Pediatric Therapeutic Services

Interoception: Five Q&As About This New Sense of Self

Most of us learn about “the five senses” at an early age: sight, sound, smell, taste, and touch. As a professional working in special education though, you’re familiar with two more: vestibular sense (balance) and proprioception (movement).

Smiling school-based therapist stands behind three elementary school boys and one girl in front of white board with drawings.Professional therapy clinicians also know about interoception, often described as the “eighth sense.” This lesser-known sense helps you feel and understand what’s going on inside your body. Developing an awareness of bodily sensation is part of many contemplative practices such as mediation, yoga, and tai chi.

Recent studies have focused not only on measuring interoception, but also on training individuals in recognizing interoceptive sensations in order to potentially improve resilience to stress, emotional instability, and mental illness.

Kids who struggle with interoceptive awareness may have trouble knowing when they feel stressed, hungry, full, hot, cold, or thirsty. And when children have difficulty recognizing how their bodies feel inside, self-regulation can become a challenge.

Self-regulation is a foundational skill missing in many students we at Pediatric Therapeutic Services (PTS) treat. At our recent Delaware Therapist Training Program, PTS occupational therapist Susan Hammond presented on interoception, giving our practitioners a greater understanding of it and its impact on their work. 

Here are five common questions about interoception, along with answers from Susan’s informative overview. We’re happy to share this with you so you can more effectively serve the students you work with, too!

What’s the Difference Between Interoception and Feelings? 

Interoception is awareness of the physical sensations in your body when you have certain feelings. Different emotions can cause different physical sensations that help us identify what feeling we’re experiencing. 

For example, imagine a police officer pulls you over for speeding. You might feel your heart race and “butterflies in your stomach.” Your interoception lets you know these body sensations mean you’re feeling nervous.

Interoception also helps us identify our bodily needs. For example, when you have to go to the bathroom, you might feel pressure in your bladder. 

How Does Interoception Help With Self-Regulation? 

Flow chart of five rectangles arranged in a ladder, labeled from top to bottom: “Feel Sensations,” “Body State or Emotion,” “Urge to Act,” “Action,” “Outcome”Interoception is like a big warning system. Certain physical sensations in our body alert us to danger, discomfort, and distress, thereby motivating us to take action and address the situation at hand.

That motivation to find relief and restore homeostasis is what we call self-regulation. We sense a threat exists because our interoceptive sense alerts us, then we take action to alleviate the threat.

But what happens if you’re experiencing all these internal sensations and can’t identify them… or don’t notice them at all? What if the warning system is broken or sending you the wrong signals? You may feel a lump in your throat and tears in your eyes, but not know you’re sad, so you won’t seek comfort. Or you may feel your stomach grumbling, but not know you’re hungry, so you don’t eat anything.

Is Interoception Important to Any Other Areas? 

In addition to self-regulation, interoception is clearly linked to many other important skill areas, including higher-level thinking and problem solving, interpersonal skills, and general mental health. When the interoceptive system isn’t functioning, it can impact all these key areas. 

“Your body is part of your mind, not in some gauzy mystical way, but in a very real biological way,” said Dr. Lisa Barrett, Distinguished Professor of Psychology at Northeastern University, at the 2019 International Convention of Psychological Science (ICPS) in Paris. “This means there is a piece of your body in every concept that you make, even in states that we think of as cold cognition… Sometimes you feel wretched for a purely physical reason. It’s not thoughts that are driving feelings, but feelings that are driving thoughts.”  

Is There a Link Between Interoception and Autism?

The role of interoceptive impairments for people with autism is a hot topic. Researchers now view a lack of interoception as an important missing skill set for these individuals.

In her book Interoception: The Eighth Sensory System: Practical Solutions for Improving Self-Regulation, Self- Awareness and Social Understanding of Individuals With Autism Spectrum and Related Disorders, Kelly Mahler MS, OTR/L surveys this research. She describes the clear link between interoception and cogitative, social, and emotional skills.

People with low interoceptive sensitivity have a compromised ability to be aware of, understand, and effectively manage their feelings or emotions. They may also have difficulty recognizing emotions or cues from others, which can impair their ability to interact socially.  

For example, if a student is growing more and more anxious but doesn’t recognize the physical signs in her body alerting her to do something like ask for help or self-calm, she may end up bolting right out of the classroom. 

When individuals are unable to “read their feelings,” they have a condition called alexithymia. Dr. James Huffine reports how research has shown that people who experience mental health problems have a much higher rate of alexithymia than the 10% rate reported in the general population:

  • Smiling female school-based therapist stands behind young elementary school girl who is holding a large book open on desk.Psychosomatic disorders – an approximately 40%−60% rate of alexithymia
  • Anxiety disorders – 13%−58%
  • Depressive disorders – 32%−51%
  • Eating disorders – 24%−77%
  • Addictive disorders – 30%−50%
  • Obsessive-compulsive disorder – 11%−36%
  • Autism spectrum disorder – 40%−60%

Huffine describes interoceptive impairment as akin to flying a plane without instruments. How can someone be expected to “control their emotions” when they’re unable to recognize what they’re feeling, let alone problem solve how to change it?

