Fact-checked by Grok 2 weeks ago

Interoception

Interoception is the process by which the senses, interprets, and integrates signals originating from within the body, including visceral, cardiovascular, respiratory, and gastrointestinal states, to provide a moment-by-moment representation of the body's . This sensory modality encompasses both conscious , such as feeling or a racing heartbeat, and unconscious processing that supports and emotional regulation. Originally coined by physiologist Charles Sherrington in 1906 to describe afferent information from internal organs, the concept was revitalized in the early 2000s through neuroscientific frameworks emphasizing its role in integrating bodily signals with and . At its core, interoception involves multiple components: sensing through specialized interoceptors that detect biochemical, mechanical, and thermal changes in organs and tissues; integration in and cortical regions; interpretation linking these signals to subjective feelings; and regulation via descending neural pathways that modulate bodily responses. Key neural structures include the nucleus of the solitary tract in the , which relays afferent signals, and the insula cortex, particularly its posterior-to-anterior gradient, which processes and represents interoceptive information for higher-order functions like and . These pathways operate across conscious and non-conscious levels, with vagal and spinal afferents conveying information from the viscera to central brain areas such as the and , facilitating the brain's bidirectional communication with the body. Interoception plays a pivotal role in physical and by underpinning , emotional experience, and , with disruptions implicated in various psychopathologies. For instance, altered interoceptive processing is associated with anxiety disorders, where heightened sensitivity to cardiac signals may exacerbate panic; , involving blunted awareness of bodily states; and conditions like autism spectrum disorder, characterized by deficits in integrating internal cues with social emotions. In clinical contexts, it influences , perception, and responses to stress through interactions with the and gut-brain axis, highlighting its broader implications for and therapeutic interventions such as mindfulness-based practices. Ongoing research employs techniques like heartbeat detection tasks and to quantify interoceptive accuracy, sensibility, and awareness, advancing models of its metacognitive dimensions.

Fundamentals

Definition and Etymology

Interoception refers to the of the internal physiological condition of the , encompassing signals arising from organs, tissues, metabolic processes, and other visceral activities that contribute to the of bodily state. This sensory provides information about homeostatic , such as feelings of , , or the rhythm of the , enabling the organism to maintain internal balance. Unlike exteroception, which involves the detection of external environmental stimuli through like and hearing, or , which monitors position and movement via muscles and joints, interoception is primarily concerned with internal bodily signals that may or may not reach conscious . The term "interoceptive" was first introduced by the British neurophysiologist Charles Sherrington in 1906 in his seminal work The Integrative Action of the Nervous System, where he used it to describe sensations originating from the internal surfaces of the body, particularly the viscera, in contrast to exteroceptive sensations from the external surface. Sherrington derived the adjective from "interior receptor," combining the Latin prefix inter- (meaning internal) with receptor (a sensory receiver), reflecting the focus on afferent signals from within the body. The noun form "interoception" emerged later in the during the , evolving to encompass a broader construct of internal bodily as a product of integration. Interoception involves both conscious and unconscious processing of signals critical for and emotional , with unconscious aspects primarily supporting autonomic while conscious facets allow subjective feelings of bodily states. It is often characterized by three interrelated dimensions: interoceptive accuracy, which measures the objective ability to detect internal signals (e.g., via counting tasks); interoceptive , reflecting subjective self-reported and to these signals; and interoceptive , a metacognitive component assessing the between one's in detection and actual performance. These facets highlight interoception's role not just in basic physiological monitoring but also in higher-order self-perception and emotional processing.

Historical Development

The concept of interoception emerged in the early as part of broader efforts to classify sensory systems. In 1906, Charles Sherrington introduced the term "interoceptive" in his seminal work The Integrative Action of the , defining it as the sensing of internal bodily states, particularly visceral sensations, in contrast to exteroceptive perceptions of the external environment. This distinction built on physiological observations of reflex arcs and nervous integration, marking the first formal recognition of internal sensory processes as a distinct category. Sherrington's framework emphasized how interoceptive signals contribute to coordinated bodily responses, laying the groundwork for understanding autonomic regulation. Shortly thereafter, in 1907–1908, Henry Head, collaborating with and others, advanced this area through studies on sensory recovery after , proposing the protopathic-epicritic distinction. Protopathic sensibility referred to diffuse, poorly localized sensations often associated with internal or painful stimuli, while epicritic sensibility involved precise, discriminative touch more typical of external senses. This work highlighted the dual nature of somatosensory pathways, with protopathic fibers linked to interoceptive-like visceral afferents, influencing later debates on the qualitative differences between internal and external sensing. In the late 19th and early 20th centuries, psychological perspectives began integrating interoceptive signals with and . , in his 1890 Principles of Psychology, argued that consist primarily of the of bodily changes, such as visceral , suggesting that feelings arise from of internal physiological states. This James-Lange theory positioned interoception as central to affective experience, influencing subsequent research on how bodily feedback shapes . Complementing this, Walter Cannon's 1927 critique of the James-Lange theory introduced the concept of , portraying interoceptive signals as essential for monitoring and maintaining internal equilibrium through feedback. Cannon's framework emphasized the brain's role in integrating these signals for adaptive regulation, bridging and behavior. From the mid-20th century through the , research shifted toward neural mechanisms and behavioral measures. Precursors to modern models appeared in 1970s studies of the , which identified pathways conveying visceral information to the brain, setting the stage for detailed mapping of interoceptive afferents. A key psychophysiological tool emerged with heartbeat detection tasks in the 1970s, pioneered by researchers like J. Brener and J.M. Jones, enabling quantification of individual differences in cardiac interoceptive sensitivity through self-reported perception of heartbeats. These methods revealed variability in bodily awareness and its links to anxiety and autonomic control. Culminating this era, A.D. Craig's synthesis described the lamina I spinothalamic pathway as a dedicated interoceptive conduit from viscera to the , unifying disparate findings into a coherent neuroanatomical model. The 2000s marked the rise of techniques, particularly fMRI, which illuminated central processing of interoceptive signals. Early studies, such as those by Hugo Critchley in 2004, demonstrated that anterior insula activation correlates with heartbeat detection accuracy, establishing the insula as a hub for interoceptive awareness. This period saw integration with , especially post-2009 through collaborations like those of Critchley and Sarah Garfinkel, who explored how interoceptive processing modulates emotional intensity and vulnerability in disorders like anxiety. These advances shifted focus from peripheral sensing to brain-body interactions in emotion regulation. Key milestones in the 2010s refined conceptual boundaries. In 2015, Sarah N. Garfinkel and colleagues proposed a multidimensional for interoception, distinguishing sensory accuracy, subjective , and their metacognitive aspects, facilitating standardized across studies. Entering the , research emphasized predictive processing models, where the brain anticipates interoceptive signals to optimize , amid heightened interest spurred by studies on altered bodily in survivors. These investigations linked disrupted interoception to persistent symptoms like and anxiety, underscoring its role in post-viral . In 2025, a major $14.2 million initiative was launched to map the brain's interoceptive pathways, aiming to deepen understanding of brain-body communication.

Physiological Systems

Cardiovascular and Respiratory Systems

Interoception in the cardiovascular system primarily involves the detection of fluctuations and cardiac rhythm through specialized mechanoreceptors. High-pressure , located in the and , sense stretch induced by changes in pressure, providing critical feedback for maintaining hemodynamic stability. These generate pulsatile signals synchronized with the , which are transmitted as afferent impulses to the . Additionally, heartbeat signals are conveyed via vagal afferents from cardiac mechanoreceptors, enabling the of cardiac timing and intensity. In orthostatic responses, play a pivotal role in the , where a sudden drop in upon standing triggers rapid adjustments in and vascular tone to prevent and syncope. This helps preserve cerebral during postural changes, highlighting the interoceptive system's contribution to immediate homeostatic corrections. Respiratory interoception encompasses the sensing of gas levels and mechanical aspects of through distinct receptor populations. Peripheral chemoreceptors in the carotid bodies detect alterations in blood oxygen (O₂), (CO₂), and , initiating ventilatory adjustments to correct or . Central chemoreceptors, concentrated in the retrotrapezoid nucleus of the , respond primarily to brain interstitial CO₂ and changes, driving increases in and depth during . Lung stretch receptors, including slowly adapting pulmonary stretch receptors, monitor lung inflation and contribute to the of rhythm via the Hering-Breuer reflex, which inhibits inspiration upon excessive lung expansion. These respiratory signals integrate to form the of dyspnea, the subjective of discomfort, which arises from mismatched afferent inputs during conditions like or airway obstruction. Dyspnea serves as an interoceptive alarm, prompting behavioral adaptations such as increased respiratory effort. for both cardiovascular and respiratory interoception relies on that relay sensory data to the . The (cranial nerve X) carries pulsatile cardiac signals and pulmonary stretch information from the , heart, and lungs, while the (cranial nerve IX) transmits baroreceptive and chemosensory inputs from the and bodies. These afferents converge in the nucleus tractus solitarius (NTS) of the medulla, where initial processing occurs before ascending pathways distribute the signals. In homeostatic functions, these interoceptive signals regulate autonomic balance by modulating sympathetic and parasympathetic outflows, ensuring coordinated cardiovascular and respiratory adjustments to maintain internal equilibrium. (HRV), quantified as fluctuations in inter-beat intervals, serves as a key metric of interoceptive signaling integrity, with higher HRV reflecting enhanced and better autonomic flexibility. For instance, individuals with greater HRV demonstrate superior accuracy in detecting their own heartbeats, underscoring HRV's role in interoceptive precision.

