Listening to the Body: Why Interoception Might Be Critical to Mental Health

Fred Shaffer
4 days ago
13 min read

In January 2026, Scientific American published a wide-ranging feature by science journalist Diana Kwon, edited by Jeanna Bryner, titled "A Distorted Mind-Body Connection May Explain Common Mental Illnesses."

Drawing on neuroscience, psychiatry, and psychology, Kwon (2026) argues that interoception, the brain's capacity to sense and interpret signals from within the body, may be a foundational process linking emotional experience, psychopathology, and emerging interventions.

For mental health professionals, this argument resonates with daily clinical experience.

Clients rarely present with purely cognitive distress. Instead, anxiety arrives with racing hearts and shortness of breath, trauma with numbing or dissociation, depression with fatigue and bodily heaviness, and eating disorders with visceral discomfort that defies reassurance.

Kwon's article offers a way to understand these bodily experiences not as secondary symptoms but as integral to the generation and maintenance of mental health difficulties.

What follows is a revised and expanded narrative summary of Kwon's article, enriched with peer-reviewed research. The cover art for Erik Peper and Catherine Holt's (1993) Creating Wholeness inspired our opening graphic.

From a "Sixth Sense" to Clinical Significance

Interoception is sometimes called the body's sixth sense, though it operates quite differently from vision or hearing. Unlike the external senses, interoception typically does not announce itself unless something feels abnormal. Signals from the heart, lungs, gastrointestinal tract, immune system, and vasculature are continuously relayed to the brain, shaping arousal, motivation, and emotional tone. The brain uses these signals to help answer a fundamental question: how am I doing right now?

Kwon opens with the case of a woman with atypical anorexia nervosa who participated in a trial of flotation-REST, an intervention designed to reduce external sensory input and amplify internal bodily signals. By floating in a warm, soundproof tank, participants are encouraged to attend to heartbeats, breathing, and visceral sensations. For this patient, the experience temporarily softened her distressing relationship with her body.

This case illustrates a central idea of the article: when internal signals are unreliable or inaccessible, people may over-rely on external cues such as mirrors, scales, or perceived social threat (Kwon, 2026).

This insight echoes a long intellectual history. In the late nineteenth century, William James and Carl Lange independently proposed that emotions arise from the perception of bodily changes. While their theory has been refined and challenged over the intervening decades, modern affective neuroscience strongly supports the idea that bodily states are not mere by-products of emotion but key ingredients in its construction (Critchley & Garfinkel, 2017).

For clinicians, this means that the pounding heart a client reports is not simply a symptom of anxiety but part of the machinery generating the anxious experience itself.

The Brain as a Prediction Engine

A unifying theme in contemporary interoception research is predictive processing. Rather than passively receiving sensory input, the brain continuously generates predictions about what internal sensations should feel like and compares them with incoming signals. When prediction and sensation align, experience feels coherent. When they diverge, discomfort, confusion, or distress may follow.

Kwon highlights how this process is especially fragile for bodily sensations because they are often ambiguous. A pounding heart can signal excitement, exertion, or danger. Hunger can signal nourishment or threat. If the brain's predictions skew toward danger or disgust, emotional suffering may emerge even in objectively safe contexts. This idea, that the brain guesses first and feels second, is central to modern models of anxiety, panic, and eating disorders (Kwon, 2026).

Experimental evidence supports this account. In panic disorder, laboratory manipulations that alter heart rate or breathing can reliably trigger fear, particularly when sensations are interpreted catastrophically. Conversely, interventions that modify expectations about bodily sensations can reduce symptoms (Khalsa et al., 2020).

The clinical implication is clear: changing how a client interprets bodily signals may be as important as changing the signals themselves.

Parsing Interoception: Accuracy, Sensibility, Awareness

One of the most clinically useful contributions discussed in the article is the three-part framework proposed by Sarah Garfinkel and Hugo Critchley. They distinguish among three related yet separable constructs essential to understanding how interoception functions and malfunctions in clinical populations.

Interoceptive accuracy refers to objective performance on tasks such as detecting one's heartbeat or sensing changes in breathing resistance. This is what a person can actually do when asked to track internal signals under controlled conditions.