The good news is alexithymia is treatable. 

Therapy for people living with alexithymia focuses on building a foundation of naming emotions and appreciating a range of feelings. Because interoceptive impairments also impact one’s ability to empathize, the process will likely include both consideration of other people’s experiences and self-reflection.

Multiple therapeutic modalities have been found to be beneficial, including:

  • Group therapy
  • Daily journaling
  • Skill-based therapy
  • Engaging in the creative arts
  • Various relaxation techniques
  • Reading emotional books or stories

How Can we Help Students Improve their Interoceptive Awareness

In the school environment, a multi-disciplinary approach generally helps the most. Counselors can use modalities like art therapy, creative writing, and social stories.

Some key, step-by-step strategies aimed at helping individuals improve their awareness and identification of interoceptive sensations exist. Kelly Mahler outlines many of them in The Interoception Curriculum: A Step-by-Step Guide to Developing Mindful Self-Regulation. They include:

Step 1. Teach students to notice and identify signals inside the body.

Until students become conscious of what they’re feeling inside their bodies and can distinguish one sensation from another, making the important emotional connections is impossible. Noticing the body’s signals is an element of mindfulness training, which has become more widely known.

One helpful activity would be having a student exercise vigorously for 5 minutes. Then, have them describe what their body is feeling (faster heart rate, sweating, breathing heavily). Wait five minutes, then have them describe what their body feels like when it is back to normal.

Activities about distinguishing hot from warm from cold are other good places to start.

Step 2.  Learn how to connect certain body signals with specific emotions.  

Making a body map for each of the common emotions—such as fear, anger, happiness, and excitement—is an excellent activity for connecting interoceptive sensations to emotions. Have students circle parts of their bodies that are affected and what happens to that body part.

Simple black outline of body on white paper, labeled at appropriate places with such sensations as “sweaty palms” and “wobbly knees.”

Step 3. Learn individualized feel-good strategies, thus completing the body-emotion-action connection.

The final component is teaching students self-calming strategies. These fall into several categories:

  • Proprioceptive activities
    These “heavy work” activities are probably the least familiar to most teachers. The name doesn’t mean lifting something that’s actually heavy! It refers to heavy weight-bearing activities on any joint or muscle: chewing, cutting, writing, squeezing, pushing, carrying, and pulling, among others. Have students erase the board, stack chairs on the desks, carry a crate containing some books, or even do jumping jacks.
  • Visualization activities
    Ask students to picture a place that makes them feel happy and peaceful, like the beach, their bedroom, or their backyard. Then ask them to imagine the sounds they hear, like the ocean or seagulls, the warmth of the sand on their feet, and the breeze blowing on their skin.
  • Outline of five-pointed star, with phrases “breathe in,” “hold,” and “breathe out” surrounding the outline.Breathing techniques
    Breathing deeply and in a controlled manner sends a signal to the brain that it’s OK to calm down. You can ask students to take in a deep breath and then blow it out as if they were slowly blowing out a candle. You can also combine breathing techniques with a visualization strategy, like “star breathing,” in which the child traces the outline of a star while breathing rhythmically.  
  • Drinking and eating
    Taking a drink of cold water or chewing on something crunchy or firm, like a licorice stick, can also be good strategies. These other sensations and activities can refocus the brain on something other than what triggered the upset. Chewing gum is helpful for the same reason, and also provides proprioceptive input to the jaw, which produces a calming effect.
  • Movement activities
    Movement is a great way to release tension, get energy out, and reset the nervous system to a more relaxed state. Doing yoga poses, delivering something to the office, handing out papers to other students, or doing some basic calisthenic exercises like toe touches or twisting at the waist can also be calming. Most movement activities are easy to implement right in the classroom and don’t cost a thing. 

Discover More About Interoception from PTS

Interoceptive instruction has applications across a wide range of students with special needs, as well as typical students. It can play a valuable role in helping students with emotional disturbance, a history of childhood trauma, or autism connect with their bodies and emotions in a whole new way.

Once these students can improve their interoception, they can identify what they’re feeling and use a wide range of self-regulation strategies to help them “get it together!”

To find some excellent ideas on self-calming strategies, visit PTS’ Parent/Teacher Resource library

And if you’d like to discover more about how special education programs can help students increase their interoceptive sensitivity and experience more success academically and socially, visit www.mypts.com to learn about our school-based therapy supports. To find out how PTS’ innovative service model can transform your therapy program and your budget, contact PTS for a free related services audit.

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