Charlottesville
August 14, 2022
Fascinating article from the WSJ. I remember when I used to ignore the signals my body was sending my brain. Now to some degree that represents growth — delayed gratification in a way. And it is important to remember that our brains are lazy and are satisfied with a story that makes sense (versus a story that is the truth). I’m other words, we need to use our rational mind (as opposed to our intuitive mind) to get to the bottom of what our emotions mean.
The article:
Mental-health professionals are coming up with techniques to help people improve their ‘interoceptive’ awareness. Being in tune with our bodies can help us read and regulate our emotions—and read and respond to the emotions of others.
If your heart has ever ached with longing, your stomach churned with anxiety or your face flushed with anger, you know emotions can be as much about physiology as psychology. In fact, your brain constantly monitors countless signals from within your body—pulse, respiration, digestion, muscle tension, temperature, bile production, etc.—to sort out how you are feeling and what may need fixing, whether it’s more or less food, or more or less of someone’s company.
Problems arise, however, when we become insensitive to, or misconstrue, those inner, or interoceptive, cues. For example, we may ignore a prickling or tingling down our spines when we meet someone who would do us harm. Or, we mistake a gnawing emptiness and lethargy for hunger when boredom or loneliness is the true culprit.
Mounting scientific evidence suggests such inaccuracies in how the brain responds to the avalanche of interoceptive signals it receives underlie a host of emotional and behavioral problems, including anxiety and depression as well as addiction, panic, post-traumatic stress, obsessive compulsive, and attention deficit hyperactivity disorders.
As a result, mental-health professionals are investigating and implementing a range of techniques to help people improve their interoceptive awareness and precision, which preliminary clinical trials indicate can have a significant impact not only on how well people read and regulate their own emotions, but also on how well they read and respond to the emotions of others.
“One of the things I think is so beautiful about human beings is that we represent in our own physiology the emotions of others, such as when our hearts race with the fears of others,” says Sarah Garfinkel, professor of cognitive neuroscience and interoception researcher at the Institute of Cognitive Neuroscience, University College London. “So if you get physiological changes in your own body, your capacity to sense and read those signals will also help you understand the state of others.”
Indeed, people with autism spectrum disorder tend to be disconnected from or overwhelmed by their interoceptive signals, which can lead to either flat affect (shutting down) or overreactivity (melting down) in social situations. On the other hand, people who score higher in interoceptive accuracy, reflected by their facility in say, counting their own heartbeats or precisely reporting when fluid they drank hits their bladder, tend to be more resilient when put in challenging social situations. They have also been shown, both in experiments and real life, to make sounder financial decisions.
Biofeedback blip
Interoception was introduced as a concept at the turn of the 20th century. But, except for a brief blip in biofeedback studies in the 1950s and 1960s, the particulars of how well we surveil our internal worlds all but disappeared from the scientific literature until around 2015 when the number of papers on the topic began to skyrocket, due in part to the development of better technology to measure and track various interoceptive signals, but also to intriguing findings about the role of interoception in consciousness and homeostasis (the latter meaning the tendency and process by which the body returns to a healthy equilibrium when thrown off by internal or external forces or stressors).
“The brain’s most important job is regulating the systems in your body, and part of that is modeling the state of the body based on sense data, which is what interoception is,” says Lisa Feldman Barrett, university distinguished professor of psychology and director of the Interdisciplinary Affective Science Laboratory at Northeastern University. “It suggests that interoception is this really basic ingredient of the brain’s action plans.” In other words, interoception is a primary instigation, or prod, for everything you do to feel OK and thrive in the world, from getting a drink of water to putting on a sweater to having sex.
Of course, it would be maladaptive for us to be aware of every whoosh, rush, tug, tickle and burble going on within us. Instead, we more often feel a vague sense of pleasant vs. unpleasant or tranquility vs. agitation, what scientists call affect or mood, which prompts us to act or not. Typically, we look for outside reasons for our feelings, and something external could well be the cause, such as a backhanded compliment or working under a deadline.
But the problem could be coming from within, like maybe lack of sleep or too much sugar. If you have poor interoception, your brain has a hard time figuring out the source of your discomfort and taking care of the problem. You may feel uneasy and depressed but you can’t really sort out why.