Interoceptive sensibility reflects subjective beliefs about bodily awareness, often measured using questionnaires that ask how much attention a person pays to internal states.

Interoceptive awareness captures how well those beliefs align with objective ability, serving as a metacognitive measure of whether someone knows how well they sense their body (Garfinkel et al., 2015).

This distinction matters clinically because distress often arises not from heightened or blunted sensation per se, but from miscalibration between perception and belief. Kwon describes work in autistic adults showing that anxiety is associated with poorer heartbeat detection alongside inflated confidence in that ability. In other words, people may feel certain they understand their bodies even as they are systematically misinformed by them (Kwon, 2026). Similar patterns have been observed across anxiety and trauma-related conditions (Garfinkel et al., 2015).

For clinicians, this framework helps explain a common therapeutic frustration: why reassurance alone often fails. If a client's internal predictions remain unchanged, contradictory information may be discounted or may even intensify distress. The mismatch between what the body is signaling and what the client believes it is signaling creates its own source of confusion and alarm.

Interoception Across Psychiatric Presentations

Kwon is careful not to frame interoception as a single deficit common to all mental illnesses. Instead, she emphasizes heterogeneity. Anxiety and panic disorders are often associated with heightened attention to bodily signals. In contrast, conditions such as borderline personality disorder, schizophrenia, and trauma-related dissociation may involve reduced access to or trust in those signals.

Neuroimaging studies repeatedly point to the insula, a cortical region located beneath the frontal and temporal lobes that integrates bodily, emotional, and cognitive information. A 2021 review found altered insula activation during interoceptive tasks across multiple psychiatric diagnoses, suggesting a shared neural substrate alongside disorder-specific patterns (Nord et al., 2021).

Importantly, findings are mixed. Some studies link anxiety to heightened interoceptive accuracy, others to reduced accuracy, and still others find no relationship at all.

As Kwon notes, it is unlikely that every disorder disrupts the same interoceptive system or the same level of processing (Kwon, 2026).

Cardiac, respiratory, gastrointestinal, and immune-related interoception may each play different roles depending on the condition. For clinicians, this means that a client presenting with panic attacks may have a very different interoceptive profile than one presenting with chronic dissociation, even though both involve disrupted body awareness.

Development, Trauma, and Bodily Trust

The article devotes substantial attention to development, and this section carries particular weight for clinicians working with trauma. Evidence suggests that sensitivity to bodily rhythms appears early in life, with infants showing differential responses to stimuli synchronized with their heartbeats. Over time, caregiver responsiveness may shape how bodily signals are interpreted. When caregivers consistently respond to cues of hunger, pain, or distress, children may learn that bodily sensations are meaningful and manageable. This early learning establishes a kind of bodily trust that persists into adulthood.

Conversely, chronic interpersonal trauma is often associated with dissociation, a reduced sense of bodily presence that clinicians have long recognized as both protective and problematic. Emerging evidence links poorer interoceptive accuracy to histories of self-harm and suicide attempts, even among individuals with similar psychiatric diagnoses (Khalsa et al., 2020).

Disrupted body awareness may therefore represent a transdiagnostic risk factor, impairing emotional regulation and self-protective signaling. When the body's alarm system becomes unreliable or unintelligible, clients may struggle to recognize danger, hunger, fatigue, or the early signs of emotional dysregulation.

Interoception also appears to be plastic, which offers grounds for clinical optimism. Periods such as early childhood and adolescence, marked by rapid bodily change, may represent both windows of vulnerability and opportunity. This plasticity underpins growing interest in interventions that explicitly target bodily awareness, suggesting that what was disrupted by adverse experience may, under the right conditions, be rebuilt.

Interoception as a Therapeutic Target

Perhaps the most forward-looking aspect of Kwon's article is its discussion of intervention. Flotation-REST, heartbeat-detection training, breath-synchronized vibration, mindfulness-based practices, and focused ultrasound stimulation of the insula are all under investigation. Early trials suggest reductions in anxiety, body dissatisfaction, and trauma-related symptoms, with effects sometimes persisting beyond the intervention period (Kwon, 2026).