Gastrointestinal, Genitourinary, and Other Systems

Interoceptive signals from the arise primarily from mechanoreceptors and chemoreceptors embedded in the gut wall, which detect mechanical distension associated with fullness and chemical changes linked to or nutrient composition. These receptors, including low-threshold mechanosensitive endings in the muscular layers, respond to stretch during gastric filling and transmit signals via vagal afferents to convey and digestive status. Spinal afferents, originating from dorsal root ganglia, complement vagal pathways by relaying similar signals from the lower gut, contributing to the perception of postprandial fullness and aversion to . In the , distension is sensed by mechanosensitive afferents in the , which activate as volume increases to signal the urge to void. These low-threshold stretch receptors, innervated by pelvic and hypogastric nerves, provide graded feedback proportional to filling pressure, enabling conscious awareness of fullness. Renal osmoreceptors, located in the kidney's and renal nerves, monitor osmolarity to detect and status, influencing regulation through afferent signaling. Other interoceptive systems include visceral thermoreceptors that monitor core body temperature deviations, with warm-sensitive neurons in the abdominal viscera responding to and cold-sensitive ones to . Visceral nociceptors, specialized free nerve endings in organ walls, detect inflammatory or ischemic conditions to signal , often referred diffusely due to convergent spinal pathways. Endocrine-related signals, such as glucose levels, are sensed by specialized afferents in the wall, where vagal nerve endings respond to postprandial glucose excursions to regulate hepatic and . These signals integrate with central processing to drive motivational states, such as , which is primarily triggered by central activation in the in response to hyperosmolarity, prompting fluid-seeking behavior to restore . Immune-related signals, conveyed via cytokine-sensitive visceral afferents, contribute to sickness responses by modulating motivational drive and aversion to maintain during .

Sensory and Neural Pathways

Peripheral Sensory Mechanisms

Interoceptive signals originate from specialized peripheral receptors embedded in visceral tissues, which detect internal physiological changes and initiate transmission to the central nervous system. These receptors primarily include free nerve endings, mechanoreceptors, and chemoreceptors located in organs such as the heart, lungs, gastrointestinal tract, and bladder. Free nerve endings, often polymodal nociceptors, respond to multiple stimuli including mechanical distortion, chemical irritants, temperature variations, and itch, thereby integrating diverse sensory information from bodily tissues. Mechanoreceptors sense stretch or pressure in organ walls, while chemoreceptors monitor biochemical shifts like pH or ion concentrations. The transmission of these signals occurs via visceral afferent fibers, which differ from somatic afferents in their composition and conduction properties. The majority (over 90%) of vagal visceral afferents are unmyelinated C-fibers, responsible for slow, diffuse transmission of non-painful sensations such as satiety or nausea, whereas the remaining include thinly myelinated Aδ-fibers for faster conduction of sharper signals like acute visceral discomfort. This predominance of unmyelinated fibers in visceral pathways contrasts with the more myelinated somatic system, enabling a nuanced representation of internal states over precise localization. Polymodal nociceptors within these fibers further contribute by encoding integrated threat signals, such as inflammation-induced pain combined with thermal changes, crucial for protective responses. At the periphery, these sensory inputs undergo initial integration through local reflex and that without immediate central involvement. For instance, the enteric nervous system in the gut processes nutrient and microbial signals via local circuits, facilitating the gut-brain axis through vagal afferents to modulate digestion and feeding behaviors. Efferent loops, involving parasympathetic and sympathetic outflows, reciprocally adjust organ function in response to afferent inputs, maintaining physiological balance such as or gastrointestinal motility. These peripheral processes briefly interface with broader homeostatic regulation by fine-tuning autonomic responses. Evolutionarily, the core peripheral mechanisms of interoception are highly conserved across mammals, reflecting their fundamental role in survival through monitoring vital functions like cardiorespiratory status. This conservation is evident in shared receptor types and afferent fiber profiles from to . In humans, —manifested in —supports advanced social and emotional regulation, building on these ancient pathways.

Ascending Neural Pathways

The ascending neural pathways for interoception primarily convey signals from peripheral visceral and somatic sensors through the and to thalamic relay nuclei, enabling the to monitor and regulate internal bodily states. These pathways integrate multimodal information, including nociceptive, thermal, and autonomic signals, distinguishing them from exteroceptive routes by their focus on homeostatic maintenance rather than external environmental cues. Key routes include the and vagal projections, which differ in their anatomical trajectories and functional emphases. The lamina I spinothalamic tract originates from projection neurons in the superficial dorsal horn (lamina I) of the spinal cord, where Aδ and unmyelinated C fibers from visceral and somatic afferents synapse, carrying signals related to pain, temperature, and certain visceral sensations directly to the thalamus. This pathway is crucial for transmitting multimodal interoceptive information, such as thermal and nociceptive inputs from internal organs, via the anterolateral funiculus of the spinal cord. Studies highlight its role in relaying these signals to posterior thalamic nuclei, supporting basic sensory discrimination of internal states. Visceroceptive pathways, particularly those mediated by vagal afferents, provide a parallel route for interoceptive signaling from thoracic and abdominal viscera. Vagal sensory neurons in the nodose ganglion project to the nucleus tractus solitarius (NTS) in the medulla, where they relay information on gastrointestinal, cardiovascular, and respiratory states using glutamatergic transmission. From the NTS, second-order neurons ascend to the in the , which serves as a critical relay for visceral afferents before projecting to the and other targets, facilitating rapid homeostatic adjustments. Somatosensory contributions to interoception occur via secondary pathways, such as the dorsal column-medial lemniscus system, which carries some overlapping cutaneous and visceral signals from low-threshold mechanoreceptors. Although primarily associated with touch and , certain visceral afferents, including those from , project to the , providing subtle integration of superficial and deep sensory inputs for comprehensive bodily . This route is less dominant for pure interoception but supports boundary perceptions between and internal states. These pathways exhibit specificity along homeostatic and affective dimensions, where homeostatic signals—such as those from or osmoreceptors—prioritize physiological regulation through NTS and parabrachial routes, while affective dimensions involve nociceptive and emotional salience conveyed via spinothalamic projections to limbic-associated thalamic areas. Recent 2020s research has updated understanding of lamina V projections, revealing their role in autonomic ; neurons in lamina V of the receive convergent visceral and somatic inputs, enabling local reflex arcs to the intermediolateral cell column for sympathetic outflow and ascending projections via the for broader interoceptive processing. Thalamic nuclei, such as the posterior and ventroposterior lateral regions, act as final relays for these ascending signals before cortical dissemination.

Central Processing

Thalamic and Insular Processing

Interoceptive signals from peripheral afferents, primarily via the spinothalamic tract, are relayed through specific thalamic nuclei to initiate central processing. The ventral medial posterior (VMpo) and ventral medial basal (VMb) nuclei of the thalamus function as key relays for visceral inputs, contributing to the initial subcortical integration of interoceptive information en route to cortical regions, distinct from the ventral posterolateral (VPL) nucleus's primary role in somatosensory processing. Additionally, intralaminar thalamic nuclei, including posterior groups, contribute to arousal and broad integration of autonomic signals in homeostatic regulation. The parvocellular part of the ventral posteromedial nucleus (VPMpc), within the ventral medial complex, specializes in processing certain visceral and gustatory afferents, providing a dedicated pathway for interoceptive representation. These thalamic structures project primarily to the , where interoceptive signals undergo hierarchical processing. The granular posterior insula acts as the primary sensory mapping region, receiving direct thalamic inputs to form a topographic representation of bodily states such as cardiorespiratory and gastrointestinal sensations. This area encodes raw interoceptive data in a manner analogous to primary sensory cortices for exteroception. Moving anteriorly, the dysgranular mid-insula integrates these primary signals with contextual information, enabling the synthesis of multisensory interoceptive experiences. The exhibits a distinct cytoarchitectonic progression that underlies its functional specialization in interoception. Posterior regions are predominantly granular, characterized by well-defined layer and dense cellular packing suited for sensory relay. This transitions to the dysgranular mid-insula, with reduced and increased for associative , and further to the agranular anterior insula, which lacks a prominent layer and supports higher-order . This gradient reflects an evolutionary adaptation for escalating complexity in interoceptive handling, from basic sensation to predictive regulation. Functional neuroimaging studies from the 2010s have established the insula as a central hub for interoceptive processing, with robust connectivity to autonomic centers such as the brainstem and hypothalamus. Functional MRI evidence demonstrates that posterior insular activation correlates with direct interoceptive stimuli, while mid- and anterior regions show graded involvement in integrating these signals for predictive coding. The insula's role extends to generating allostatic predictions, where anterior portions anticipate bodily needs and adjust autonomic responses preemptively, minimizing prediction errors in homeostatic maintenance. This predictive function underscores the insula's position as an integrative nexus, linking thalamic relays to broader neural networks for adaptive interoception.

