Interoceptive Awareness, Eating Disorders, and Other Mental Health Symptoms: A Promising Treatment Target

· by · in anorexia nervosa, ARFID, atypical anorexia nervosa, BED, body dissatisfaction, body image, bulimia nervosa, CEED and CEDI Science, disordered eating, education, healthcare, medicine, mental health, nutrition, recovery, research, Treatment, Uncategorized. ·

by Aurora Green, UNC CEED Summer Research Fellow and PhD student in clinical psychology University of Maine

What Is Interoceptive Awareness?

Mental health symptoms can have many different causes. Some of these causes, called transdiagnostic mechanisms, can lead people to experience more than one mental health symptom or illness at the same time.

One transdiagnostic mechanism that I’ve been especially interested in since starting my Ph.D. studies is interoceptive awareness, or one’s awareness and understanding of their own bodily functioning1. Interoception is linked to how we breathe and how our heart works,2 how we respond to stress,3 how we digest food,4 and how we sleep.5

Being too focused on or too unaware of what’s going on inside your body has been linked with mental health symptoms including panic, depression, self-injury, suicidal thoughts, eating disorders, unexplained pain such as headaches and stomach aches, substance use, PTSD, anxiety, and autism.6

Can We Train Interoceptive Awareness?

The good news is that it seems like the answer to that question is yes! Treatments are being developed that “target” interoceptive awareness. A past UNC Exchanges blog post discussed interoception’s link to anorexia nervosa and interoceptive exposures. If you’d like to learn more about that, check out the post here.

Recently, treatments targeting interoception have emerged including interoceptive training, mindfulness-based therapies such as mindfulness-based stress reduction (MBSR), and even guided breathing.

For youth, many of these pilot studies have been done in schools, which has pros including access for a wider range of youth, the opportunity for teachers who know their students to deliver the intervention, and a lesser strain on the larger healthcare system. There are also challenges with this. Schools may not have enough resources to offer the programs to every student. Some children feel nervous about doing group activities that focus on body awareness7, and teachers are already busy enough without taking on another role.

To fix this, future programs should be tested in other places too: like in one-on-one therapy, inpatient and residential treatment, and in primary care offices. Improving interoceptive awareness might help treat several mental health problems at the same time.

Where do we go from here?

One important issue is that interoceptive awareness is not always measured in research, even when a treatment (such as yoga or guided breathing) does seem to be targeting it. To truly know if these programs work, researchers need to use the same tools to measure interoception across studies.

Finally, for people with eating disorders, interoception-focused treatments will likely work best when combined with other evidence-based therapies, such as cognitive behavioral therapy (CBT-E), family-based-treatment (FBT), and exposure therapy.

Learning to tune into our bodies is challenging work, but with the right support, it might just be the key to understanding ourselves through lasting physical, mental, and emotional healing.

References

  1. Craig A. D. (2002). How do you feel? Interoception: the sense of the physiological condition of the body. Nature reviews. Neuroscience, 3(8), 655–666. https://doi.org/10.1038/nrn894
  2. Leganes-Fonteneau, M., Bates, M. E., Muzumdar, N., Pawlak, A., Islam, S., Vaschillo, E., & Buckman, J. F. (2021). Cardiovascular mechanisms of interoceptive awareness: Effects of resonance breathing. International Journal of Psychophysiology, 169, 71–87. https://doi.org/10.1016/j.ijpsycho.2021.09.003
  3. Ueno, D., Ohira, H., & Narumoto, J. (2023). Editorial: Interoception and the autonomic nervous system: Investigating affect, decision-making, and mental health. Frontiers in Neuroscience, 16. https://doi.org/10.3389/fnins.2022.1130324
  4. Alhadeff, A. L., & Yapici, N. (2024). Interoception and Gut–Brain Communication. Current Biology, 34(22). https://doi.org/10.1016/j.cub.2024.10.035
  5. Wei, Y., & Van Someren, E. J. (2020). Interoception relates to sleep and sleep disorders. Current Opinion in Behavioral Sciences, 33, 1–7. https://doi.org/10.1016/j.cobeha.2019.11.008
  6. Khalsa, S. S., Adolphs, R., Cameron, O. G., Critchley, H. D., Davenport, P. W., Feinstein, J. S., Feusner, J. D., Garfinkel, S. N., Lane, R. D., Mehling, W. E., Meuret, A. E., Nemeroff, C. B., Oppenheimer, S., Petzschner, F. H., Pollatos, O., Rhudy, J. L., Schramm, L. P., Simmons, W. K., Stein, M. B., Stephan, K. E., … Interoception Summit 2016 participants (2018). Interoception and Mental Health: A Roadmap. Biological psychiatry. Cognitive Neuroscience and Neuroimaging, 3(6), 501–513. https://doi.org/10.1016/j.bpsc.2017.12.004
  7. Tymofiyeva, O., Sipes, B. S., Luks, T., Hamlat, E. J., Samson, T. E., Hoffmann, T. J., Glidden, D. V., Jakary, A., Li, Y., Ngan, T., Henje, E., & Yang, T. T. (2024). Interoceptive Brain Network mechanisms of mindfulness-based training in healthy adolescents. Frontiers in Psychology, 15. https://doi.org/10.3389/fpsyg.2024.1410319

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