8/10/21

Interoception, The 8th Sense:

Impact on Self-Regulation, Mental

Health & Social Connection

Kelly J Mahler OTD, OTR/L

www.kelly-mahler.com

Mahler © 2021

Potential
Trigger
Warning:

Mahler © 2021

Your inner
experience
is always
correct
and valid.
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What is Interoception?

Module
Outline

The 8 Senses
The Outside Senses The Inside Senses

Ms. Visual Ms. Tactile Mr. Proprioception

Mr. Vestibular

Mr. Gustatory Ms. Olfactory

Mr. Interoception
Myles, Mahler, Robbins, 2014
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Receptor Locations for Interoception

Brain
Eyes Ears
Mouth Nose

Lungs Muscles
Heart
Stomach

Bladder
Hands

Skin
Feet

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Interoception and the Brain

Critchley et al., 2004

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Interoception Helps Us Feel

Homeostatic Affective
Emotions Emotions
Hunger Fullness Thirst Excitement Distraction
Sensory Overload Pain Joy Frustration Calmness
Illness Body Temperature Fear Safety Sadness
Physical Exertion Sleepiness Love Focus Anxiety
Need for the Bathroom Boredom Energized

Craig, 2002
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Interoception Defined

The
Sensory System
that gives us
information regarding
our BODY-EMOTION
connections.

Craig, 2002
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Interoceptive Awareness (IA)

The ability to:

1. NOTICE body
signals
2. CONNECT
body signals to
the emotion

Better Insula = Better Interoceptive Awareness (IA)

Critchely et al., 2004
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Unique Inner Experiences

Module
Outline

WE ALL HAVE UNIQUE

INTEROCEPTION EXPERIENCES!

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IA: A Variety of Extremes

Body Signals Characteristics

• Strong
too BIG • Overpowering
• Too many body signals at
once

• Muted
too small • Completely miss body
signals OR only notice
intense body signals

(Mahler, 2019; Miller, Anzalone, Lane, Cermak, Osten, 2007; Endow, 2010)
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IA: a Sliding Scale

TOO BIG

Anxiety
Too Small

Physical exertion

Hunger

Fullness

Pain

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IA Extremes
Connected to Many Conditions

Autism Trauma Disorders

ADHD Obsessive Compulsive Disorder

Anxiety Panic Disorder

Depression Suicide Attempters

Eating Disorders Drug & Alcohol Addiction

Obesity Chronic Pain Syndromes

Schizophrenia Sensory Processing Disorder

Self-injurious behavior
Dementia
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IA Extremes & Mental Health

Khalsa et al, 2018

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IA Extremes & Trauma

Almost every brain

imaging study of trauma
patients finds abnormal
activation of THE
INSULA (Van Der Kolk,
2014)

(Clausen, et.al, 2019; Marusak, Etkin, & Thomason, 2015; Van Der Kolk; Ansell, Rando, Tuit,
Guarnaccia, & Sinha, 2012; Herringa, Phillips, Almeida, Insana, & Germain, 2012)
Mahler © 2020

IA Extremes
Connected to Many “Non-Conditions”

• Over-focus on external life

• Little appreciation for the body
• Screen Time
• Behavioral Approaches

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IA Extremes & Current Behavioral Approaches

A Focus on Compliance (further) Affects IA:

A focus on compliance teaches a person to ignore their own
body needs in order to comply with a demand and earn the
‘reward’

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IA Extremes
Possible Causes

Organic Causes: Environmental Causes:

• Autism • Trauma
• ADHD • Busy Lifestyle
• OCD • Screen Time
• Anxiety Disorders • Little appreciation for body
• Depression • Behavioral Approaches

Interoception is an EVERYONE thing.

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Interoception: Impact on Self-Regulation &

Positive Mental Health

Module
Outline

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IA & Regulation

Co-Regulation Self-Regulation
A back and The ability to
forth identify and
partnership manage
where one is emotions
RELYING ON INDEPENDENTLY
OTHERS to with minimal help
help identify Interoceptive from other
and manage Awareness people
emotions

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IA & Self-Regulation
The ability to IDENTIFY and
MANAGE the way that we feel.

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Self-Regulation of Emotions

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IA & Toileting Regulation

Homeostatic Example
NOTICE the body signals
Full, heavy abdomen; pressure or slight pain in
This is genitals
Interoceptive
Awareness CONNECT the body signals to the emotion
Need to Urinate

Urge to act

REGULATE with an action (behavior)

Go to the bathroom

Outcome
Discomfort Fades (No more: Full, heavy
abdomen; pressure or slight pain in genitals)
Mahler © 2020

IA & Anxiety Regulation

Affective Example
NOTICE the body signals
Shaky hands, fast heart, swirling brain &
This is shut-off ears
Interoceptive
Awareness CONNECT the body signals to the emotion
Anxious

Urge to act

REGULATE with an Action (Behavior)

Go for a Walk

Outcome
Discomfort fades (No more: Shaky hands,
fast heart, swirling brain & shut-off ears)
Mahler © 2020

When IA Breaks Down

“If an adult does not remind her, my teenage daughter will go an

entire day without drinking a single drop of liquid.”

“My son does not feel the need to poop until it is an extreme
sensation. By then he is in tears, trying desperately not to
have an accident and we are running for the nearest toilet. It
is a very lucky day if we make it on time.”

“My 5-year old grandson walked around on a broken

femur for 3 days before we knew it was broken.”

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When IA Breaks Down

“My son has been taught every single coping skill known to man:
take deep breaths, go for a walk, ask for help, etc. But he doesn’t
feel the need to use these strategies in the moment. His school
labels him as a ‘major behavior problem’, and sees him as
‘oppositional’ because he won’t use the coping strategies they’ve
taught him.”