Cingulate and Somatosensory Integration

The () plays a pivotal role in integrating interoceptive signals with cognitive processes, particularly through its midcingulate region, which facilitates conflict monitoring and error detection in contexts involving bodily states. This function allows the midcingulate cortex to evaluate discrepancies between expected and actual internal physiological conditions, such as autonomic fluctuations during demanding tasks, thereby supporting adaptive behavioral adjustments. For instance, during tasks requiring sustained attention, heightened interoceptive awareness in the midcingulate contributes to error detection and performance optimization by signaling bodily discomfort or arousal mismatches. In contrast, the subgenual region of the is primarily involved in affective valuation, where it processes interoceptive inputs to appraise emotional significance and regulate responses to internal states. This area modulates the hedonic tone of bodily sensations, influencing how visceral signals contribute to and motivational states, as evidenced by its hyperactivity in response to stress-related interoceptive perturbations that alter dynamics and emotional reactivity. Such valuation mechanisms enable the subgenual to weigh the affective costs and benefits of internal signals, bridging physiological with subjective emotional experience. The somatosensory cortices, including primary (S1) and secondary () areas, extend into the parietal operculum to integrate interoceptive signals with representation, facilitating a unified of internal bodily states. This integration occurs through cross-modal interactions with exteroceptive inputs, where parietal opercular regions process tactile and visceral afferents to refine spatial and temporal aspects of the , as demonstrated in illusions that combine cardiac signals with visual cues to modulate somatosensory activity. These extensions ensure that interoceptive information, such as from mechanoreceptors in viscera, is calibrated against external sensory data for coherent self-. Network dynamics between the cingulate and somatosensory regions reveal overlaps with the (DMN), where the pregenual and insula contribute to internally directed interoceptive processing during rest or self-referential thought. Recent diffusion tensor imaging studies from the 2020s have highlighted enhanced tract integrity linking the insula to the , supporting efficient propagation of interoceptive signals across these associative networks and underscoring their role in . These integrative processes underpin adaptive functions in under bodily , where interoceptive cues, often termed "gut feelings," inform by providing intuitive signals of physiological mismatch. For example, individuals with superior interoceptive accuracy exhibit better performance in high-stakes financial trading, leveraging subtle visceral signals to navigate ambiguous risks without explicit reasoning. This mechanism enhances survival-oriented choices by incorporating bodily into probabilistic evaluations, as seen in scenarios requiring rapid judgments amid internal variability.

Interoception in Emotion and Awareness

Role in Emotional Experience

Interoceptive signals play a central role in the generation of by providing bodily feedback that constitutes the subjective experience of feeling states. The James-Lange theory, originally proposed in the late , posits that arise from the of physiological changes, such as accelerated during , rather than preceding them. This perspective has experienced a revival in contemporary interoception research, where bodily sensations are viewed as integral to emotional constitution, integrating peripheral signals to form the core of affective experience. For instance, the of visceral arousal, like increased , is interpreted as the itself, emphasizing how interoception bridges physiological responses and emotional phenomenology. Building on this, Damasio's (1994) further elucidates interoception's influence on emotion by proposing that bodily states associated with past emotional experiences serve as "somatic markers" to guide value-based . These markers, derived from interoceptive cues such as gut feelings or autonomic shifts, bias choices toward advantageous outcomes by evoking emotional without full conscious deliberation. In this framework, emotions are not mere byproducts but active regulators, with interoceptive signals from the body reinforcing or inhibiting behavioral responses in complex social and decision contexts. At the neural level, the and (ACC) form a critical for binding interoceptive inputs to emotional processing, with the providing modulation for affective intensity. The anterior insula integrates visceral signals to generate emotional awareness, relaying them to the ACC for cognitive evaluation and response selection. Amygdala inputs to this circuit enhance the salience of interoceptive signals during threat or reward, facilitating rapid emotional binding that underlies adaptive behaviors. This network's activity overlaps during interoceptive tasks and emotional elicitation, underscoring its role in translating bodily states into felt emotions. Empirical evidence from biofeedback studies demonstrates that manipulating heartbeat perception can alter emotional experiences, supporting interoception's regulatory function. For example, training individuals to enhance cardiac awareness via leads to improved control over autonomic responses during emotional provocation, reducing intensity in negative states like . Similarly, greater heartbeat accuracy correlates with heightened emotional intensity, indicating that precise interoceptive processing amplifies affective outcomes. Cultural variations further highlight this role, as studies have reported differences in interoceptive accuracy for cardiac signals between East Asian and individuals, with mixed findings across populations; for instance, one study found higher accuracy in compared to Belgian participants. These differences suggest that sociocultural norms shape the interoceptive-emotional link, with implications for emotional .

Interoceptive Awareness and Subjectivity

Interoceptive sensibility refers to the subjective perception and self-reported intensity of interoceptive signals, distinct from objective measures of accuracy. This dimension captures how individuals attend to and interpret their internal bodily states, often assessed through validated questionnaires that emphasize metacognitive aspects such as noticing, trusting, and emotional response to sensations. A prominent tool for this evaluation is the , a 32-item scale developed in that measures eight facets of interoceptive awareness, including noticing bodily sensations, not distracting attention from them, and emotional awareness of discomfort. The has demonstrated strong psychometric properties, with high (Cronbach's α ranging from 0.64 to 0.86 across scales) and test-retest reliability, making it widely used in to quantify individual differences in subjective interoception. A key distinction in interoceptive research lies between accuracy and , highlighting a potential where self-perceived sensitivity does not always align with objective performance. Interoceptive accuracy is typically measured through behavioral tasks, such as the heartbeat counting paradigm, where participants estimate the number of their s over a fixed without external cues, yielding scores based on deviation from actual counts (e.g., ). In contrast, interoceptive encompasses metacognitive elements like in one's judgments or subjective ratings of signal intensity, often showing weak or no with accuracy scores (r ≈ 0.10-0.20). This is evident in studies where high- errors occur, suggesting that reflects attentional biases or beliefs rather than perceptual , as demonstrated in experiments comparing heartbeat tracking performance with post-task ratings. Individual differences in interoceptive awareness are influenced by demographic and experiential factors. Sex differences reveal that women generally report higher interoceptive , with elevated scores on scales like the (effect size d ≈ 0.3-0.5), potentially linked to greater attention to bodily signals in emotional contexts, though accuracy on objective tasks shows mixed results with no consistent female advantage. Aging is associated with declines in interoceptive accuracy, particularly in detection tasks, where performance worsens progressively from young adulthood ( r = -0.35 with age), attributed to reduced neural sensitivity in afferent pathways rather than motivational changes. training, conversely, enhances both sensibility and awareness; brief interventions (e.g., 5-day programs) increase scores across multiple subscales (e.g., +0.5-1.0 standard deviations in noticing and non-distressing), fostering greater attentional allocation to interoceptive cues without altering physiological baselines. Philosophically, interoceptive awareness ties into phenomenological accounts of , where subjective bodily sensations ground the of selfhood and in first-person . In phenomenology, interoception contributes to the pre-reflective sense of , enabling a felt unity of body and mind that underpins and emotional , as explored in frameworks emphasizing the lived body (Leib) over objectified . Recent 2020s research extends this to conditions like , characterized by absent voluntary mental imagery, which correlates with reduced interoceptive sensibility and bodily imagery vividness (e.g., lower MAIA emotional awareness scores, d ≈ 0.8), suggesting impaired integration of internal signals into self-referential representations.

