Over the past couple of years, I saw many clients with a wide range of conditions: insomnia, pain, anxiety, depression, obesity, reduced libido, and many others. Usually, these clients come to our training or private sessions because their physicians say there is not much they can do with their chronic conditions. For many of these patients, we are able to resolve their conditions or drastically reduce the symptoms. All patients find that their quality of life improves dramatically, even if they have chronic diseases, such as asthma, arthritis, and diabetes.
Across the board, all clients have two things in common:
- Their interoceptive system is not functioning correctly.
- Activating and healing the interoceptive system leads to either a complete resolution or substantial reduction in symptoms for many disorders. Even when dysfunction in the interoceptive system is unrelated to the condition (e.g., cancer), healing the interoceptive system leads to a dramatic increase in the quality of life.
What is the Interoceptive System?
The interoceptive system allows you to feel your inner body sensations and change your behavior based on these sensations.
Let’s say you stayed up late and went to bed at 3 a.m. The next morning, you feel unwell inside, you feel a bit nauseous and tired. Behind these general feelings of being “nauseous and tired,” there are more subtle physical sensations. These signals are being sent by your endocrine and nervous systems to your brain with the aim of changing your behavior to help bring the endocrine system back to balance. For example, your body might be asking you to lie down and rest. Awareness of these inner body sensations, both physical sensations and emotional feelings, form the foundation of our ability to self-regulate. When the interoceptive system is dysfunctional, and we cannot feel these subtle inner body sensations, we lose the ability to self-regulate. This process gradually degrades your physical, psychological, and emotional health.
How and Why does the Interoceptive System Become Dysfunctional?
Here is what happens to our interoceptive system on its way to dysfunction:
F1: Inner Body Sensation Suppression
We regularly ignore and suppress signals of bodily discomfort. For example, most people tend to ignore neck or shoulder pain they feel after slouching behind a computer.
F2: Reduced Sensitivity
Repeatedly suppressing inner body sensations lowers your brain sensitivity to notice subtle bodily sensations.
F3: Impulse Action Suppression
Inner body sensations communicate a specific motivation. For example, when you feel shoulder pain, your body is motivated to act to resolve this pain. Your rational mind interferes and says: “No, ignore the pain, you need to work.” This way, you prevent yourself from fulfilling action impulses.
F4: Reduced Self-Regulation
Action impulses you suppress are homeostatic. They aim to help your body to self-regulate and maintain health. When you ignore action impulses and fail to self-regulate, your health starts declining.
F5: Reduced Self-Worth
Your mind observes you ignoring the essential needs of your body. When you don’t take care of your loved one, your brain concludes this person is not important to you. In the same way, when you don’t take care of your bodily needs, your mind realizes that you are not important to yourself. You are not worthy. This is a path to depression.
F6: Reduced Sense of Meaning
Having a sense of meaning to your life is created from several components. One component is all about satisfying your needs, yearnings, and dreams. When the primary needs and desires of the body are not met, one’s sense of meaning reduces. And this once again is a path towards depression.
F7: Muscle Tightness and Interoception
Interoceptive receptors that register the state of the inner body, including the endocrine and immune systems, are housed in muscle and fascial tissue (or myofascial tissue). When you prevent self-regulation from taking place, muscle tissue becomes more and more dysfunctional, tight and painful.
Tightening of the myofascial tissue changes the environment within which interoceptive receptors live. Just like the toxicity of lake water negatively affects the health of fish, in a similar manner tightness of myofascial tissues adversely affects the entire interoceptive system. Tight and painful myofascial tissues keep sending signals of discomfort, hoping for a resolution. If you do not address the underlying problem, the nervous system gets bombarded with SOS signals. This process leads to nervous system hyperarousal.
F8: Harder to sense emotional feelings
Due to all of the factors described above, it becomes harder to feel more subtle inner body sensations. Many emotional feelings are very subtle. Thus, your ability to sense emotional feelings reduces, leading to a lower capacity for emotional self-regulation. This also potentially means more misunderstandings and conflicts with family, friends, and at work, as emotional awareness is essential for effective communication.