“I feel so many things inside my body at once. It is messy and

chaotic. I can’t make sense of it all.”

“Before working on interoception, my anxiety seemed to come out

of nowhere. I didn’t feel it coming. All of a sudden, I would be
overcome with anxiety-- screaming, shaking, crying. And then
people would say things to me like “make a smart choice” or “pick
a tool” or “use your words”. Don’t you think I would if I could?!?!
This statements made me feel even more guilty –evidence that no
matter how hard I tried, I was a failure.”

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IA & Self Regulation

NOTICE the body signals
Faster heart, clenched fists, tight
muscles, louder voice

CONNECT the body signals to the

emotion DRY MOUTH
Angry BODY
& THROAT
EMOTION THIRSTY
URGE to act ACTION DRINK

REGULATE with an action

Go for a Walk

Outcome
Discomfort fades (No more: Faster
heart, clenched fists, tight muscles,
louder voice, hot)

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Building IA can enhance existing

Self-Regulation Strategies

NOTICE
Body & CONNECT
Body signals to
signals Emotion
The Zones of Regulation, Leah Kuypers, (2011, Social Thinking Publishing)
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Building IA can enhance existing

Self- Regulation strategies

Using
coping
skills in
the
moment

NOTICE
Body & CONNECT
Body signals to
signals Emotion

Mahler © 2020

The Vast Influence of Interoception: Impact

on Social Connection

Module
Outline

IA & Social Connection

Perspective Taking:
The ability to
understand another
person’s emotions,
thoughts, intentions,
desires and ideas
Also known as Theory of Mind

Frith & Frith 1999, 2009

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IA & Social Connection

The INSULA:
How Do I Feel?
and
How Do YOU Feel?

Singer, 2009; Gu et al., 2013

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IA & Social Connection

People with Good People with good

INTEROCEPTIVE INTEROCEPTIVE People with well-
working INSULA
AWARENESS AWARENESS
are better at score better on are better able to
reading body tests of TOM. detect the
language & facial emotions of
expressions others

Bird et al, 2010; Cook et al, 2013; Shah et al 2017

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Theory of Own Mind

(Free blog/video)

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Building IA can Enhance Social Participation

Social Emotional Social Skill Attachment &

Learning Supports Attunement

NOTICE
Body & CONNECT
Body signals to
signals emotion

Mahler © 2018

Interoception-Based
Supports
If you don’t feel at home in your body,
you will never feel at home in the
world.
---Harari, 2018

Module
Outline

The Established Evidence

Interoceptive
Awareness
& Body
Mindfulness

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The Established Evidence

Why traditional body

mindfulness may not be a
match:
– Too abstract
– Requires a certain
degree of cognition and
attention
– Assumes a safe
relationship with internal
sensations

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IA Builders: Definition

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IA Builders

• Chunked into 1 body part at a time—slow build to

the entire body
• Evoking stronger sensation--captures attention
• Playful & learning while doing—feels safe
• Visual & Language supports

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A Framework for IA Builders

www.kelly-mahler.com

Fosters a
process that
allows each
person to
discover their
own inner
experience.

Mahler © 2020

Before using IA Builders

Co-Regulation
+
Felt-Safety
+
Mutual
Relationship

and Always Trauma-Informed

Mahler © 2020

IA Builder: Focus Area Experiments

Invitation to try:
Squeeze your hand in
a fist for 5 seconds.
How does your hand
feel while you are
squeezing?

Considerations:
• IA Builders are always an invitation,
not a required demand
• Accept & Validate all responses
• Meet each learner’s communication
needs
• Make it playful
• Do with learners (not to learners)
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IA Builder: Focus Area Experiments

Invitation to try:
Blow on the back of
your hand for 5
seconds. How does
your hand feel when
you are blowing?

Considerations:
• IA Builders are always an invitation,
not a required demand
• Accept & Validate all responses
• Meet each learner’s communication
needs
• Make it playful
• Do with learners (not to learners)
Mahler © 2020

IA Builder: Focus Area Experiments

Invitation to try:
Shake your hands fast
for 5 seconds. How do
your hands feel when
you are shaking them?

Considerations:
• IA Builders are always an invitation,
not a required demand
• Accept & Validate all responses
• Meet each learner’s communication
needs
• Make it playful
• Do with learners (not to learners)
Mahler © 2020

IA Builder: Everyday Focus Area Experiments

Free:
www.kelly-mahler.com
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IA Builder: Everyday Focus Area Experiments

At School
Consider your normal daily routines. What activities are you already doing that
could serve as Focus Area Experiments? What activities might evoke a stronger
feeling within the following body parts:

Hands:
• Writing
• Typing
• Clay/Playdough/Slime
• Manipulatives
• Handwashing
• Hand sanitizer

Heart:
• Recess
• PE
• Movement Breaks

Mahler © 2020

IA Builder: Interoception Yoga Cards &

Interoception Exercise Cards
More Focus Area Experiments

Cow Standing Bicycle Twist

How do your hands feel during this

How do your hands feel while holding exercise? Link your fingers together
this pose? Gently press each of your behind your head. How do your hands
fingers into the mat one at a time. How feel? Now unlink your fingers and rest
do your hands feel while you press your hands on the back of your head
your fingers into the mat? while continuing the exercise. Does
this change the way your hands feel?
Can you describe the difference?
© Mahler 2021 © Mahler 2021

Mahler © 2020

IA Builder: Focus Area Experiments

WHY it helps
• Concrete meaning to
interoception words
• Fun practice
NOTICING and
DESCRIBING
interoceptive
sensations
• Safe way to
experience
sensations

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THANK YOU!!

FOR MORE INFORMATION:

• www.kelly-mahler.com
• Facebook-Interoception: The Eighth
Sensory System

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