Expand Your Understanding of Interoception
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Heart rate, blood pressure, pain, hunger, thirst: Our awareness of these internal states is called interoception. It’s been called the “eighth sense,” and it has strong links to the capacity to regulate emotions.
Catana Brown, Ph.D., OTR/L, professor emerita of occupational therapy at Midwestern University, and Winnie Dunn, Ph.D., OTR, distinguished professor at the University of Missouri, authors of the Adolescent/Adult Sensory Profile (A/ASP), have developed a new tool, Sensory Profile Interoception (SPI), to identify participation patterns associated with high and low interoception.
"As occupational therapists, our main concern is identifying an individual's interoceptive ability because it plays a vital role in their overall well-being,” Brown says. “It seems so obvious to us; interoception is central to the basic activities of daily living.”
Research shows that people can experience difficulties in awareness of hunger, thirst, pain, and touch because of a reduced ability to integrate interoceptive stimuli. Some research suggests a tendency toward lower interoceptive awareness among people with depression and higher awareness in those with anxiety. Brain differences seen in autism may also contribute to differences in interoceptive functioning.
The essential role that interoception plays in shaping self-regulation, sense of self, and participation in activities of daily living makes it important for clinicians across disciplines to consider interoception when developing interventions.
Broader Is Better
Previous interoceptive measures have focused on three dimensions: accuracy, sensibility, and awareness. According to Brown, this approach falls short because it fails to consider interoceptive impact beyond physiological responses, awareness of internal sensations, emotions, and cognition.
Brown notes, “There’s at least a superficial…awareness of what interoception is; it’s becoming much more common in the literature as well as in clinical practice for people to talk about interoception, but I tend to think that they look at it in a very narrow way.”
Previous approaches to interoception have included focusing on specific diagnostic groups and linking external behaviors with interoceptive responses. Narrow approaches to interoception make it difficult for occupational therapists (OTs) to know the effect of interoception on a person’s participation in everyday life, which makes it difficult to plan effective interventions.
A broader understanding of interoception provides insight into how interoceptive awareness and unawareness manifest as symptoms. The need for an expanded understanding of interoception has led to the development of interventions to build interoceptive awareness.
Introducing Sensory Profile Interoception
SPI is a participation-focused interoceptive measure that includes subscales of Sensitivity, Avoiding, Registration and Seeking, to understand how the nervous system responds to sensation, and assess interoceptive impact on participation in daily activities. The SPI will be first published as a research edition, which Dunn and Brown hope will be used to develop targeted interventions that complement existing sensory strategies.
SPI uses a cross-sectional psychometric design and studies concurrent validity using Pearson Product Moment Correlations to identify relationships between the SPI and the A/ASP subscales.
Accounting for interoceptive impact is a key element of SPI. The major concern, according to Dunn, is how people’s life experiences and bodily sensations influence participation in daily life. It’s an element missing from other interoceptive assessments and allows multiple disciplines to look at the same concept from different angles.
“In OT, I find that a lot of people focus on interoception and emotion regulation as almost the exact same thing, but we see them as two distinct but related constructs,” Brown says. “The next step of participation is where OT has an impact, and because we already have the model that came out of the Sensory Profile, we have a way to both assess and provide intervention to target the different preferences people might have in terms of their interoception.”
Clinicians interested in sensory processing evaluation can explore Pearson’s Sensory Profile 2 and the Adolescent/Adult Sensory Profile as companion resources to SPI. Together, these tools offer a more holistic understanding of how sensory preferences, including interception, shape the way people function in everyday life.