“Our interoceptive senses are murkier than we think,” says Dr. Barrett. “What the brain is really doing is putting together all this sense data to form an ensemble of what it thinks is going on.”
A disconnect
This murkiness isn’t helped by our culture of busyness and distraction, which seems to have encouraged an increasing disconnect between our bodies and ourselves. For many it is a way of life, if not a badge of honor, to ignore bodily signals to rest, eat, or even to give and receive love: “I’ll get to it after I close this deal, write that report, tweet my thoughts, play another round of Fortnite, etc.” People rely more on biometric apps on their phones or fitness trackers to tell them how they are doing than surveying their internal landscape to discover how they actually feel, the potential causes and what they should do about it.
“The challenge in the literature is a lot of times people have focused on how accurately an individual perceives the state of their body and less on how often they are actually paying attention to the status of their body,” says
Sahib Khalsa, director of clinical operations at the Laureate Institute for Brain Research in Tulsa, Okla. “It’s like trying to figure out if someone needs corrective lenses by asking, ‘Can you see what’s on the page?’ when you really should be asking, ‘Are you even looking at the book?’”
Dr. Khalsa recently concluded a study using “flotation therapy” to help people with eating disorders raise their interoceptive awareness. Flotation therapy involves floating in a dark and very quiet ovoid chamber (imagine a giant egg), which is filled with salty water warmed to near body temperature. With external sensory inputs of hearing, touch, vision and even the pull of gravity neutralized, people tend to become hyperconscious of their internal symphony—the hum, strum and thrum of their breathing, heartbeat, intestinal activity and blood sluicing through their veins.
“We found people’s body image was improved, and also found a very large effect lowering anxiety levels,” says Dr. Khalsa about the flotation study, which included 67 subjects diagnosed with anorexia nervosa who were randomly assigned to either float therapy plus standard care or standard care alone. “Some of these positive effects were sustained at the six-month follow-up point,” he says. While Dr. Khalsa doesn’t envision flotation therapy as a stand-alone treatment for people with eating disorders, he does find the results encouraging: “I’m optimistic that the evidence could have the potential to lead to broader clinical adoption of the technique.”
That isn’t to say people aren’t on their own adopting flotation therapy for treatment of a range of other interoception-linked conditions, from anxiety to fibromyalgia, thanks to a proliferation of commercial flotation therapy centers popping up in strip centers across the U.S. (cost: $60 to $80 for an hourlong session).
Proponents describe an almost “trippy” experience similar to taking psychedelics, which likewise disconnects people from external reality and heightens internal sensations, but minus the hallucinatory effects.
Count the beats
Other promising treatments, typically provided under the supervision of a psychologist or occupational or physical therapist, involve helping patients become more in tune with their bodies by having them engage in activities that make their internal signals more pronounced. For example, they may do jumping jacks to raise their heart rate so they can more easily count the beats. Then they receive feedback on their accuracy, even as their pulse returns to baseline, using devices similar to electrocardiograms or pulse oximeters hooked up to pulsing lights or tones to give visual or auditory cues.
“We divide our curriculum into 15 different body parts, starting with outside body parts like hands on a stress ball, and then we work our way into how your stomach feels, how your bladder feels, how does your heart feel, and so on,” says Kelly Mahler, an occupational therapist in Hershey, Pa., who specializes in helping neurodivergent adults and children improve their interoceptive attention and accuracy.
The next step, she says, is figuring out what those feelings mean for that particular person, which is tricky because the experience of say, hunger, thirst, fatigue, tension, not to mention joy, sadness, anger and anxiety varies depending on the individual, the moment and the context.
And then there’s the critical piece of learning what to do about those feelings once perceived.
Dr. Mahler says the protocol is usually prescribed for those who are experiencing “interoceptive extremes,” where you are so overwhelmed by your internal sensations that you can’t cope or are largely insensitive to them so you fail to practice self-care. But she was quick to add that everyone can benefit from becoming more tuned in to their interoceptive experience: “The benefits are profound when you slow down, really notice what your body is telling you and give yourself permission to attend to its needs.”
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