Clinical and Health Implications

Associations with Mental Disorders

Interoception plays a significant role in the of various mental disorders, with alterations in interoceptive processing contributing to symptom maintenance and across psychiatric conditions. Dysfunctions in sensing and interpreting internal bodily signals, such as or gastrointestinal sensations, have been linked to heightened vulnerability in anxiety, , eating, and neurodevelopmental disorders, often involving imbalances in neural regions like the insula and (). In anxiety disorders, including (GAD) and , individuals often exhibit heightened interoceptive sensibility, characterized by increased attention to and amplification of benign bodily signals. For instance, in , catastrophic misinterpretation of cardiac sensations as threats can trigger acute anxiety episodes, perpetuating a cycle of and avoidance. A meta-analysis of 71 studies found a moderate positive association between self-reported interoceptive awareness and anxiety symptoms, suggesting that subjective hypersensitivity to internal cues exacerbates worry and autonomic arousal in GAD. This heightened processing is supported by evidence of insula hyperactivity during interoceptive tasks in anxiety patients. Mood disorders, such as (MDD) and (PTSD), are associated with blunted interoceptive accuracy, impairing the ability to accurately detect internal states like . In MDD, a of 6 studies demonstrated significantly reduced cardiac interoceptive accuracy compared to healthy controls, with moderate effect sizes (Cohen's d ≈ 0.5–1.3) that correlate with the intensity of positive affect. For PTSD, ACC hyperactivity during emotional processing reflects dysregulated integration of interoceptive signals with trauma-related cues, contributing to and re-experiencing symptoms. These alterations may underlie emotional numbing and avoidance in mood disorders. Eating disorders, particularly (AN), involve impaired interoceptive accuracy and sensitivity, with difficulties perceiving internal signals such as or , contributing to the suppression of intake and reinforcement of restrictive behaviors through attenuated awareness and maladaptive reliance on exteroceptive cues. Functional MRI meta-analyses reveal altered insula activation in AN during interoceptive tasks, linking this over-attunement to distortions and weight preoccupation. In neurodevelopmental disorders like autism spectrum disorder (ASD), reduced interoceptive awareness is common, often tied to insula hypoactivation and difficulties in integrating bodily signals with social-emotional cues. Reviews indicate that individuals with ASD exhibit lower accuracy in heartbeat detection tasks, correlating with alexithymia and challenges in emotional self-regulation. This hypoactivation in the insula disrupts the subjective experience of internal states, contributing to sensory processing differences. Meta-analyses highlight interoception as a transdiagnostic factor across categories. A 2019 systematic review by Eggart et al. synthesized evidence of impaired interoceptive accuracy in , while broader transdiagnostic work, including a 2024 review, confirms consistent alterations in anxiety, , and , with effect sizes ranging from small to moderate. Recent 2023-2025 updates on obsessive-compulsive disorder (OCD) emphasize heightened interoceptive sensibility in compulsions, where sensory phenomena like discomfort from incomplete actions drive repetitive behaviors, supported by systematic reviews linking insula dysfunction to OCD symptom severity. These findings underscore interoception's role in unifying mechanisms across disorders. Interoceptive dysfunction plays a significant role in conditions such as , where amplified nociceptive signals arise through central mechanisms. In syndrome (FMS), patients exhibit heightened interoceptive processing, leading to increased sensitivity to internal bodily signals that exacerbate pain perception. Central in FMS involves enhanced neural responsiveness in the , amplifying interoceptive inputs from nociceptors and contributing to widespread pain and . This altered interoception correlates with emotional factors, where predictive interoceptive models link pain intensity to distorted awareness of bodily states. Neurological disorders further illustrate interoceptive impairments through specific brain lesions and dysregulations. Stroke-induced lesions in the insula can result in , a condition where patients detect painful stimuli but lack the appropriate emotional or affective response, disrupting the integration of sensory and interoceptive signals. In , autonomic dysregulation manifests as impaired interoceptive processing of visceral signals, contributing to symptoms like and gastrointestinal issues due to disrupted neural pathways in the and insula. These deficits highlight the insula's critical role in modulating interoceptive awareness of autonomic functions. Beyond these, involves impaired mental simulation of bodily states, linked to reduced interoceptive precision and weakened integration of physiological signals with cognitive imagery. Individuals with aphantasia show diminished insula-anterior connectivity, which hampers the simulation of internal sensations and affects . In post-COVID long-haul syndrome, persistent respiratory symptoms such as dyspnea persist despite normal pulmonary function, suggesting altered that heightens symptom awareness through dysregulated signaling in cardiorespiratory networks. Recent evidence from 2022 studies on () demonstrates interoceptive alterations contributing to and balance issues, with randomized trials showing that interoceptive training improves postural stability by enhancing awareness of bodily signals. Biomechanical models of altered interoceptive signaling, particularly in , incorporate computational frameworks to explain how disrupted afferent pathways lead to maladaptive predictions of internal states, perpetuating symptom cycles. These models emphasize hierarchical inference processes where imprecise interoceptive signals amplify perceived discrepancies in bodily .

Theoretical Frameworks

Predictive Processing Models

Predictive processing models conceptualize interoception as a form of active , where the brain generates top-down predictions about internal bodily states to minimize prediction errors arising from sensory inputs. These models, rooted in the , posit that interoceptive signals are not passive representations but hypotheses shaped by prior expectations, enabling the brain to reduce and surprise in maintaining —the proactive regulation of physiological stability. Seminal frameworks emphasize hierarchical generative models in which descending predictions from higher cortical regions interact with ascending interoceptive afferents, particularly via the insula, to refine internal models of the body's state. A key contribution is the Embodied Predictive Interoception Coding () model, which integrates anatomical corticocortical connectivity with Bayesian active inference to describe how agranular visceromotor cortices, such as the anterior insula and , issue predictions about visceral states that are updated by prediction errors from granular sensory cortices. In this framework, interoceptive experiences emerge from minimizing surprise through iterative adjustment of predictions or autonomic actions, rather than direct readout of bodily signals. Complementing this, Seth and Friston's active interoceptive inference model extends the to , where interoception serves to bound uncertainty in energy regulation by treating bodily states as probabilistic inferences. Here, the brain minimizes variational free energy as a proxy for surprise, with prediction errors computed as the discrepancy between sensory input s and model-based predictions \mu, formalized as: \delta = s - \mu This error signal drives perceptual updating or behavioral interventions to align the body with predictions. Empirical support for these models comes from active inference simulations of multisensory illusions, such as the interoceptive rubber-hand illusion, where synchronous cardio-visual feedback induces ownership of a virtual hand by resolving prediction errors between exteroceptive and interoceptive signals, mirroring how the brain integrates bodily predictions. Functional MRI studies further implicate the insula as a central hub for predictive interoception, showing its strong connectivity with the anterior cingulate in modeling internal states during rest, consistent with hierarchical error minimization across the allostatic-interoceptive system. Critiques of predictive processing models highlight an overemphasis on top-down predictions at the expense of bottom-up sensory drives, as evidenced by fMRI dissociations where thalamic networks support stimulus-dependent interoceptive processing, while amygdalar pathways modulate model-dependent aspects. Recent extensions in 2024 address this by incorporating , demonstrating how synchronous visuo-tactile and interoceptive feedback in virtual environments enhances bodily through refined that balances top-down and bottom-up signals in the rubber-hand .

Embodied and Integrative Theories

Embodied cognition theories posit that higher-level mental processes, including abstract thought, are grounded in perceptual, motor, and interoceptive simulations derived from bodily states. In this framework, interoception serves as a critical mechanism for anchoring conceptual representations in the internal milieu, allowing bodily signals such as or visceral sensations to inform and shape cognitive operations. For instance, Barsalou's perceptual symbols theory emphasizes that concepts are not amodal but arise from multimodal simulations, including interoceptive experiences that integrate internal physiological states with external perceptions to facilitate understanding of abstract ideas like or values. This grounding role of interoception underscores how bodily awareness contributes to the simulation of situated actions, enabling to be inherently tied to the organism's physical and internal dynamics rather than isolated symbolic processing. Ecological approaches extend James J. Gibson's —originally focused on environmental opportunities for action—to the internal bodily domain, framing as the of "internal " that guide adaptive responses to physiological needs within the body's milieu. These perspectives signals not merely as passive inputs but as active invitations for organism-environment interactions, where bodily states offer possibilities for regulation and akin to external action opportunities. Recent ecological models of propose an affective spectrum of embodied experiences, integrating awareness with the broader ecological context of being-in-the-world, thereby emphasizing how internal sensations dynamically shape self- and environmental engagement. Integrative theories within the 4E paradigm—encompassing embodied, , enactive, and extended dimensions—apply these principles to interoception by highlighting its role in whole-body integration and processes. Interoception is seen as foundational to embodied selfhood, where internal signals enact cognitive processes through dynamic interactions with the and others, extending beyond individual physiology to influence extended . In particular, interoception facilitates by enabling the sharing and of others' bodily states, allowing individuals to attune to interpersonal cues and co-regulate affective experiences. For example, heightened interoceptive awareness enhances neural responses in empathy-related networks, supporting and emotional resonance in interactions. Recent developments in integrative theories include the concept of social allostasis, which posits that interpersonal interactions regulate bodily predictions and energy balance through shared interoceptive mechanisms, linking to internal predictive adjustments for collective . This model builds on earlier somatovisceral afference frameworks by emphasizing how touch and social touch, in particular, mediate allostatic processes via interoceptive pathways, fostering emotional construction and bonding. Such approaches unify interoception within broader 4E frameworks, illustrating its enactive role in and adaptive integration across individual and collective levels.

