Defining Body Awareness
Body awareness has been studied a great deal over the years beginning in the late nineteenth-century. It is defined as “an attentional focus on and awareness of internal body sensations” (Mehling et al., 2009, p. 1). This is only a partial definition as internal body sensations include feelings from the viscera (visceroception) and the muscles (somatoperception) as well as posture and movement of the joints (proprioception). Internal awareness is broadly categorized as interoception. Interoception is defined as the perceptual process of receiving, accessing and appraising sensory signals from within the body. Interoception is critical for our sense of embodiment, motivation, and well-being. Yet, despite its importance, interoception remains poorly understood within modern science (Farb et al., 2015). But there is also the awareness of what is being experienced on the surface the body and this includes input from the primary sensory organs. This is called exteroception. Both interoception and exteroception are the two sides of body awareness. While body awareness as a concept seems simple, obvious, and straightforward, it is really much more complex and nuanced concept to fully comprehend.
Most studies of body awareness have focused on its pathological states as found in anxiety disorder, panic disorder, somatic symptom disorder (formerly hypochondriasis), and somatization disorder. Somatization is the somatopsychic conversion of emotional energy into physical symptoms which cannot be explained by conventional medicine. It is a common condition and one often subsumed under the rubric of medically unexplained symptoms, a social and clinical predicament (Kirmayer et al., 2004).
Somatization disorders are marked by body awareness becoming hyper-acutely sensitive to any bodily changes and then these sensations are misinterpreted (Mehling et al., 2009). This practice of anxiously dwelling on disturbing body sensations is known as somatic amplification (Barsky, Wyshak, & Klerman, 1990; Cioffi, 1991). Anxious people usually attribute the meaning of body sensations to psychological causes while somatizers—those who convert negative emotions into physical aches and pains—are quick to attribute them to threatening maladies. A large German study found that the majority of somatizers are female, 45 years or older, and from lower socioeconomic levels (N=2,552). More than 20 percent reported pains in the back, head, and extremities as well as food intolerances, sexual problems, and painful menstruation. About three out of four somatizers experience problems below the line of clinical significance and this may be one reason why somatization is often under-reported by the medical community (Hiller, Rief, & Brähler, 2006). The most common form of somatization is chronic pain with the back, abdomen, chest, head, pelvis, and various muscle groups most commonly affected. Other areas affected are the heart, lungs, and bones. Multiple somatic complaints are almost always be related to emotional distress. This distress stems from unresolved issues, past surgeries, or a family history of mental illness (Iezzi et al., 1994). Somatic pain results from emotional or sexual abuse and manifests as breast pain in women who are anxious or depressed. Many of these women have a higher incidence of emotional and sexual abuse as compared to women with breast lumps. Chronic and medically unexplained breast pain may be a sign of past trauma (Colegrave, Holcombe, & Salmon, 2001). Somatization is often comorbid with hypochondriasis although it is more likely that somatization—with or without hypochondriacal beliefs—is associated with severe bodily preoccupation, personality issues, mood and anxiety problems.
Neurological Aspects
The human brain, at birth, comes hard-wired for body consciousness. It possesses a neuroanatomical system that represents body experience. Very shortly after delivery, hours or perhaps even minutes later, newborns can imitate mouth, facial, and head movements performed by adults within their close visual range. Whether or not this imitation is reflexive or under conscious volition is still open to debate, but the more salient point is that a neural mechanism must exist that is related to the visual experience and reflected in the motor responses that mirror the perceived adult movements. Primates are highly imitative and this neural system may be the basis for that ability; an ability that becomes more sophisticated with experience over time. This neural system is most likely the ventral premotor cortex, posterior parietal cortex, temporo-parietal junction, and the insula. The end result—a continuous stream of body consciousness a la the famous image from William James—is the mental representation of the body distilled from the integration of sensory impressions. The primary neural contributors are proprioceptive flow, fluctuations from sensory-motor feedback activity, visceral interoception, and visual orientation. Obviously, body awareness is a multi-sensory mode function of which proprioception and vision together form body experience and control movement (Berlucchi & Aglioti, 1997).
At its simplest, neuroanatomical studies have identified pathways responsible for interoceptive awareness. These neural circuits may be affected by disease, emotional disorder, or meditative practices. This neural system is made up of peripheral receptors, C-fiber afferents, spinothalamic projections, thalamic nuclei, posterior and anterior insula as the limbic sensory cortex, and the anterior cingulate cortex as the limbic motor cortex (Bush et al., 2000; Critchley & Harrison, 2013; Vaitl, 1996; Vuilleumier, 2005).
The anatomical pathways for interoception are well-specified, detailing the connections between sensory receptors, spinal cord, brainstem, and brain (Craig, 2002). Neurotransmitter concentrations in the insula and ACC in particular have been associated with subjective interoceptive awareness and subjective well-being (Ernst et al., 2014; Wiebking et al., 2014). However, how such neural representations are constructed and the mechanisms by which they influence thinking remain unclear.
In general, interoceptive attention is controlled by the anterior insula as it refers our attention to physiological sensations arising from the body. The insula is activated by autonomic arousal and emotional responses (Craig 2002, 2003, 2009; Wang et al., 2019).
Facets of Body Awareness
Body awareness researchers offer a model of body awareness possessing four dimensions. These were identified after evaluating a variety of body awareness scales and measurement devices (Mehling et al., 2009).
