphy, J. (2022). Sex differences in interoceptive accuracy: a meta-analysis. Neuroscience Biobehavioral Reviews, 132, 497-518. https://doi.org/10.1016/j.neubiorev.2021.11.030.
17. Re, A., Malvica, S., Lucifora, C., Perconti, P., Bruni, D. (2023). Gender differences in the interoceptive awareness: a pilot study on Italian people. Mediterranean Journal of Clinical Psychology 11(1). https://doi.org/10.13129/2282-1619/mjcp-3571.
18. Schachter, S., & Singer, J. (1962). Cognitive, social, and physiological determinants of emotional state. Psychological review, 69(5), 379
19. Schulz A., & Vögele C. (2015). Interoception and stress. Frontiers in Psychology, 6, 993. https://doi.org/10.3389/fpsyg.2015.00993.
20. Terasawa, Y., Moriguchi, Y., Tochizawa, S., & Umeda, S. (2014). Interoceptive sensitivity predicts sensitivity to the emotions of others. Cognition and Emotion, 28(8), 1435-1448.

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