This aligns with broader trends in somatic therapies, biofeedback, and mindfulness-based approaches, while grounding them in identifiable neural and physiological mechanisms (Critchley & Garfinkel, 2017; Khalsa et al., 2020). For clinicians already using body-focused techniques, this research provides empirical scaffolding and a shared vocabulary for discussing mechanisms with clients and colleagues.

Biofeedback Can Enhance Interoception

Biofeedback is a learning-based intervention in which a person receives real-time information about their own physiological signals and uses that feedback to practice voluntary self-regulation. This is relevant to interoception because biofeedback can externalize normally private signals and make them easier to notice, label, and calibrate.

The clearest peer-reviewed evidence that biofeedback can train interoception comes from studies targeting cardiac interoception, defined as the perception of signals arising from the heart and cardiovascular system. In this work, researchers often operationalize interoceptive accuracy, for example, as the ability to detect whether a tone, light, or vibration is synchronized with one’s heartbeat. In a controlled comparison of brief interventions, contingent cardiac feedback produced larger gains in interoceptive accuracy than noncontingent feedback, mindfulness practice, or waiting, supporting the idea that accurate feedback can sharpen perception of internal signals (Meyerholz et al., 2019).

However, the overall literature also reveals important boundary conditions that inform what biofeedback teaches. A preregistered randomized controlled trial, meaning the design and analyses were specified publicly before data collection to reduce researcher degrees of freedom, did not reproduce large improvements in behavioral cardiac interoception on a heart rate discrimination task, suggesting effects may depend on the specific task demands and what strategies participants adopt (Rominger et al., 2021). Similarly, multiweek heartbeat perception training has shown early improvements that are not uniformly sustained across all interoception measures and time points (Schillings et al., 2022).

Feedback modality also matters, which speaks to the mechanism. In a randomized study, real-time haptic feedback, meaning feedback delivered through touch or vibration, improved both objective performance and confidence relative to visual feedback, implying that somatosensory channels may better support learning to map bodily sensations to external cues (Dobrushina et al., 2024).

Beyond heartbeat tasks, biofeedback appears able to shift broader interoceptive facets such as interoceptive sensibility, meaning self-reported tendency to notice and use bodily sensations, and interoceptive self-efficacy, meaning confidence in one’s ability to interpret and apply bodily cues under challenge.

A preregistered trial pairing slow breathing with cardiac biofeedback during stress reported improvements in adaptive interoception, as measured by the Multidimensional Assessment of Interoceptive Awareness (MAIA), a multidomain self-report measure of interoceptive sensibility, relative to an active control (Tanzer et al., 2025).

Applied studies point in the same direction, though many remain in early phases. A mobile heart rate variability (HRV) biofeedback intervention was associated with improvements in interoceptive sensibility in a sample of healthcare workers (Mensinger et al., 2024). A proof-of-concept follow-up linked HRV-biofeedback–associated change to interoceptive mechanisms in eating-disorder symptom outcomes (Mensinger, 2025).

Interoceptive training via biofeedback is also not limited to the heart. Gastric biofeedback has been shown to improve gastric interoception, meaning perception of stomach signals relevant to hunger and satiety, alongside outcomes that reflect increased body listening (Tiemann et al., 2025).

At the synthesis level, a systematic review concludes that heart rate and HRV biofeedback show promise for improving interoception across behavioral, physiological, and neural outcomes, while emphasizing substantial heterogeneity in methods and measures and the need for more harmonized, fully powered trials (Wareing et al., 2024).

Taken together, the peer-reviewed evidence supports a cautious yet affirmative conclusion that biofeedback can improve interoception, particularly when interoception is defined as a trainable mapping between internal sensations and verifiable physiological signals.

The strongest evidence base is for cardiac-focused training, with more mixed results when studies use different tasks, feedback modalities, and learning contexts, and with promising expansion to self-report domains such as interoceptive sensibility and efficacy beliefs.

The most defensible integrative interpretation is that biofeedback can improve interoception by increasing signal salience, reducing perceptual ambiguity, and strengthening metacognitive calibration (confidence aligned with accuracy). Still, future trials should standardize outcomes across objective performance, self-report, and physiological markers to specify who benefits, from which modality, and on which interoceptive dimension.

