Interoception

This post will look a bit about interoception. I will explain a bit more about what it actually is, and how/why it is relevant in adoption later, but wanted to explain a bit more about why I wanted to learn more myself.

It all started when I was looking at sensory processing, and learning about how it is relevant to adoption. I wrote about it (here).

I decided I wanted to look into interoception further when someone else on twitter said that they had looked at sensory processing, but wanted to understand it further, to help their children be more in tune with themselves. To learn how to listen to their bodies in order to help them regulate themselves better.

I bought a book from amazon that is specifically all about interoception. It has only just been published this year, so is full of up to date research and concepts. It is written by an OT, so being an OT as well, I was immediately drawn to her work. From reading the book, Cara has also considered interoception in it’s relation to trauma and Adverse Childhood Experiences (ACEs), which is very relevant to adoption. The book is a great read, and I really do feel like I understand interoception more now. It is quite technical and includes a lot of science. I do think this is relevant and helpful, and being an OT with some understanding of basic anatomy and neurology, I could follow most of it. The book also includes lots of helpful practical activities and exercises to try at home. The link to the book is (here).

What is interoception?

Interoception is all about the sensory system. It includes the sensory receptors in the skin and body, as well as raw processors and responses that are formed by the brain. Interception also acknowledges that responses depend on our past experiences, so it takes into account previous learning. It is essential our survival mechanism, without it we would not have the correct responses needed to survive. (e.g. temperature regulation, hunger sensations). Interoception relies on receptors inside our body which detect chemical changes. Eg, pressure receptors in the bladder tell us when it is full. This then sends a signal to the brain. The higher level brain function allows us to problem solve and we can decide that we can wait to find a toilet to empty the bladder. As children grow and learn, their responses become less reflex, and more learnt functional behaviours. When their reflexes do not develop along the normal routes, it results in incomplete sensory regulation. The child grows up not very well connected to their world. They do not learn to think about their actions, or the consequences of them. Sensory development is one earliest systems to develop. A strong sensory base is needed to achieve higher brain skills such as language, co-ordination.

Interoception is about how we as individuals feel, it’s about what makes us, us. It includes concepts such as hungry, thirsty, hot, cold, excited, anxious so feelings are important, and are linked. for it to work we need to have an awareness of how we feel inside ourselves as well as an awareness of emotion. Interoception is a skill that can be improved because practicing a skill builds and strengthens nerve pathways and connections. If we are aware of our body, we develop a sense of self. 

Interoception is partly managed by a part of the brain called the insular cortex, which is deep inside the brain. The insular has connections to the amygdala and hippocampus of the limbic system. This is the system that is responsible for making new memories. It also helps us to react emotionally to the environment around us and maintain a level of alertness. This is where we see that emotions and feelings are linked to interoception.

How does stress affect interoception?

Learning takes place when the amygdala (responds to emotions), the hippocampus (moves experiences to long term memory) and the cerebral cortex (where the information is stored) work together and interact. In an optimal learning environment the learner is relaxed and in a settled environment. This means the amygdala is relaxed, and will allow the hippocampus to to send information to the cerebral cortex. This is where the information is stored and ready for later retrieval. However, when the learner is stressed, it awakens the amygdala, which then blocks the access to the hippocampus. In addition, cortisol (stress hormone) is released and stops the hippocampus woking properly. New information can not be transferred across for long term storage. In terms of learning, stress inhibits learning because new information is never able to make it to the cerebral cortex, and therefore can’t be stored for further reference.

Cortisol (the stress hormone) as well as adrenaline then set off the fight or flight response. This the body’s physiological response to a real or perceived threat or dangerous/stressful situation. It will cause physiological responses such as heart racing, faster breathing and a burst of energy to literally ‘fight the danger or take flight’. Alternatively, they may also freeze and not be able to do anything at all.

When people are exposed to prolonged periods of stress ( such as childhood developmental trauma), their body has very little chance to relax and recover and is in a prolonged state of high alert.. The body quickly learns to accept the stress, and learns to live with it. Chronic stress will harm both the body and brain, as well as the links and connections between the two.

When someone is stressed, learning cannot take place. so we do not try to teach new skills whilst they are in this state. They need to have totally calmed down in order to attempt to successfully learn.

How is interoception linked to feelings/emotion?:

This was an area I found interesting, because feelings is something we can discuss and teach to our children. We can help them recognise feelings, and teach them how to respond to them.

Interoceptive awareness is developed in the insular cortex, which is the same area that controls emotional awareness and subjective feelings. The physiological condition of our body may affect our emotional and perceptions, and they can equally affect our physiological condition. When someone is more aware of their internal body processes, they may well have a better positive body image. We use our past experiences when evaluating new ones. Part of this learning will have included our feelings and emotions about an experience. When we have good emotional awareness we can adapt and react quickly, however, when we struggle to identify those feelings and emotions, we find it harder to adapt quickly. This can be demonstrated in rigid black and white thinking. When we feel more in control of our emotions and well-being we feel better equipped to adapt when we need to. If we experience a new experience similar to a previous one, we can access the long term memory store, we remember how we felt, and we can quickly respond. When we are stressed, we can’t access that memory, and we can’t store this new information for another time. We don’t learn or remember feelings.

How do we improve interoception?

There are several ways in which we can improve our interoception, however, developing it is a lengthy process that will require lots of work and practice. It is not an instant skill we can learn. It is important to begin at the level the child is at, this may mean teaching them the basics such as body parts, feelings and emotions before putting this awareness and knowledge together, We want them to be successful, and definitely don’t want to set them up to fail. A successful experience builds confidence, which is vital.

