“Awareness in and of itself is healing.” Ruella Frank, Center for Somatic Education
Body awareness is divided into two types: awareness of experience from within the body and from the effects of the external world on the exterior body boundary. The first type is Interoception and further divided into the proprioception of muscles and joints and visceroception of internal organ processes.
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 and time (Berlucchi & Agliotti, 1997).
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, to borrow the term made famous by William James (1842-1910)—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, visceroception, and visual orientation. Of these, proprioception is probably the most important, but there is growing evidence that vision plays a key role in modulating body experience and movement (Berlucchi & Agliotti, 1997).
Neural Basis of Interoception
The influence of neural flows from the bodily interior on experience and behavior has been investigated for more than a century and profoundly shapes our understanding of what it means to be an embodied self (Herbert & Pollatos, 2012). Interoception is the process of perceiving, identifying, and evaluating internal body sensations. A cortical pathway of five distinct areas governs interoceptive perception. This neural chain begins in the peripheral sensory receptors to C-fiber afferents to the spinothalamic projections up to the thalamus then over to the posterior and anterior insula as the limbic sensory cortex and to the anterior cingulate cortex (ACC) as the limbic motor response cortex. Interoception is a fundamental aspect of body awareness and it is critical for maintaining homeodynamics. Maintaining physiological balance and being able to respond to sudden needs as signaled by body sensations guides self-regulation. The degree of successful self-regulation is intimately related to a sense of well-being. Interoceptive sensitivity may sustain or degrade well-being. This is illustrated by Eastern meditation methods which focus on being body sensations. Contemplation of internal experience leads to being more conscious of the present moment; a state termed “presence,” and “agency” which is the ability to effect purposeful change. The insula and anterior cingulate cortex are central to somatic experience and neurotransmitters in both of these structures modulate body awareness and the sense of well-being.
Benefits of Body Awareness
A basic premise in the use of body awareness in mind-body interventions is that self-awareness is an innate tendency toward self-organization, self-actualization, and holistic well-being. Common treatment methods are yoga, Tai Chi Ch’uan, clinical somatic psychotherapy, movement and posture modalities, meditation, breathwork, and specific body awareness techniques. Use of body awareness in these healing approaches leads to integration of emotional distress, increased insights into the personality and the healing journey, and less experiential differentiation between the body and the self. Many health problems relate to distorted interoception such as emotional disorders, addiction, eating disorders, chronic pain, dissociation, somatoform disorder, and post-traumatic stress disorder. Distortions in awareness lead to distortions of body image as well.
When Awareness Becomes Too Much
Typically, most people have low to average body awareness acuity. This is called interoceptive accuracy and having more awareness of one’s body and its sensations is related to better health, self-understanding, and positive body image…for most people. Others who are chronically anxious and prone to ruminative thinking may find themselves obsessing over their body sensations. Ruminators may also become more obsessive when under stress. They tend to report more bodily complaints during these times (Schlinkert, Herbert, Baumann, & Koole, 2020).
Mind-Body Interventions
Clinical Somatic Psychotherapy
The clinically-guided use of body awareness makes for an extremely powerful therapeutic tool in the basic psychotherapy session as substantiated by decades of awareness-based therapy beginning in the 1960s with Frederick “Fritz” Perls (1893-1970) and Gestalt Therapy. Awareness is a powerful means to explore and integrate partially-experienced emotional material and its power becomes especially evident when applied to cases of trauma. It works by resolving blocked, biological defensive responses that become chronically-locked in place (Payne et al., 2015).
Meditation
Mindfulness meditation may serve as a powerful tool with which to rehabilitate body awareness disturbances and treat these various conditions. It may be especially efficacious in reducing body dissociation from chronic pain and sexual abuse as well as addiction, depression, and disordered eating patterns. Meditation has positive impact cognitive health as it improves self-reference, attention, emotional regulation, pain perception, sense of empowerment, and social interactions. Meditation accomplishes this by affecting seven aspects of bodymind functioning.
(1) Heightens interoceptive sensitivity. While laboratory measurements show that meditation does not increase interoceptive sensitivity to body sensations such as heartbeat, it most likely does so with other body processes such as the breath cycle. Meditation does increase the power of holding attention to body signals.
(2) Decreases negative emotional responses to body sensations. Many persons with health disorders are self-conditioned to identify body sensations as being bad or harmful. Meditation training fine tunes awareness to better distinguish the positive from the negative from the irrelevant.
(3) Strengthens the self-regulation function. Increased sensitivity to body sensations leads to a wider range of choice in attending to them and responding appropriately. Better acumen at disregarding certain sensations as signs of danger in favor of identifying positive sensations leads to enhanced well-being.
(4) Deepens insight. Greater sensitivity toward and familiarity with body sensations creates a more detailed knowledge base which leads to seeing how sensations, emotions, and thoughts are all inter-related.
(5) Fosters presence and self-agency. As noted above, meditative practice increases a meditator’s present-centered awareness which leads to more conscious decision-making and enhanced sense of personal power and control.
(6) Creates positive experiences. Heightened discernment of sensations eventually leads to a stronger ability to engage with positive sensations and appreciate the value of pleasurable sensations.