What unites these approaches is not symptom suppression but recalibration. By helping individuals better predict, detect, and interpret bodily signals, interventions may restore a sense of coherence between mind and body.

Practically speaking, interventions need not be exotic to engage interoceptive processes. Breathing exercises, grounding techniques, body scans, and even simple heartbeat awareness tasks may all serve to sharpen the accuracy of bodily perception, calibrate beliefs about that perception, and ultimately reduce the gap between what the body signals and what the mind understands.

Integrating Interoception into Clinical Practice

Kwon does not suggest abandoning established therapies. Rather, she invites clinicians to widen their conceptual frame. Thoughts, emotions, and behaviors are inseparable from bodily states.

Interoception provides a bridge between subjective experience and neuroscience, offering language for experiences that clients often struggle to articulate. When a client says "I just feel wrong" or "my body doesn't feel like mine," interoceptive frameworks offer a way to take that report seriously and explore its components.

As research advances, interoception may function as a transdiagnostic lens rather than a diagnostic category, enriching assessment, formulation, and treatment without reducing human distress to a single mechanism.

Interoception invites clinicians to ask not only "what are you thinking?" and "what are you feeling emotionally?" but also "what is your body telling you, and how clearly can you hear it?"

Key Takeaways

Several core insights emerge from this research for mental health practice:

Interoception describes how the brain senses and interprets internal bodily signals, and distortions in this processing are now linked to anxiety, eating disorders, trauma-related conditions, and other psychiatric presentations.
Clinical distress often reflects misinterpretation or miscalibration of bodily signals rather than simple hypersensitivity or numbness, which helps explain why clients may report intense bodily experiences that do not match observable physiological states.
Interoceptive abilities develop through early relationships and remain plastic across the lifespan, suggesting that therapeutic intervention can meaningfully alter body awareness even in adulthood.
Emerging interventions focused on recalibrating body awareness show promise for supporting psychological well-being, offering clinicians new tools and a mechanistic rationale for body-focused work already in use.
Biofeedback can improve interoception, particularly when interoception is defined as a trainable mapping between internal sensations and verifiable physiological signals.

Glossary

adaptive interoception: a pattern of interoceptive functioning characterized by flexible, context-appropriate attention to bodily signals and effective use of those signals for self-regulation.

baroreceptors: sensory receptors located in blood vessel walls that detect changes in blood pressure and transmit this information to the brain, contributing to cardiovascular regulation and, indirectly, to emotional experience.

biofeedback: a training method that provides real-time information about physiological activity to support learning and voluntary self-regulation. cardiac interoception: an aspect of interoception focused on perceiving and interpreting signals arising from the heart and cardiovascular system.

dissociation: a psychological process involving reduced integration of bodily sensations, emotions, or perceptions, often experienced as detachment from one's body or surroundings.

gastric biofeedback: a form of biofeedback that provides real-time information about stomach-related activity to train awareness and interpretation of gastric sensations.

gastric interoception: an aspect of interoception focused on perceiving and interpreting stomach sensations such as fullness and satiation.

haptic feedback: a form of feedback delivered through touch or vibration that conveys information via somatosensory channels. heart rate variability (HRV): a set of metrics indexing beat-to-beat variation in heart period that reflects interactions among autonomic, respiratory, and baroreflex influences.

insula: a cortical brain region located beneath the frontal and temporal lobes, involved in integrating interoceptive, emotional, and cognitive information and considered a central hub for body awareness.

interoceptive accuracy: an objective measure of how precisely a person can detect internal bodily signals, typically assessed through laboratory tasks such as heartbeat counting.

interoceptive awareness: a metacognitive ability describing how well a person's subjective beliefs about their bodily perception match their objective performance on interoceptive tasks. interoceptive confidence: a metacognitive estimate of certainty about interoceptive judgments. interoceptive self-efficacy: a belief that one can notice, interpret, and use internal bodily signals effectively, especially under challenge or stress.

interoceptive sensibility: a self-reported tendency to attend to and value internal bodily sensations, typically measured through questionnaires. Multidimensional Assessment of Interoceptive Awareness (MAIA): a self-report instrument assessing multiple facets of interoceptive sensibility, including attention, emotional awareness, and self-regulatory use of body signals.

preregistration: a research practice in which hypotheses, design, and analysis plans are specified in advance to reduce biased analytic flexibility.

predictive processing: a theoretical framework proposing that the brain continuously generates predictions about sensory input and updates those predictions based on incoming information, with mismatches between prediction and sensation potentially generating emotional or physical discomfort.