1) Naming Body Parts: The book suggests that we begin with simply naming body parts (e.g. heart, lungs etc). It suggests that you make it fun, and give the body parts a personality (e.g. ‘Billy Bone’) It gives a simple age/developmental level appropriate explanation of the job that body part does. It suggests feeling where appropriate (e.g. elbow), or looking/listening to what that part does (e.g. for the lungs, deep breath in and watching the chest expand, or for the heart, listening for lub dub beat if you have a stehescope handy). If it helps you can use pictures, or small models of body parts to give a visual aid. By naming and learning about body parts, it helps the child be more aware of what they have, what they do and starts to encourage them to be in tune with their bodies.

2) Body Scanning; Once you have body parts sorted, the book suggests having a go at body scanning. These are useful to help the child visualise what & where things are happening, and it can eventually help them link feelings and emotions to different parts go their body. By drawing round their own body, it becomes very personal to them. Everyone will have a different body scan. Alternatives you could just draw a generic body for a scaled down version. 

3) Emotional awareness/feelings: this is where you can use the body scan you’ve already done to start to think about and identify feelings and emotions. Encourage the child to identify common feelings and emotions that impact the body (e.g. worry, happiness, excited, needing the loo, tired, pain, hot, weak, relaxed). The list is endless, and can include anything we feel really. It helps us begin to link body signals to our emotions, which then mean we understand what or why we are feeling things.Discuss where/on your body you feel each emotion. If possible it can be helpful to discuss with the child how they feel when they mention emotions, feelings and physical symptoms in everyday life. For example, if they feel anxious you could ask if they feel like they’re hot, heart racing, sweaty palms, funny feeling in their tummy.

3) Listening to your body: this follows on from the body scanning and emotional awareness. It helps us to start to listen more closely to our body signals. Once we listen, we can then learn how to respond. It can be helpful to ask the child some questions about specific aspects. For example, positional questions such as does your body feel comfortable sitting? does your body feel tired? what sort of seating do you prefer to relax? Think about sensory questions such as do your eyes feel tired/itchy/watery? Does your mouth feel wet/dry? Do you feel like you need to loo? What do you hear? Do the sound make you feel happy/sad? How do your clothes feel, soft/itchy?. Then it asks you to question how your organs feel. Can you feel Lub Dub beating? is it fast/slow? Is your stomach making a noise?

Sometimes it can be helpful to do some activities that make the body feel different so that the child can clearly experience how sensations change. For example, suggest jumping/bouncing up and down and comparing before and after. Or drinking a cold drink. Or laying under a weighted blanket.

By teaching children how to be aware of their bodies and how they react to stimuli, they slowly learn and build new pathways in the brain. This creates a response, and because they are learning, it can prevent the fight or flight response. They learn the perceived threat is not actually a threat at all, and they can deal with it calmly.

4) Mindfullness: This is being aware of the present moment. Being mindful helps us focus on the current body sensations, feelings and emotions as we feel them. It also helps us to appreciate the world around us, and take in the sights, smells, sounds. Relaxation can help practice mindfulness, ask the child to lay down (when calm), and close their eyes. They ask them to gradually relax and tense muscles, and to really take in how they feel . Ask them if they feel ‘heavy/calm/cool/floating etc’

5) Breathing exercises: Many of the functions of the autonomic nervous system eg heartbeat, perspiration are automatic, and we don’t have a lot of conscious control. However, breathing is one subsystem that we can change with conscious effort. The book suggests several breathing exercises that all encourage us to be aware of our breathing. if we are more aware of it we can do something about it. When stressed we tend to develop shallow breathing, with means that less oxygen is getting to the brain. The brain needs to be well oxygenated to work effectively. We need to learn to breathe out as much as we breathe in because breathing out will activate the parasympathetic nervous system. This counteracts the stress response that is activated when we breathe in. A helpful way to visualise effective breathing is to do rectangle breathing. Look at a rectangle, breathe in through your nose as you follow the first vertical line up. When you reach the corner, breathe out through your moth as you follow the line horizontally. The idea is that the out breath is longer than the in breath. repeat for the other two sides of the rectangle. With practice you will not need to be looking at a rectangle as you can learn to visualise it, and therefore do this activity anywhere, anytime.

Hyperventilation occurs when we breathe too quickly, and we breathe out too much carbon dioxide before more is produced. When we hyperventilate, the blood vessels constrict, and blood (and oxygen) flow to the brain is reduced.

6) sensory diets: This is recommended to improve sensory awareness and regulation. The idea is that you complete a sensory activity every couple of hours. This is useful if you are inactive or sit for long periods, or for children at school. It will provide consistent sensory input to the body. It is recommended that it includes heavy work such as lifting, pushing, carrying heavy items so that the gross muscles are worked, and the body generally feels grounded. Other activities can include jumping/bouncing/swinging/eating crunchy foods. Fidget items and restrict exercise bands are helpful as they can be used whilst sitting (e.g. in class), and provide constant sensory feedback.

If you are concerned about sensory processing, and feel that the difficulties are bigger than low level ones, then I would recommend getting a professional OT assessment and treatment plan. Otherwise, much of the activities suggest here and in the book should be fine to have a go at with your child. Hopefully they might just help them feel a little more in tune with themselves, which should help them feel more in control and content.