F9: Suppressing emotions
Just like a sensation of shoulder pain is a signal for you to act to relieve the pain. Similarly, many emotions encourage you to respond. Suppression of emotional feelings leads to dysfunction of the interoceptive system. There are many emotions that people tend to suppress, such as anger, sadness, and shame.
F10: Hyperarousal of the nervous system
When your nervous system is in overdrive, it tenses up the myofascial system, leading to pain and tightness. As discussed above, myofascial pain and tightness lead to dysfunction of the interoceptive system.
When the interoceptive system is dysfunctional, and we cannot feel these subtle inner body sensations, we lose the ability to self-regulate.
Interoception: Resolving Insomnia, Depression, and Low Back Pain
Here is a typical client story, composed of a combination of several real clients’ cases.
A male client, let’s call him Jack, in his 40s, was exhibiting a combination of severe insomnia, depression, and low back pain. Every night was torture for Jack, as he spent 1-2 hours trying to fall asleep. He would fall asleep, only to wake up 2 hours later. His physicians put him on an antidepressant and referred him for psychotherapy. Antidepressants and psychotherapy somewhat stabilized his condition but did not help him in resolving the problems. Two years passed and he came to a soma® session.
After the first soma® session, for the first time in several years, Jack was sleepy in the evening. He followed the urge, went to his bedroom, and fell asleep. He slept for 5 hours with no interruptions for the first time in 5 years! In subsequent sessions, we continued working on reviving the interoceptive system in his entire body. Within three weeks, his low back pain decreased in intensity from a score of 9 to 2. After 3 months of therapy, he went off his antidepressants. He now sleeps 6-7 hours a night and feels very healthy. These benefits resulted from methodical and careful work on improving Jack’s dysfunctional interoceptive system.
I don’t rely only my observations of the benefits from working on the interoceptive system. Recent scientific publications provide further support. Scientists have studied interoception for over 100 years, and within the past ten years, there has been an upsurge of interest in the field [1-4].
Recent research publications are implicating faulty interoception in some disorders [5-8]:
- anxiety disorders
- mood disorders
- eating disorders
- addictive disorders
- panic disorders
- pain disorders
- disorders unexplainable by medicine
- addictive disorders
- Autism spectrum disorders
Unfortunately, scientific non-pharmaceutical advances are very slow to find their way to clinical medicine. My experience shows that quality of life measures of any patient, irrespective of the nature of the chronic condition, can be dramatically improved by bringing the interoceptive system back to health.
Interoception: Severe Problem With The Modern Medical System
There is one tremendous problem with the interoception.
In clinical medicine and psychotherapy, most practitioners have no idea what interoception is and how to work with this system. In fact, physicians, nurses, and physical therapists have hardly even heard of the term “interoception.” There is not a single profession in the modern medical system that has been trained to work and treat the interoceptive system.
Let’s look at the typical experience of somebody like Jack, who initially came to his physician complaining of severe insomnia, depression and low back pain.
The physician is likely to either prescribe antidepressants or refer the patient to a psychotherapist to work on depression. She is also expected to prescribe a sleeping pill for insomnia and painkiller or physical therapy for low back pain.
There will be no conversation relating to Jack’s inner sensations. Antidepressants are likely to d depress nervous system hyperarousal (factor F10 above). Medications may also interfere with the interoceptive system by suppressing the level of sensations, thus potentially reducing sensitivity to inner body sensations even further and jeopardizing the patient’s self-regulating capacity. Physicians do not work with factors F1-F9.
Psychotherapist talks to Jack. He may help him to recognize thoughts, emotions, and even body sensations. Depending on the psychotherapist’s training, he may end up working with the client to build self-worth, sense of meaning, and overcome the suppression of emotional feelings.
A psychotherapist’s ability to bring a client’s interoceptive system back to balance is severely restricted since s/he does not work on other factors. For example, psychotherapists cannot touch the client, and thus can not affect muscle tightness and trigger points (factor F7). Talk therapy and mindfulness practices have little influence on the other factors F1-F10, and therefore psychotherapists have limited ability to affect a client’s interoceptive system.