Assessment and Interventions

Measurement Methods

Interoceptive accuracy, which refers to the objective ability to perceive internal bodily signals, is commonly assessed through behavioral tasks such as the heartbeat detection paradigm developed by Schandry. In this method, participants silently count their heartbeats over intervals of varying lengths (typically 25, 35, 45, or 100 seconds) without external cues, and accuracy is calculated as the proportion of correctly estimated heartbeats compared to the actual number recorded via (ECG). The standard formula for interoceptive accuracy (IAcc) across n trials is IAcc = (1/n) ∑ [1 - (|n_i - r_i| / n_i)], where n_i is the actual number of heartbeats in trial i and r_i is the participant's reported count; scores range from 0 (no accuracy) to 1 (perfect accuracy), with typical healthy adult means around 0.65–0.80. This task distinguishes interoceptive accuracy from (subjective perception) and has been widely adopted due to its simplicity and reliability, though it primarily targets cardiac signals. Subjective measures of interoceptive sensibility and awareness, which capture self-reported perceptions of bodily states, rely on validated questionnaires. The Body Perception Questionnaire (BPQ), developed by Porges, assesses awareness of bodily sensations, autonomic reactivity, stress responses, and related health attitudes through 122 items rated on a 5-point Likert scale, yielding subscale scores for dimensions like respiratory and cardiac awareness. Complementing this, the Interoceptive Accuracy Scale (IAS) evaluates metacognitive beliefs about one's ability to accurately detect interoceptive signals (e.g., hunger, heartbeat) independently of attention focus, using 21 items on a 5-point scale; higher scores indicate greater perceived accuracy, with good internal consistency (α ≈ 0.80) and discriminant validity from related constructs like alexithymia. These tools provide insights into trait-like differences in interoceptive processing, often correlating moderately with objective tasks (r ≈ 0.20–0.40). Neuroimaging techniques offer objective neural correlates of interoception by examining brain activation during tasks. (fMRI) frequently reveals activation in the insula, particularly the posterior and mid-insula, during heartbeat detection or respiratory tracking, reflecting the integration of visceral signals; for instance, higher interoceptive accuracy associates with greater insula BOLD signal in response to cardiac cues. (EEG) measures evoked potentials, such as heartbeat-evoked potentials (HEPs) or respiratory-related evoked potentials (RREPs), to assess ; reduced RREP amplitude in the second of paired stimuli indicates effective neural filtering of respiratory signals, linking to interoceptive precision in anxiety contexts. These methods highlight the insula's role as a hub but require controlling for confounds like motion artifacts. Recent advances include (VR) paradigms that simulate multisystem interoceptive experiences, such as integrating cardiac, respiratory, and gastrointestinal cues in immersive environments to enhance over traditional tasks. A 2023 VR protocol, for example, uses guided attention to bodily signals in virtual scenarios to probe across modalities, showing improved engagement and sensitivity detection compared to static methods. However, validity challenges persist, including demand characteristics where participants may guess or conform to expected patterns, inflating scores via top-down expectations rather than true ; studies recommend signal detection adaptations to mitigate this.

Therapeutic and Research Applications

Interventions targeting interoception have shown promise in enhancing bodily awareness and managing stress-related conditions. (MBSR) programs, which emphasize non-judgmental attention to internal sensations, have been found to improve interoceptive awareness, particularly when supplemented with tools like smartwatches for real-time monitoring of physiological signals. Adapted versions of , such as those focused on reduction, further bolster interoceptive sensibility and adherence to healthy behaviors in clinical populations. Similarly, (HRV) training enables individuals to voluntarily regulate autonomic responses, thereby reducing anxiety symptoms by refining interoceptive processing and promoting cardiac coherence. This approach has demonstrated efficacy in lowering trait anxiety through repeated sessions that enhance awareness of internal bodily states. Clinical trials have increasingly incorporated interoceptive elements into established therapies for anxiety and mood disorders. Interoceptive exposure therapy, a core component of cognitive-behavioral therapy for panic disorder, involves deliberate induction of bodily sensations to reduce fear responses, with meta-analyses indicating it as a key predictor of symptom reduction across various CBT formats. For instance, successful exposure-based interventions have been shown to decrease defensive reactivity to interoceptive threats in patients with panic disorder. In depression treatment, transcutaneous auricular vagus nerve stimulation (taVNS) devices modulate interoceptive sensitivity by influencing vagal pathways, leading to rapid improvements in mood through enhanced awareness of internal signals. Such neuromodulation techniques provide a non-invasive means to target interoceptive deficits associated with affective disorders. Ongoing research frontiers explore computational and developmental aspects of interoception to inform future interventions. models, inspired by biological systems, simulate interoceptive networks to predict internal state dynamics, offering tools for personalized therapeutic simulations in . approaches have also classified interoceptive traits from training data, aiding in the differentiation of sensibility levels for targeted interventions. Longitudinal studies post-2020 have revealed age-related declines in cardiac interoceptive sensitivity, particularly under , highlighting the need for interventions to mitigate sensory processing changes in older adults. Recent investigations into psychedelics, such as , indicate they induce altered interoceptive states by enhancing subjective awareness of bodily signals and autonomic balance, potentially reopening therapeutic windows for conditions involving disrupted interoception. These findings underscore emerging directions in integrating and predictive modeling to address interoceptive gaps in aging and psychiatric care.

