Interoception in Psychiatric Disorders: A Review of Randomized, Controlled Trials with Interoception-Based Interventions

Abstract

Interoception, or the process of sensing, interpreting, and integrating internal bodily signals, has increasingly been the subject of scientific research over the past decade but is still not well known in clinical practice. The aim of this article is to review clinical treatment interventions that use interoception, to synthesize the current research knowledge, and to identify the gaps where future research is needed. We conducted a comprehensive literature search on randomized, controlled trials that both include interoception in treatment interventions for individuals with psychiatric disorders and measure aspects of interoception using self-report measures. Out of 14 randomized, controlled trials identified, 7 found that interventions with interoception were effective in ameliorating symptoms. These studies included individuals with anxiety disorders, eating disorders, psychosomatic disorders, and addictive disorders. All of the intervention studies with positive clinical outcomes also demonstrated changes on interoceptive measures; however, these measures were often related to specific illness symptoms. Interoception may be a mechanism of action in improving clinical symptomatology, though studies incorporating general, symptom-independent interoceptive measures remain scarce. To further our understanding of the role interoception has in psychiatric disorders and their treatment, more studies integrating interoceptive measures are needed, along with a clearer definition of interoceptive terms used.

Mindfulness and Behavior Change

“… 172 Broader definitions of interoceptive awareness include the tendency to listen to and trust body sensations as occurring within a dynamic relationship with appraisal and interoceptive regulation processes. 173 , 174 Mindfulness training enhances interoceptive awareness and function. 20 Most MM starts with the body and seems to develop greater interoceptive accuracy.…”

If It All Comes Down to Bodily Awareness, How Do We Know? Assessing Bodily Awareness

“…These objective measures assess one dimension of interoception, namely its accuracy. Other aspects such as regulatory aspects (Bornemann, Herbert, Mehling, & Singer, 2014), different styles of attention (Mehling, 2016), the degree of mind-body integration with emotions (Khoury, Lutz, & Schuman-Olivier, 2018), and trusting one's body (Velten & Brotto, 2017) are not captured by measures of interoceptive accuracy. These measures, to use an analogy, test the (Ahead of Print) equivalent of your visual acuity when looking at modern art in a museum, rather than how you process what you see and feel.…”

Serotonergic Effects on Interoception

“…Conclusions: Research on exteroceptive perceptual decision-making has identified dissociable processes of perception and metacognitive oversight (Fleming & Dolan, 2012) with focal metacognitive deficits present in psychiatric (Hauser et al, 2017;Rouault et al, 2018) and neurological conditions. With this study, we contribute to a growing body of work that makes similar dissociations between perception and metacognition in the interoceptive domain (Garfinkel et al, 2015;Khoury et al, 2018;A. P. Owens et al, 2018).…”

“…Clinical Implications: The effect of citalopram on interoceptive awareness provides a new framework for the study of serotonin in interoception-associated disorders. SSRI treatments and successful interoceptive therapies in depression and anxiety (Khoury et al, 2018) may be found to overlap in mechanism as they ameliorate blunted affect (Paulus et al, 2019) or break maladaptive cognitive cycles (Roy-Byrne et al, 2006). Perceptual biases that appear before clinical effects of SSRIs are observed and are thought to predict clinical outcomes (Harmer & Cowen, 2013;Michely et al, 2020) may be discovered to have interoceptive foundations.…”