Visiting Massage Therapist
The majority of massage therapists practice Swedish massage. Some massage therapists are trained to work with muscle trigger points. Unfortunately, practically no massage therapists are trained to change soft tissue structure and none, as far as I know, work with interoception. The great thing is that, unlike psychotherapists, massage therapists can touch the client and will be doing some direct work on soft tissues. They will focus on the client’s muscles and occasionally posture. They can do an excellent job on factors F7 (muscle tightness and trigger points) and F10 (nervous system hyperarousal).
However, while psychotherapists are trained to communicate with the client verbally, massage therapists are not qualified to use talk therapy. They can only perform massage! So, there will be no conversation about inner body sensations, and communication is essential to bring the interoceptive system back to balance.
Moreover, massage may harm the patient. Direct and forceful application of pressure onto painful muscles without regard to the client’s sensations may lead to re-traumatization. I often get clients who have sustained psychologically traumatic events. These events frequently include an aspect of physical violence and injury that leaves the client with muscle knots. Massage therapists try to resolve the painful knots while ignoring the client’s inner body sensations. Pressure on the sore spots triggers memories of traumatic events and thus may lead to re-traumatization.
Massage therapy can provide short-term relief from depression. It may also reduce lower back pain and even downregulate or relax your nervous system. Unfortunately, this therapy will not have any impact on other factors contributing to interoceptive system dysfunction.
Visiting Physical Therapist
A physical therapist is likely to prescribe an exercise program. There are physical therapists trained in manual medicine, but they are few and far between. And even then, these therapists are not prepared to work with inner sensations and interoception, as interoception is not part of the standard manual medicine curriculum.
Visiting Body-Oriented Psychotherapist
You would think that body-oriented psychotherapists are trained to work on interoception. Unlike traditional psychotherapists, many body-oriented therapists do have a right to touch and apply pressure to a client’s body.
Body-oriented therapists might be much more hands-on than traditional psychotherapists, but they still primarily focus on helping a client to become aware of bodily sensations evoked by emotional experiences. The hands-on work tends to be superficial and does not focus on changing the structure of soft tissues. Some body-oriented therapists may work on inner body sensations but focus primarily on building awareness of emotional sensations and using talk therapy in parallel. They may use superficial touch to help the client become aware of what s/he feels while s/he is in contact with another human being. This is something that a traditionally-trained psychotherapist would not do.
Still, body-oriented therapists will not be working with a client’s muscle tightness or with most other factors involved in interoceptive dysfunction.
In clinical medicine and psychotherapy, most practitioners have no idea what interoception is and how to work with this system.
As you can see, the issue is not just the lack of a single expert who can work on the interoceptive system, but even referrals will not work. The way the modern medical system works with interoception is a lot like the famous story about six blind men touching an elephant.
Each professional interacts with the interoceptive system, but does so in a fragmented way and therefore does not get the dramatic benefit that is possible when one works holistically, with the interoceptive system as a whole.
 Craig, Arthur D. “How do you feel? Interoception: the sense of the physiological condition of the body.” Nature reviews neuroscience 3.8 (2002): 655.
 Craig, A. D. “Interoception: the sense of the physiological condition of the body.” Current Opinion in Neurobiology 13.4 (2003): 500-505.
 Craig, Arthur D. (2014) “How do you feel? An Interoceptive Moment with Your Neurobiological Self
 Fogel, A (20130) Body Sense: The Science and Practice of Embodied Self-Awareness (Norton Series on Interpersonal Neurobiology)
 Harshaw, Christopher. “Interoceptive dysfunction: Toward an integrated framework for understanding somatic and affective disturbance in depression.” Psychological Bulletin 141.2 (2015): 311.
 Tsakiris, M., & Critchley, H. (2016). Interoception beyond homeostasis: affect, cognition, and mental health.
 Paulus, Martin P., and Murray B. Stein. “Interoception in anxiety and depression.” Brain structure and Function 214.5-6 (2010): 451-463.
 Khalsa, Sahib S., et al. “Interoception and Mental Health: a Roadmap.” Biological Psychiatry: Cognitive Neuroscience and Neuroimaging (2017).