References

  1. [1]
    Interoception and Mental Health: A Roadmap - PMC - PubMed Central
    Interoception refers to the process by which the nervous system senses, interprets, and integrates signals originating from within the body, providing a ...
  2. [2]
    The Emerging Science of Interoception: Sensing, Integrating ...
    Interoception refers to the representation of an organism's internal states, and includes the processes by which it senses, interprets, integrates, and ...
  3. [3]
    Interoception - an overview | ScienceDirect Topics
    Interoception is defined as awareness of the body or the body's internal state, playing a crucial role in mental health and wellbeing.
  4. [4]
  5. [5]
  6. [6]
    On the Origin of Interoception - PMC - PubMed Central
    May 23, 2016 · In its overarching meaning, interoception primarily is a product of the central nervous system, a construct based on an integration of various ...Introduction · Aspects Of Interoception · Visceroceptor...
  7. [7]
    Interoception - Scholarpedia
    May 10, 2022 · Definition. Sherrington introduced the term interoceptive to refer to internal sensing, which he distinguished from external sensing and muscle ...
  8. [8]
    (PDF) Henry Head's lifelong studies of cutaneous sensation
    This resulted in the revolutionary idea summarised in his description of protopathic and epicritic sensory systems in peripheral sensory nerve. ... 1907 ...
  9. [9]
    Classics in the History of Psychology -- James (1890) Chapter 25
    My theory, on the contrary, is that the bodily changes follow directly the perception of the exciting fact, and that our feeling of the same changes as they ...Missing: interoception | Show results with:interoception
  10. [10]
    Interoceptive discrimination in intact humans: detection of cardiac ...
    Interoceptive discrimination in intact humans: detection of cardiac activity. Physiol Behav. 1974 Dec;13(6):763-7. doi: 10.1016/0031-9384(74)90259-5.Missing: heartbeat | Show results with:heartbeat
  11. [11]
    Interoception, emotion and brain: new insights link internal ...
    Mar 9, 2013 · While interoception encompasses both skeletomuscular and circulating (humoral) signals ... Cannon, 1927; Schachter and Singer, 1962; Damasio et al ...
  12. [12]
    Interoception accuracy and awareness in COVID-19 survivors
    Therefore, it's necessary to deepen the different shades of body awareness and IA in post-covid stages and to study how interoceptive dimension change over time ...
  13. [13]
    Baroreceptor modulation of the cardiovascular system, pain ...
    High-pressure baroreceptors are located in the carotid sinus and aortic arch. Low-pressure baroreceptors are found in the heart and lungs. Baroreceptor ...
  14. [14]
    The Coding Logic of Interoception - PMC - PubMed Central - NIH
    When blood pressure elevation is sensed at the aortic arch and carotid sinuses and transmitted to the NTS via the glossopharyngeal and vagus nerves, the NTS ...
  15. [15]
    Brain structures involved in interoceptive awareness and ...
    It has to be assumed that signals from the cardiac mechanoreceptors (baroreceptors) enter the brain primarily via the vagus nerve. The majority (80–85%) of ...
  16. [16]
    Impaired orthostatic heart rate recovery is associated with smaller ...
    Apr 30, 2020 · Orthostatic challenge (standing up) is a physiological stressor which involves baroreflexes, via baroreceptors, blood pressure, and heart rate ...
  17. [17]
    Chemoreflex function in pulmonary diseases – A review - PMC
    The chemoreflex is a vital protective reflex that is crucial in restoring normal blood gas and pH levels. The carotid bodies are peripheral chemoreceptors ...
  18. [18]
    Central respiratory chemoreception - PMC
    RTN regulates breathing frequency, inspiratory amplitude, and active expiration. It is exquisitely responsive to acidosis in vivo and maintains breathing auto- ...
  19. [19]
    Characteristics and predictors for silent hypoxemia in a cohort of ...
    These neurons receive monosynaptic excitatory inputs from slowly adapting lung stretch receptors and peripheral chemoreceptors in the aortic and carotid bodies ...
  20. [20]
    An Official American Thoracic Society Statement - PubMed Central
    Background: Dyspnea is a common, distressing symptom of cardiopulmonary and neuromuscular diseases. Since the ATS published a consensus statement on dyspnea ...
  21. [21]
    Attention to cardiac sensations enhances the heartbeat-evoked ...
    Mar 27, 2024 · ... baroreceptors located in the aortic arch, carotid sinus, and carotid arteries. ... interoceptive interventions to fine-tune cardiac interoception.
  22. [22]
    Heart Rate Variability Modulates Interoceptive Accuracy - PMC
    We found a positive association between heartbeat detection and heart rate variability, implying that individuals with higher heart rate variability were more ...
  23. [23]
    Internal senses of the vagus nerve - PMC - PubMed Central
    Here, we review the state of knowledge related to vagal sensory neurons that innervate the respiratory, cardiovascular, and digestive systems.
  24. [24]
    From bladder to brain: How you know when it's time to go
    As the bladder fills, distension is sensed by mechanosensory afferents in the bladder wall that relay this signal to the brain. Barrington's nucleus in the ...
  25. [25]
    Neural Control of the Lower Urinary Tract - PMC - PubMed Central
    The functions of the lower urinary tract to store and periodically eliminate urine are regulated by a complex neural control system in the brain, spinal cord, ...
  26. [26]
    Renal Interoception in Health and Disease - PMC - PubMed Central
    Jul 31, 2024 · Individual differences in the interoceptive states of hunger, fullness and thirst. Appetite. 2015;95:44–57. doi: 10.1016/j.appet.2015.06.008 ...
  27. [27]
    A computationally informed distinction of interoception and ...
    The historical definition of interoception by Sherrington (Sherrington, 1906) ... interoception were defined as pertaining only to stimuli of internal origin ...2. Terminology And Concepts · 2.3. Thermoception · 4.1. Interoception As...<|control11|><|separator|>
  28. [28]
    An enteric-DRG pathway for interoception and visceral pain in mice
    Oct 23, 2025 · Interoception is mediated by sensory neurons that relay information from organs to the brain. ... Two anatomically segregated sensory pathways ...
  29. [29]
    Hepatic Interoception in Health and Disease - PMC - PubMed Central
    In contrast, there is considerable evidence for glucose sensors in the wall of the hepatic portal vein and their importance for glucose handling by the liver ...
  30. [30]
    Neural Circuits of Interoception - PMC - PubMed Central - NIH
    The present paper considers recent progress in our understanding of the afferent/ascending neural pathways and neural circuits of interoception.
  31. [31]
    Interoception and Inflammation in Psychiatric Disorders - PMC
    Here we provide an overview of how immune activation of neural and humoral interoceptive mechanisms interact to mediate discrete changes in brain and behavior.
  32. [32]
    Nociceptors - Neuroscience - NCBI Bookshelf - NIH
    Other unmyelinated nociceptors tend to respond to thermal, mechanical, and chemical stimuli, and are therefore said to be polymodal. In short, there are three ...Missing: interoception | Show results with:interoception
  33. [33]
    General Visceral Afferent Fibers - an overview | ScienceDirect Topics
    Although it is composed of about 80% afferent sensory fibers carrying information to the brain from the head, neck, thorax, and abdomen, the vagus nerve has ...
  34. [34]
    A Systematic Review of Associations Between Interoception, Vagal ...
    Visceral interoceptive information is largely conveyed by the afferent fibers of the vagus nerve and subsequently integrated within higher relay areas to ...
  35. [35]
    Polyvagal Theory: A biobehavioral journey to sociality - ScienceDirect
    Polyvagal Theory explains how the autonomic nervous system was repurposed to support sociality, enabling social behavior to regulate and optimize physiological ...
  36. [36]
  37. [37]
    Sensory spinal interoceptive pathways and energy balance regulation
    Major interoceptive pathways include gut-to-brain and adipose tissue-to brain signaling via vagal sensory nerves and hormones, such as leptin.
  38. [38]
    Interoception beyond homeostasis: affect, cognition and mental health
    Nov 19, 2016 · Interoception, as the sense of the physiological condition of the body, supports homeostatic control and allostatic adaptation, ensuring the ...
  39. [39]
    Interoception, homeostatic emotions and sympathovagal balance
    The interoceptive relay nuclei in the thalamus (the posterior and basal portions of the ventral medial nucleus, VMpo and VMb) are aligned with a topographic ...2. The Ascending... · 4. Is There A Direct... · Figure 2<|separator|>
  40. [40]
    A functional subdivision within the somatosensory system and its ...
    Ma proposes a functional subdivision of the somatosensory system into two branches that respond to external threats and internal body injuries, respectively.
  41. [41]
    Processing of sensory, painful and vestibular stimuli in the thalamus
    Oct 14, 2022 · The thalamus plays an important role in the mediation and integration of various stimuli (eg, somatosensory, pain, and vestibular).
  42. [42]
    Granular Insular Cortex - an overview | ScienceDirect Topics
    Neuroanatomists divide the insula across species into three subdivisions based on its cytoarchitecture - granular, dysgranular, and agranular IC. These ...Introduction · Anatomical Location and... · Functional Roles in Sensory...
  43. [43]
    Cytoarchitecture and Probabilistic Maps of the Human Posterior ...
    Both granular areas (Ig1 and Ig2) are located in the dorsal part of the posterior insula and are bordered ventrally and anterior by dysgranular insular cortex ...
  44. [44]
    Hemispheric divergence of interoceptive processing across ... - eLife
    Feb 8, 2024 · In this study, the authors provide compelling evidence for dysgranular insular involvement in top-down and bottom-up interoceptive processing.Experimental Design And... · Fmri Task-Based Analysis · Fmri Resting State Analysis
  45. [45]
    The Organization of the Primate Insular Cortex - Frontiers
    This model proposes that interoceptive afferents that represent the ongoing physiological status of all the organs of the body are first being received in the ...
  46. [46]
    The insula: an underestimated brain area in clinical neuroscience ...