Perception of body sensations
This is the ability to sensitively detect changes in body sensations that may or may not indicate subtle meanings of emotional-physiological states. It is subdivided by (a) sensations of distress, worry, pain and tension, (b) feelings of well-being, (c) ambiguous sensations whose meanings are uncertain and to be determined, and (d) the emotional tones associated with different sensations.
Quality of attention
The quality of body awareness is affected by the kind of attention it is given. Attention, in turn, is determined by intensity of the focus, the ability to control the focus of attention, and the type of attention being focused: analyzing, reflecting, or ruminating on the body sensations.
Attitude of body awareness
Awareness is also affected by either a positive or negative attitude toward what is being experienced. One can trust that the sensory experience is helpful or is a healthy aspect of the body-self or one can assign catastrophic meanings to the sensations.
Awareness of mind-body integration
This aspect refers to whether or not the awareness leads to a connection the meaning of physical sensations to emotional needs and states or if it just contributes to the overall sense of embodiment or alienation of the feelings from the body-self.
Body Awareness, Health, and Well-Being
In everyday states of healthy functioning, body awareness is crucial for daily operations and survival. It is also the basis for organismic self-regulation to maintain balanced states of physiological functioning. At higher levels, it is involved in thinking, decision-making, and forms the basis for well-being. And, at the highest level of all, it is used for mindfulness meditation and contemplation (Farb et al., 2015). Body awareness contributes to body image. People who are high in interoceptive accuracy are less susceptible to objectifying their own bodies. Conversely, persons low in body awareness are more dissatisfied with their bodies (Zamariola et al., 2017).
From this perspective, greater accuracy of interoceptive self-representation promotes greater moment-by-moment adaptation, whereas dissociation from accurate representation can lead to dysregulation. Accordingly, many contemporary health problems involve dysregulated interoceptive processes, including addiction (Naqvi & Bechara, 2010), affective disorders (Paulus & Stein, 2010), chronic pain (Schmidt et al., 1989), dissociative disorders (Hankin, 2012; Michal et al., 2014; Sedeño et al., 2014), eating disorders (Garner et al., 1983; Pollatos et al., 2008; Herbert & Pollatos, 2014), female sexual response (Afshari et al., 2016; Seal & Meston, 2018); post-traumatic stress disorder (Wald & Taylor, 2008), and somatoform disorders (Mirams et al., 2012; Schaefer et al., 2012). Understanding how interoceptive processes influence representations of the self in the world and self-regulation may lead to improved treatment methods (Pollatos et al., 2005).
Closing Thoughts
Little wonder that body awareness has always been a fundamental instrument in the tool kits of clinical somatic psychotherapists going back to at least the 1930s (e.g., Perls, Hefferline, & Goodman, 1951).
In summary, body awareness—at its simplest conception—is self-reflective consciousness of body experience. It possesses several functional dimensions pertaining to quality of attention, attitude, emotional orientation, and cognitive interpretation. One key purpose of body awareness is how it contributes to states of health or dis-ease. Obsessive fixation on body sensations is a key symptom in both somatic symptom and somatization disorders. Conversely, focused and reflective awareness contributes to physical and mental health. The sensitivity of interoceptive awareness and the positive appraisal of interoceptive sensations are linked to various aspects of body image including appreciation for the body, appreciation for the body’s functionality, self-conscious emotions related to the body’s appearance, and body pride (Todd et. al., 2019).
This feature has not been studied very much and the scientific world believes that its discovery of the relationship between interoception and health is new, but they are mistaken (i.e., Farb et al., 2015). The use of body awareness for health and self-development has been used for ages in the forms of Yoga and Buddhism.
What those in the holistic health and somatic clinical psychotherapy fields have long known is that working to develop a client’s body awareness can contribute to restoring or enhancing his or her body image (Todd et al., 2019). The clinically-guided use of body awareness is an extremely powerful therapeutic tool in the basic psychotherapy session, but especially dramatic when applied to cases of trauma. It works by resolving blocked, biological defensive responses that become chronically-locked in place. A singular case example is that of the development of Somatic Experiencing (Payne, Levine, & Crane-Godreau, 2015). A wealth of other body-oriented healing and psychotherapy methods may also fall into this classification, such as Gestalt therapy (Sills, Lapworth, & Desmond, 2012), Bioenergetic Therapy (Lowen, 1992), Dialectical–Behavioral Therapy (Linehan et al., 1999), Acceptance and Commitment Therapy (Hayes, Strosahl, & Wilson, 1999) and other body-mind approaches such as Yoga Therapy (Schmitt & Bharati, 2023), Aston Patterning (Hannon, 2005), Feldenkrais Method (Buchanan & Ulrich, 2001), Alexander Technique (Woodman & Moore, 2012), Rolfing Movement Integration (1993), Focusing (Gendlin, 2012), Rosen work (Fogel, 2009), Hakomi (Kurtz, 1997), Sensory Awareness (Selver et al., 2007), Somatic Experiencing (Payne et al., 2015), Breath Therapy (Mehling, 2001), Holotropic Breathwork (Grof & Grof, 2010), and Mindful Awareness in Body-oriented Therapy (Price, 2005).
Paul Shane, Ph.D., LMT
Director, Academic Content
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Revised 05-03-24.