References

Critchley, H. D., & Garfinkel, S. N. (2017). Interoception and emotion. Current Opinion in Psychology, 17, 7–14. https://doi.org/10.1016/j.copsyc.2017.04.020

Dobrushina, O., Tamim, Y., Wald, I. Y., Maimon, A., & Amedi, A. (2024). Interoceptive training with real-time haptic versus visual heartbeat feedback. Psychophysiology, 61(11), e14648. https://doi.org/10.1111/psyp.14648

Garfinkel, S. N., Seth, A. K., Barrett, A. B., Suzuki, K., & Critchley, H. D. (2015). Knowing your own heart: Distinguishing interoceptive accuracy from interoceptive awareness. Biological Psychology, 104, 65–74. https://doi.org/10.1016/j.biopsycho.2014.11.004

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Kwon, D. (2026). A distorted mind-body connection may explain common mental illnesses. Scientific American, 334(1), 50–57. https://doi.org/10.1038/scientificamerican012026-Y3Kvjhfs9IUIw9svFTsA6

Mensinger, J. L., Weissinger, G. M., Cantrell, M. A., Baskin, R., & George, C. (2024). A pilot feasibility evaluation of a heart rate variability biofeedback app to improve self-care in COVID-19 healthcare workers. Applied Psychophysiology and Biofeedback, 49(2), 241–259. https://doi.org/10.1007/s10484-024-09621-w (PMID: 38502516).

Mensinger, J. L. (2025). Interoceptive mechanisms of a mobile heart rate variability biofeedback app for eating disorder symptoms: Proof-of-concept findings. Eating Behaviors, 60, 102060. https://doi.org/10.1016/j.eatbeh.2025.102060 (PMID: 41319396).

Meyerholz, L., Irzinger, J., Witthöft, M., Gerlach, A. L., & Pohl, A. (2019). Contingent biofeedback outperforms other methods to enhance the accuracy of cardiac interoception: A comparison of short interventions. Journal of Behavior Therapy and Experimental Psychiatry, 63, 12–20. https://doi.org/10.1016/j.jbtep.2018.12.002

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Rominger, C., Graßmann, T. M., Weber, B., & Schwerdtfeger, A. R. (2021). Does contingent biofeedback improve cardiac interoception? A preregistered replication of Meyerholz, Irzinger, Withöft, Gerlach, and Pohl (2019) using the heartbeat discrimination task in a randomised control trial. PLOS ONE, 16(3), e0248246. https://doi.org/10.1371/journal.pone.0248246

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Tiemann, A., Rubo, M., Garfinkel, S. N., Vögele, C., van Dyck, Z., & Munsch, S. (2025). Listening to your stomach: Effects of gastric biofeedback training on interoception, eating behavior and eating disorder symptoms. Physiology & Behavior, 302, 115108. https://doi.org/10.1016/j.physbeh.2025.115108

Wareing, L., Readman, M. R., Longo, M. R., Linkenauger, S. A., & Crawford, T. J. (2024). The utility of heartrate and heartrate variability biofeedback for the improvement of interoception across behavioural, physiological and neural outcome measures: A systematic review. Brain Sciences, 14(6), 579. https://doi.org/10.3390/brainsci14060579

About the Author

Fred Shaffer earned his PhD in Psychology from Oklahoma State University. He earned BCIA certifications in Biofeedback and HRV Biofeedback. Fred is an Allen Fellow and Professor of Psychology at Truman State University, where has has taught for 50 years. He is a Biological Psychologist who consults and lectures in heart rate variability biofeedback, Physiological Psychology, and Psychopharmacology. Fred helped to edit Evidence-Based Practice in Biofeedback and Neurofeedback (3rd and 4th eds.) and helped to maintain BCIA's certification programs.