    Supported by recent human neuroimaging studies, the insula is re-emerging as an important brain area not only in the physiological understanding of the brain, ...Missing: rise | Show results with:rise
  47. [47]
    Functional connectivity of the insula in the resting brain - ScienceDirect
    Mar 1, 2011 · Resting brain studies confirm and extend the notion that the human insula can be divided into two functionally distinct areas, the anterior and the posterior.
  48. [48]
    Anterior insular cortex plays a critical role in interoceptive attention
    Apr 15, 2019 · Using fMRI, we showed that the AIC is involved in interoceptive attention towards respiration, with the underlying connectivity between the AIC ...
  49. [49]
    Evidence for a Large-Scale Brain System Supporting Allostasis and ...
    Allostasis is defined in terms of prediction, and recent theories propose that the prediction of interoceptive signals is necessary for successful allostasis ( ...
  50. [50]
    Cortical and subcortical mapping of the human allostatic ... - Nature
    Oct 23, 2025 · The brain continuously anticipates the body's energetic needs and prepares to meet them before they arise—a process called allostasis.
  51. [51]
    What Are the Functions of Interoception and Allostasis and Their ...
    Oct 29, 2025 · Interoceptive signals are conveyed to the CNS by both neural and humoral pathways ... interoceptive, homeostatic, and affective relevance of ...
  52. [52]
    Disentangling interoception and its links to cognitive functioning in ...
    Aug 26, 2025 · The classical Stroop test measures executive functioning, like conflict monitoring and inhibitory control. This test consists of three tasks, ...
  53. [53]
    Functional neuroanatomy of interoceptive processing in children ...
    Nov 7, 2019 · Adults activate the frontal-insula-parietal-anterior cingulate cortex (ACC) neural network when performing heartbeat detection during fMRI.
  54. [54]
    Functional organization of human subgenual cortical areas - NIH
    Human subgenual anterior cingulate cortex (sACC) is involved in affective experiences and fear processing. Functional neuroimaging studies view it as a ...
  55. [55]
    Over-activation of primate subgenual cingulate cortex enhances the ...
    Oct 26, 2020 · We show that over-activation of sgACC/25 reduces vagal tone and heart rate variability, alters cortisol dynamics during stress and heightens reactivity to ...
  56. [56]
    Neural correlates of interoception - NIH
    Sep 12, 2017 · ... somatosensory cortex near the parietal operculum [Hobday et al., 2001; Lotze et al., 2001], but variability in the extent of the involvement ...
  57. [57]
    Cardio-visual full body illusion alters bodily self-consciousness and ...
    Jun 18, 2018 · These data demonstrate that interoceptive and exteroceptive signals can be combined to modulate activity in parietal somatosensory cortex.
  58. [58]
    Structural network topology and microstructural alterations of the ...
    Aug 6, 2021 · In this study, we found alterations in network topology and microstructural integrity of white matter tracts for the anterior insula, primarily ...
  59. [59]
    Interoceptive Ability Predicts Survival on a London Trading Floor
    Sep 19, 2016 · Interoceptive information, even if unconscious or occupying the fringes of awareness, provides valuable inputs in risky decision making. Antoine ...
  60. [60]
    Interoceptive accuracy is associated with benefits in decision ...
    Nonconscious fear conditioning, visceral perception, and the development of gut feelings. Psychol. Sci. 12, 366–370. doi: 10.1111/1467-9280.00368. PubMed ...
  61. [61]
    The James-Lange Theory of Emotion - Verywell Mind
    May 19, 2024 · The James-Lange theory of emotion suggests that physical changes in the body happen before the experience of the associated emotion.
  62. [62]
    From Emotions to Consciousness – A Neuro-Phenomenal and ...
    The James–Lange theory considers emotional feelings as perceptions of physiological body changes. This approach has recently resurfaced and modified in both ...
  63. [63]
    Interoception primes negative emotion processing during cognitive ...
    Interoception has been proved to be associated with emotional feeling states. The James-Lange theory of emotion states that the perception of activity within ...
  64. [64]
    The somatic marker hypothesis and the possible functions ... - Journals
    The key idea in the hypothesis is that 'marker' signals influence the processes of response to stimuli, at multiple levels of operation.Missing: 1994 | Show results with:1994<|separator|>
  65. [65]
    Somatic Marker Hypothesis - an overview | ScienceDirect Topics
    The Somatic Marker Hypothesis suggests that emotions and feelings create "somatic markers" which act as signals guiding behavior towards beneficial outcomes.
  66. [66]
    Anterior insular cortex and emotional awareness - Wiley Online Library
    Jun 8, 2013 · This paper reviews the foundation for a role of the human anterior insular cortex (AIC) in emotional awareness, defined as the conscious experience of emotions.Missing: binding | Show results with:binding
  67. [67]
    Dynamic interactions between anterior insula and anterior cingulate ...
    Jun 30, 2023 · The ACC is believed to receive and integrate multisensory perceptual information and underpins diverse cognitive functions, including emotion, ...
  68. [68]
    Overlapping activity in anterior insula during interoception and ...
    Aug 9, 2025 · The insula integrates input from various brain regions, such as the amygdala, anterior cingulate cortex, and hypothalamus, to create a ...Missing: binding | Show results with:binding<|separator|>
  69. [69]
    Heart rate biofeedback improves cardiac control during emotional ...
    Aug 7, 2025 · In neuroscience research, it was reported that manipulating heart rate variability can create different response to anger-inducing stimuli [16].
  70. [70]
    Heart Beat Perception and Emotional Experience - Schandry - 1981
    Individuals who show good perception of heart activity tend to exhibit higher levels of a momentarily experienced emotion (in this case anxiety)Missing: altered | Show results with:altered
  71. [71]
    Cultural Differences in Interoceptive Accuracy: Comparison Between ...
    Aug 30, 2023 · The present study examined cultural differences in interoceptive processing. We focused on a behavioral measure of cardiac processing.
  72. [72]
    Cross-cultural differences in self-reported and behavioural ...
    Dec 21, 2023 · How we express and describe emotion is shaped by sociocultural norms. These sociocultural norms may also affect emotional self-awareness, ...
  73. [73]
    The Multidimensional Assessment of Interoceptive Awareness (MAIA)
    Nov 1, 2012 · This paper describes the development of a multidimensional self-report measure of interoceptive body awareness.Missing: sensibility | Show results with:sensibility
  74. [74]
    Interoceptive awareness declines with age - PMC - PubMed Central
    Here we report an inverse association between aging and interoception, as indexed by the ability to sense the heartbeat at rest.
  75. [75]
    The impact of a brief mindfulness training on interoception - NIH
    Sep 7, 2022 · The brief mindfulness training group increased interoceptive sensibility while active control had no effects on this variable. Five out of eight ...
  76. [76]
    Interoceptive experiences and ecological care: an embodied ...
    Feb 9, 2024 · Our interest lies in exploring the potential relevance of the phenomenology of embodied self-awareness in relation to interoceptive processes ...
  77. [77]
    Aphantasia as suboptimal interoception and emotion processing - OSF
    Sep 23, 2024 · Our preliminary evidence suggests that aphantasia is linked to reduced interoceptive attention, raising the possibility that aphantasia reflects suboptimal ...Missing: 2020s | Show results with:2020s
  78. [78]
    Interoceptive Mechanisms and Emotional Processing
    Jan 17, 2025 · Interoception, the sensing of internal bodily signals, is intricately linked with the experience of emotions. Various theoretical models of ...Missing: revival | Show results with:revival
  79. [79]
    The relationship between self-reported interoception and anxiety
    This meta-analysis of 71 studies explored the relationship between self-report measures of interoception and anxiety.
  80. [80]
    Altered Interoceptive Processing in Generalized Anxiety Disorder ...
    Sep 5, 2019 · The brain's dysfunctional processing of interoceptive information is increasingly recognized as an important component of anxiety disorders.
  81. [81]
    Major Depressive Disorder Is Associated with Impaired Interoceptive ...
    Evidence suggests that low accuracy of heartbeat perception is linked with affective, cognitive and somatic symptoms of depression and is also associated with ...Missing: blunted | Show results with:blunted<|control11|><|separator|>
  82. [82]
    Interoception in Fear Learning and Posttraumatic Stress Disorder
    Jul 14, 2023 · In this review, we propose that interoception, the process of sensing, interpreting, and integrating internal body signals, can offer valuable ...
  83. [83]
    The Role of Interoception in the Pathogenesis and Treatment of ...
    Apr 16, 2020 · Anorexia nervosa (AN) is a psychiatric illness characterized by extreme overvaluation of weight and disturbed eating.
  84. [84]
    An FMRI meta-analysis of interoception in eating disorders
    Prior research indicates that aberrant interoception -one's sense of the internal condition of the body - contributes to symptoms in both Anorexia (AN) and ...
  85. [85]
    Interoception in Autism Spectrum Disorder: A review - ScienceDirect
    This review article summarizes original scientific research published to date on interoception in individuals with Autism Spectrum Disorder (ASD).
  86. [86]
    The anterior insula in autism: Under-connected and under-examined
    Horwitz and colleagues demonstrated two decades ago that individuals with ASD showed reduced correlations between the insula and fronto-parietal regions ( ...Anterior Insula As A Network... · Anterior Insula In Asd · Brain Networks In Asd...<|control11|><|separator|>
  87. [87]
    Interoception and Obsessive-Compulsive Disorder: A Review of ...
    In this review, we outline dimensions of interoception and review current literature on the processing of internal bodily sensations within OCD.Missing: 2023 | Show results with:2023
  88. [88]
    The relationship between sensory phenomena and interoception ...