(7) Certain meditative practices emphasize proper sitting postures which support the quality and effectiveness of the practice. The Tibetan-Buddhist tradition teaches that a straight, well-grounded posture opens the flow of energy through the body’s energy meridians. The body and its musculature are being molded over time as an essential structure that supports both energetic processes as well as physiological ones such as the breathing pattern (Farb et al., 2015).
Common Clinical Issues
Eating Disorders
Disturbance in the experience of the body is a defining feature of anorexia nervosa (AN). Distortions in interoceptive awareness distort the experience of the body boundary. Indeed, the role of sensation in contributing to or constituting body image disturbance has long informed research in AN, and was first observed by Bruch in 1962. Recent studies show that active anorectics and recovered patients show an abnormal sensitivity to sensory experience which is directly related to body image disturbance. Awareness training, desensitization techniques, and acceptance-based strategies are suggested for clinical intervention (Zucker, et al., 2013). There is growing evidence that the overweight and obese have problems perceiving the visceroceptive signals of satiety while eating. They have low interoceptive sensitivity. Enhancing body awareness should help correct the dis-regulation of food intake (Herbert & Pollatos, 2014).
Body Image Disturbance
Interoception and body image make up much of the embodied self and its well-being. Interoceptive accuracy (IA) is associated with body image in that those with poor IA have more negative body images and vice versa. Studies converge on three conclusions.
- Persons with body image disturbances have problems perceiving and recognizing body sensations.
- The insula is the seat of the cortical processing of body signals.
- The function of the insula is altered in psychopathological states affecting body image (Badoud & Tsakiris, 2017).
The accuracy 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). Therefore, working with body awareness contributes to restoring or enhancing body image.
Posttraumatic Stress Disorder
The use of yoga to improve interoceptive awareness in cases of PTSD is promising good initial results. A small study applying yoga over an 8-week session to three (3) PTSD persons resulted in significant increases in body awareness with a concomitant reduction in trauma symptoms (Neukirch, Reid, & Shires, 2018).
Sexual Well-Being
A meta-analytic study of 29 studies of sensory focusing, mindfulness, and the experimental manipulation of body awareness yields important insights about awareness and sexual health. Enhancing the body awareness of women improves sexual responsiveness and low sexual arousal while reducing hypoactive desire, anorgasmia, and sexual pain and in non-clinical samples (Seal & Meston, 2018).
Closing Thoughts
This is just a small sampling of the research into the nature and effects of body awareness. What is striking is just how simple a thing as a part of embodied consciousness along with its potential power to support health and well-being. The topic of body awareness and its various aspects is discussed in other blog-lectures on this site.
Paul Shane, Ph.D., LMT
Director, Academic Content
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References
Badoud, D. & Tsakiris, M. (2017). From the body’s viscera to the body’s image: Is there a link between interoception and body image concerns? Neuroscience & Biobehavioral Reviews 77, p. 237-246.
Berlucchi, G. & Aglioti, S. (1997). The body in the brain: neural bases of corporeal awareness. TINS, 20(12), p. 560-564.
Bruch, H. (1962). Perceptual and conceptual disturbances in anorexia nervosa. Psychosomatic Medicine, 24(2), 187e194.
Farb, N., Daubenmier, J., Price, C., Gard, Kerr, C., Dunn, B., Klein, A., Paulus, M., & Mehling, W. (2015). Interoception, contemplative practice, and health. Frontiers of Psychology 6, http://doi.org/10.3389/fpsyg.2015.00763.
Herbert, B. & Pollatos, O. (2014). Attenuated interoceptive sensitivity in overweight and obese individuals. Eating Behaviors 15, p. 445-448.
Mehling, W., Wrubel, J., Dabenmier, J., Price, C., Kerr, C., Silow, T., Gopisetty, V., & Stewart, A. (2011). Body awareness: A phenomenological inquiry into the common ground of mind-body therapies. Philosophy, Ethics, and Humanities in Medicine 6(6), https://doi.org/10.1186/1747-5341-6-6.
Neukirch, N., Reid, S., & Shires, A. (2018). Yoga for PTSD and the role of interoceptive awareness: A preliminary, mixed-methods case series study. European Journal of Trauma & Dissociation 3(1), p. 7-15.
Todd, J., Aspell, J., Barron, D., & Swami, V. (2019). Multiple dimensions of interoceptive awareness are associated with facets of body image in British adults. Body Image 29, p. 6-16.
Payne, P., Levine, P., & Crane-Godreau, M. (2015). Somatic experiencing: Using interoception and proprioception as core elements in trauma therapy. Frontiers in Psychology 6, http://doi: 10.3389/fpsyg.2015.00093.
Schlinkert, C., Herbert, B., Baumann, N., & Koole, S. (2020). Preoccupied with the body: Mild stress amplifies the relation between rumination and interoception. Cognition and Emotion 34, p. 1382-1394.
Seal, B. & Meston, C. (2020). The impact of body awareness on women’s sexual health: A comprehensive review. Sexual Medicine Review 8, p. 242-255.
Zucker, N., Merwin, R., Bulik, C., Mosckovich, A., Wildes, J., & Groh, J. (2013). Subjective experience of sensation in anorexia nervosa. Behaviour Research and Therapy 51, p. 256-265.