Increasing Interoceptive Awareness

Recent interoception research, theory, and assessment necessitate an expansion of multi-disciplinary collaboration and the sensory processing frame of reference (DuBois et al., 2016). Interoception involves the nervous system registering, interpreting, and integrating sensory input to represents the current condition of the body. Interoceptive input is the primarily unconscious monitoring of our internal body sensations that is going on all the time (Khalsa et al., 2017; Price & Herting, 2017).
Interoceptive awareness is each person’s unique conscious ability to identify, access, and respond to their internal body signals (Price & Hooven, 2018). Interoceptive awareness includes the awareness of sensations of temperature, pain, hunger, thirst, needing to go the bathroom, and affective touch. It provides the foundation for our feelings and autonomic nervous system reactions for homeostasis and survival (Craig, 2015). Interoceptive awareness can be assessed with the Multidimensional Assessment of Interoceptive Awareness MAIA-2 and significantly improved by specific interventions (Khalsa et al., 2018).
Recent research suggests that clients with developmental disabilities (DuBois et al., 2016) and mental health challenges (Khalsa et al., 2018) are more likely to have interoceptive awareness and sensory processing disorders. Interoceptive awareness difficulties are associated with Autism Spectrum, Tourettes, Post-Traumatic Stress Disorder, chronic pain, substance abuse, bipolar, depression, anxiety, and borderline personality disorder. Limited emotional awareness contributes to emotional dysregulation, sensory responses that are out of proportion or inappropriate to the stimulus (Price & Hooven, 2018).
Occupational therapists are included as a discipline that uses interoception interventions (Price & Hooven, 2018). However, despite revisions of sensory processing interventions to accommodate interoception interventions (Mahler, 2017; Miller & Collins, 2012) the sensory processing frame of reference is seldom included as an interoception intervention. Popular evidence-based interoception interventions include massage, MABT (Mindful Awareness in Body-Oriented Therapy), body and breath focused mindfulness, and cognitive behavioral therapy (Khalsa et al., 2018).
Attracted to its research efficacy, I recently attended the Level 1 Course in MABT (Mindful Awareness in Body-Oriented Therapy), held at Whidbey Island, Washington. Research supports that MABT is associated with improved interoceptive awareness, emotional regulation, pain management, and addiction recovery (Price & Hooven, 2018). While it is in no way the stated intention of the MABT course, my hope is to find ways to apply MABT to facilitating improved body awareness and self-control in adolescents with complex behavioral and developmental challenges.

The six day Level 1 MABT Training Course taught the basics of providing MABT through lectures, demonstrations and extensive supervised coaching while students gave and received MABT intervention. MABT involves mindfulness, massage, touch, self-touch, and individualized verbal interactions that developmentally increase conscious awareness of body sensations as well as their relationship to thoughts and feelings. My fellow students were primarily experienced massage therapists, body workers, and yoga teachers. The course was expertly led by MABT developer Dr. Cynthia Price along with MABT Instructors Carla Wiechman and Elizabeth Chaison. MABT
MABT instruction improves interoception through the use of hands on touch and verbal reflection that facilitates body awareness as well as homework involving self-touch and instructions to notice specific body sensations. MABT involves ten 1½ hour sessions guiding developmentally sequenced expansion of the client’s ability to identify, integrate and apply internal body sensations for emotional regulation (Price & Herting, 2013; Price & Mehling, 2016).
Based on my self-assessment using the Adult Sensory Profile I was aware of my significant differences in Sensory Processing. My score is 2 standard deviations above the mean in Sensory Sensitivity and Low Registration on the Adult Sensory Profile. My scores and experiences suggest that I tend not to register functionally relevant sensory information but overreact to sensory input I do register (Dunn, 2017). Because of my self-awareness of my sensory processing challenges I was not surprised by my limited interoceptive awareness. I was initially able to identify feelings on the surface of my body, but didn’t notice internal feelings (e.g., “butterflies in my stomach”).
During the MABT course I began to increasingly develop an awareness of internal body sensations, like my heart beating. However, I was shocked by my new sensations in the airport on my trip home following completion of the MABT training. It was a couple weeks before Christmas and I noticed that I was upset by the intensive stimulation in the airport. I noticed unfamiliar physical sensations I had in my body in response to the stimulating airport environment (e.g., shaky arms, a tightness in my stomach). I felt that my high arousal level and sad mood were being influenced by the extremely crowded, visually stimulating, loud airport environment (e.g., large crowds of fast moving people, restaurant signs, bill boards, decorations, talking, repetitive announcements, and various alarms competing for my attention). I fly frequently but had never before consciously experienced any body sensations impacting my typical agitation in airports.
I am also gradually finding that my increased body awareness affects my feelings and anger management attempts. I have spontaneously shifted from anger at other drivers (e.g., the annoying people on my road getting in my way) to a realization that other drivers are just also trying to get to work on time. Body feelings seem to  provide the foundation on which my emotions arise. I try to alternate between attending to my internal body signals and monitoring those of my adolescent mental health clients, and to notice how we influence each other. In my blog post next week I will discuss the other ways that I’ve been trying to apply the MABT course to my job as an occupational therapist in an adolescent psychiatric hospital.
References:
Craig AD. How do you feel?: an interoceptive moment with your neurobiological self. 2014.
Dunn W. Child Sensory Profile–2 user’s manual. Bloomington, MN: Pearson. 2014.
DuBois D, Ameis SH, Lai MC, Casanova MF, Desarkar P. Interoception in autism spectrum disorder: A review. International Journal of Developmental Neuroscience. 2016 Aug 1;52:104-11.
DuBois D, Lymer E, Gibson BE, Desarkar P, Nalder E. Assessing sensory processing dysfunction in adults and adolescents with autism spectrum disorder: a scoping review. Brain sciences. 2017
Khalsa SS, Adolphs R, Cameron OG, Critchley HD, Davenport PW, Feinstein JS, Feusner JD, Garfinkel SN, Lane RD, Mehling WE, Meuret AE. Interoception and mental health: a roadmap. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging. 2018 Jun 1;3(6):501-13
Mahler, K. Interoception: The eighth sensory system. 2017.
Miller LJ, Collins, B. Sensory discrimination disorder. Autism Digest. 2012 Nov.-Dec;32-33.
Price CJ, Herting JR. Changes in post-traumatic stress symptoms among women in substance use disorder treatment: the mediating role of bodily dissociation and emotion regulation. Substance abuse: research and treatment. 2013 Jan;7:SART-12426.
Price CJ, Hooven C. Interoceptive awareness skills for emotion regulation: Theory and approach of mindful awareness in body-oriented therapy (MABT). Frontiers in psychology. 2018;9.
Price CJ, Mehling W. Body awareness and pain. In Integrative pain management: Massage, movement, and mindfulness strategies. 2016;235-251.