    Feb 24, 2025 · Indirect evidence suggests altered interoception may play a role in these shared experiences of sensory phenomena; however, research explicitly ...
  89. [89]
    Heightened interoception in adults with fibromyalgia - ScienceDirect
    Some evidence suggests that people with fibromyalgia syndrome (FMS) – a condition characterised by chronic pain and fatigue – may have altered interoceptive ...
  90. [90]
    Pain matters for central sensitization: sensory and psychological ...
    Patients with FMS showed various somatosensory abnormalities. These were not significantly influenced by psychological comorbidities.
  91. [91]
    Pain and emotion as predictive factors of interoception in fibromyalgia
    Apr 19, 2018 · This study investigated interoception in fibromyalgia (FM), a disorder characterized by chronic pain accompanied by mood deregulation.Missing: sensitization | Show results with:sensitization
  92. [92]
    Roles of the Insular Cortex in the Modulation of Pain
    Mar 4, 2009 · During testing with suprathreshold stimuli, individuals with insular lesions have been reported to exhibit pain asymbolia, a reduced ...
  93. [93]
    Interoception in Parkinson's disease: A narrative review and ...
    An understudied consequence of autonomic and visceral dysfunction in PD is interoception, the neural processing of internal organ system signals. Interoceptive ...
  94. [94]
    Autonomic Dysfunction in Parkinson's Disease - PMC
    Autonomic dysfunction in PD covers a broad spectrum that includes cardiovascular, gastrointestinal, urological, sexual, and thermoregulatory dysfunctions.
  95. [95]
    Interoception, insula, and agency: a predictive coding account of ...
    In aphantasia, disrupted insula–ACC function diminishes interoceptive precision, weakening both the experience of agency and the integration of bodily signals.Sense Of Agency And Mental... · Predictive Coding Model Of... · Figure 1
  96. [96]
    Increased breathlessness in post-COVID syndrome despite normal ...
    Jul 29, 2025 · Severe symptoms in the absence of measurable body pathology are a frequent hallmark of post-COVID syndrome.
  97. [97]
    Efficacy of interoceptive and embodied rehabilitative training ...
    Dec 20, 2022 · Efficacy of interoceptive and embodied rehabilitative training protocol in patients with mild multiple sclerosis: A randomized controlled trial.
  98. [98]
    Computational Models of Interoception and Body Regulation - PMC
    Here, we cover three types of internal models: (i) Models of interoception that describe how internal states can be inferred from sensory signals, (ii) models ...
  99. [99]
    Active interoceptive inference and the emotional brain - Journals
    Nov 19, 2016 · We review a recent shift in conceptions of interoception and its relationship to hierarchical inference in the brain.<|separator|>
  100. [100]
    Active interoceptive inference and the emotional brain - PMC
    The notion of interoceptive inference means that bodily states are regulated by autonomic reflexes that are enslaved by descending predictions from deep ...1. Introduction · 2. Predictive Coding In The... · 3. Interoceptive InferenceMissing: EPIC 2019
  101. [101]
    (PDF) Interoceptive predictions in the brain - ResearchGate
    Aug 7, 2025 · Interoceptive experience may largely reflect limbic predictions about the expected state of the body that are constrained by ascending visceral sensations.
  102. [102]
    (PDF) Allostasis, interoception, and the free energy principle
    Nov 26, 2019 · Allostasis describes how the organism remains stable in the face of change, via regulatory mechanisms that ensure the independence of the ...
  103. [103]
  104. [104]
    Interplay between top-down and bottom-up processing - PubMed
    Bottom-up processing is stimulus-dependent, while top-down is model-dependent. A left thalamus network is linked to bottom-up, and a left amygdala network to  ...
  105. [105]
    Enhancing bodily self-consciousness in the virtual world with ...
    Suzuki et al. Multisensory integration across exteroceptive and interoceptive domains modulates self-experience in the rubber-hand illusion. Neuropsychologia.
  106. [106]
    Grounded cognition - PubMed
    Grounded cognition rejects traditional views that cognition is computation on amodal symbols in a modular system, independent of the brain's modal systems ...
  107. [107]
    Embodied cognition and beyond: Acting and sensing the body
    As Barsalou (2008) states, “Grounded cognition reflects the assumption that cognition ... interoceptive, metacognitive, social, and linguistic experience.
  108. [108]
    [PDF] J.J. Gibson – Affordances - Brown CS
    The affordances of the environment are what it offers the animal, what it provides or furnishes, either for good or ill. The verb to afford is found in the ...Missing: inference internal
  109. [109]
    An Embodied Cognition Perspective on the Role of Interoception in ...
    Oct 11, 2021 · In this perspective, we extend the embodiment account of interoceptive inference to explain the development of the minimal self in humans.
  110. [110]
    Interoception and Empathy Impact Perspective Taking - PMC
    Jan 18, 2021 · Recent work suggests that interoceptive signals not only contribute to own-body perception and self-consciousness, but also to empathy.
  111. [111]
    Social Interoception and Social Allostasis through Touch: Legacy of ...
    Here we compare how the SAME and the more recent Theory of Constructed Emotion (TCE) view the role of interoceptive signals in creating emotional experiences.
  112. [112]
    Heart beat perception and emotional experience - PubMed
    Heart beat perception and emotional experience. Psychophysiology. 1981 Jul;18(4):483-8. doi: 10.1111/j.1469-8986.1981.tb02486.x. Author. R Schandry. PMID ...Missing: method detection paper
  113. [113]
    Methodological Recommendations for a Heartbeat Detection-Based ...
    Heartbeat detection tasks are often used to measure cardiac interoceptive sensitivity: the ability to detect sensations from one's heart.
  114. [114]
    Body Perception Questionnaire (c)1993
    The BODY PERCEPTION QUESTIONNARIE has five sub-tests: 1) Awareness, 2) Stress Response, 3) Autonomic Nervous System Reactivity, 4) Stress Style, and 5) Health ...
  115. [115]
    Interoceptive Accuracy Scale
    The Interoceptive Accuracy Scale (IAS) is a self-report assessing the independence of perceived interoceptive accuracy and attention, relating to bodily ...
  116. [116]
    Keeping the body in mind: Insula functional organization and ...
    A map of how interoceptive, exteroceptive, and emotional awareness are integrated within the insular cortex.
  117. [117]
    Respiratory sensory gating measured by respiratory-related evoked ...
    The respiratory-related evoked potential (RREP) is a useful non-invasive electrophysiological method for studying the effects of anxiety on respiratory ...
  118. [118]
    Inward VR: Toward a Qualitative Method for Investigating ...
    May 1, 2023 · We report results from a first exploratory study (n=21) applying this method to understand the interoceptive experiences of users in a VR environment.Missing: paradigms multisystem
  119. [119]
    Expectation predicts performance in the mental heartbeat tracking task
    The mental heartbeat tracking task by Schandry is sensitive to non-interoceptive (top-down) influences, e.g., estimation of heart rate and expectation.
  120. [120]
    Mindfulness-based stress reduction training supplemented with ...
    The results suggest that supplementing MBSR with monitoring interoceptive signals by a smartwatch enhances mindfulness, and maintains the effect of stress and ...
  121. [121]
    Adapted Mindfulness Training for Interoception and Adherence to ...
    Nov 2, 2023 · Overall, the findings of this phase 2 RCT showed that the MB-BP program improved interoceptive awareness compared with an enhanced usual care ...
  122. [122]
    The Utility of Heartrate and Heartrate Variability Biofeedback ... - MDPI
    We propose a three-stage model by which HR(V)-BF may improve interoception which draws upon principles of interoceptive inference and predictive coding.<|separator|>
  123. [123]
    Effects of Heart Rate Variability Biofeedback Training on Anxiety ...
    Jun 18, 2024 · This study examined the anxiety-reducing effects of HRVBF training and related brain activity changes by randomly assigning participants, employing an active ...
  124. [124]
    Remote cognitive behavioral therapy for panic disorder: A meta ...
    A recent meta-analysis comparing each of the key CBT components in treating PD found that interoceptive exposure was an important predictor of symptom ...
  125. [125]
    Decreased defensive reactivity to interoceptive threat after ... - Nature
    Mar 17, 2021 · Decreased defensive reactivity to interoceptive threat after successful exposure-based psychotherapy in patients with panic disorder.Results · Heart Rate And Skin... · Defensive Reflex...
  126. [126]
    Non-invasive vagus nerve stimulation conditions increased ...
    Sep 29, 2023 · Therefore, alterations in interoception that have been recently linked to depression might provide a mechanism for taVNS to rapidly improve ...
  127. [127]
    Vagus Nerve Stimulation as a Gateway to Interoception - Frontiers
    Jul 28, 2020 · We review a range of cognitive, affective and clinical research using Vagus Nerve Stimulation, showing that it can be applied to the study of interoception.Introduction · Preconscious Impacts on... · Psychological Dimensions... · Discussion
  128. [128]
    [2309.05999] Life-inspired Interoceptive Artificial Intelligence ... - arXiv
    Sep 12, 2023 · This paper focuses on interoception, monitoring internal environments, to build autonomous and adaptive AI agents, inspired by living organisms.
  129. [129]
    A machine learning approach towards the differentiation between ...
    We used machine learning to classify interoceptive sensibility by contrasting using data from a randomized control trial of interoceptive training.
  130. [130]
    How Aging Shapes Interoception: A Multimodal, Multidimensional ...
    Apr 10, 2025 · Our results revealed that older age was associated with reduced cardiac interoceptive sensitivity during perturbation, while respiratory ...
  131. [131]
    Psychedelics and the Autonomic Nervous System: A Perspective on ...
    Feb 18, 2025 · Emerging research suggests that psychedelics may enhance vagal tone, as reflected in increased HRV during and after psychedelic experiences.Psychedelics and the... · Psychedelics and... · Rebalancing the ANS...<|control11|><|separator|>