Most people tend to think of body awareness as a homogeneous experiential state, but it really is not. It is much more nuanced and differentiated. Awareness in general consists of exteroception and interoception. Exteroception is the consciousness of the stimuli at the exterior of the body boundary and encompasses most of what we consider everyday sensory awareness. Interoception is the perception of sensations and feelings within the body. Proprioception is the perception of body sensations related to movement, musculature, posture, movement, and balance. Visceroception is the interoceptive perception of internal organs. Because interoception deals with immediate, intimate, and often ambiguous stimuli, it almost always activates emotional responses.
And, now it has recently been discovered that interoception is three-sided: interoceptive accuracy, interoceptive sensibility, and interoceptive awareness. And both have been shown to be neurologically distinct from one another. A cortical pathway of five distinct areas governs interoceptive perception. This neural chain begins in the peripheral sensory receptors to the C-fiber afferent receptors to the spinothalamic projections up to the thalamus and then over to the posterior and anterior insula and to the anterior cingulate cortex (ACC). The posterior insula acts as the limbic sensory center while the ACC serves as the limbic motor response unit. That is, these areas serve the limbic system in evaluating the stimuli in terms of emotional value and then acting in response to that assessment (Farb et al., 2015). Classic and modern theories of emotion all say that perception of bodily sensations is the foundation for emotional experience (Schlinkert et al., 2020).
Interoception is a fundamental aspect of body awareness and it is critical for maintaining homeodynamic balance and protecting the organism. 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. The insula and ACC are central to somatic experience and neurotransmitters in both of these structures modulate body awareness and the sense of well-being. Many health problems relate to distorted interoception such as emotional disorders, addiction, eating disorders, chronic pain, dissociation, somatoform disorder, and post-traumatic stress disorder. Awareness-based, mind-body techniques are proving to be a powerful tool with which to rehabilitate body awareness disturbances (Farb et al., 2015).
There is now a renewed interest in interoception on the part of neuroscientific researchers and its relationship to cognition, memory, and decision-making. Up to this point, however, researchers have used the perception of one’s own heartbeat as the main measurement variable. The reason for this entirely practical: heartbeat is s perceptible, discrete internal event. Recent studies have gone further with this method and have confirmed three different aspects of interoception. The method was to play a series of tones and test subjects had to identify those tones which were in or out of synch with their heartbeats. A body awareness perception questionnaire was also applied (Porges, 1993). Analysis of the results led to several conclusions (Garfinkel et al., 2015).
Interoceptive Accuracy
This is the degree of sensitivity for identifying body sensations. In the literature, it was previously known as interoceptive sensitivity. Only those test subjects in Garfinkel et al. (2014) with the greatest level of accuracy had interrelated levels of interoceptive sensibility and awareness. That is, the interrelationship of all three aspects is greatest at stronger experiences of accuracy.
Interoceptive Sensibility
This is a person’s subjective assessment of their experience. It represents an alternative mode of awareness. Oddly, it was found that the degree of awareness does not correlate with degree of sensibility which means that interoceptive accuracy is the supporting principle under interoceptive awareness and sensibility (Garfinkel et al. 2014).
Interoceptive Awareness
This is the degree of correspondence between a person’s level of interoceptive accuracy and verbal self-report of that experience. Higher levels of awareness—the awareness of one’s quality of awareness—allow a person to make better evaluations of sensations and better behavioral choices in response to them (Garfinkel et al., 2014).
Closing Thoughts
There are several take-aways for myself. First, awareness is a complex phenomenon. Body awareness has three components: (a) selective attention, (b) the body schema/image, and (c) the somatosensory system. Attention acts as the gateway into awareness of somatosensory processing which yields the body schema/image (Kinsbourne, 1995, 2002). Body awareness in general contributes a great deal to how you feel and how you feel about yourself. It affects both body image and subjective well-being. The quality of interoceptive sensitivity may sustain or degrade well-being. People who are high in interoceptive accuracy are less susceptible to objectifying their own bodies. Conversely, persons low in accuracy are more dissatisfied with their bodies (Zamariola et al., 2017). Interoceptive awareness is related to emotional experience, organismic self-regulation, food intake and weight, decision-making, and time perception (Pollatos, 2016). 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). Therefore, working to develop a client’s body awareness can contribute to restoring or enhancing his or her body image. In other words, while the experience of a simple sensation may become figural in consciousness, the background against which it stands is incredibly complex. There is much yet to be learned.
Second, Interoceptive ability is relevant to theories of emotion that focus on neural activities in the peripheral nervous system. These theories propose that emotional feeling states are caused by perceptions of changes in the body’s physiology (Lange & James, 1967). It follows that individuals who are more attuned to bodily responses may experience emotions with heightened intensity (Wiens, Mezzacappa, & Katkin, 2000).
Lastly, it will be good to keep an eye on how this work develops in the coming years as it will most likely hold greater practical value in the future than is apparent now. Knowing the distinctions among accuracy of awareness, sensibility of awareness, and the metacognition of awareness may provide somatic clinicians with a broadened perspective of awareness while possibly allowing them to deepen their explorations of a client’s own interoceptive experience.
Paul Shane, Ph.D., LMT
Director, Academic Content
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References
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.
Garfinkel, S., Seth, A., Barrett, A., Suzuki, K., & Critchley, H. (2014). Knowing your own heart: Distinguishing interoceptive accuracy from interoceptive awareness. Biological Psychology 104, p. 56-74.
Lange, C. & James, W. (1967). The Emotions. New York, NY: Hafner Publishing Co.
Pollatos, O. (2016). The role of the body from the inside for embodied cognition. In Y. Coello & M. Fischer (Eds.), Perceptual and Emotional Embodiment: Foundations of Embodied Cognition, Vol. I. London, UK: Routledge, pp. 262-278.
Porges, S. (1993). Body perception questionnaire: Laboratory of development assessment. University of Maryland.
Schlinkert, C., Herbert, B., Baumann, N., & Koole, S. (2020). Preoccupied with the body: mild stress amplifies the relation between rumination and interoception. Cognition & Emotion 34 (7), p. 1382-1394.
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.
Wiens, S., Mezzacappa, E. & Katkin, E. (2000). Heartbeat detection and the experience of emotions. Cognition and Emotion 14(3), p. 417–427.
Zamariola, G., Cardini, F., Mian, E., & Serino, A. (2017). Can you feel the body that you see? On the relationship between interoceptive accuracy and body image. Body Image 20, p. 130-136.