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Cynthia Price Ph.D., M.A., L.M.T.

Research on Interoceptive Awareness Training

An innovative approach to develop awareness and body connection.

Interoceptive awareness is the awareness of inner body sensations, involving the sensory process of receiving, accessing, and appraising internal bodily signals (Craig, 2009). Interoceptive awareness is fundamental to mindfulness-based approaches, involving focused present-moment awareness on internal sensations, most often introduced by attending to the sensations of the breath (inhaling and exhaling), or by engaging in a body scan. Interoception is recognized as a possible mechanism underlying mindfulness-based approaches (Farb et al., 2015; Garland, 2016), and learning interoceptive awareness skills may improve well-being and enhance capacity for emotion regulation (de Jong, et al., 2016; Price, et al., 2018).

However, mindful attention on inner body experience is not easy for everyone. This tends to be particularly true for people who are unfamiliar with the practice, those who have high levels of stress (Schulz and Vogele, 2015), and those who may avoid awareness of their inner body sensations due to physical or emotional pain (Farb, et al., 2015). For some, individualized assistance is helpful to learn fundamental skills of interoceptive awareness, involving mindfulness skills of presence, and focused observation of inner bodily experience. Mindful Awareness in Body-oriented Therapy (MABT) is one such approach. The MABT approach grew out of clinical work with people who were seeking emotional awareness and healing but were disconnected from their bodies. Research findings highlight how helpful the MABT approach can be for learning interoceptive awareness skills, for reducing symptoms of distress, and for increasing emotion regulation. Much of this research is with women in recovery from chemical dependency (the majority of whom have extensive histories of interpersonal trauma) (Price et al., 2018; Price and Smith-DiJulio, 2016; Price et al., 2012), as well as people living with HIV (Price, et al., 2013), and women in recovery from childhood sexual abuse (Price, 2005; 2006). As one research participant with co-occurring PTSD and substance use disorder wrote about learning this approach (Price and Smith DiJulio, 2016): “I tried meditating over the years and I was never able to concentrate. With MABT, I was able to slow my mind down and then follow what she (the therapist) was saying, concentrating on a body part, and what I was feeling and afterwards talking about that. Eventually, I learned to do that by myself. This is why I thought this approach was amazing because it taught me to meditate. Now I meditate every night. The difference is having someone lead me into learning how to do it first.’’

Therapists trained in the MABT approach can teach clients to develop interoceptive awareness skills for increased emotion regulation (Price and Hooven, 2018). The therapy involves guiding clients through a staged learning process that starts with identifying and articulating physical sensations (e.g., how to describe the feeling of tense muscle), then introduces clients to specific exercises aimed at learning to bring focused attention to sensations and areas in the internal body (e.g. mindful attention on an internal space in the body), and finally teaches sustained mindful attention in specific areas of the body using a guided inquiry process. This approach supports inner exploration, and through this process, clients develop tools for self-care based on their own journey of self-discovery.

Currently, there are two NIH-funded MABT studies. One examines the effectiveness of MABT for men and women in medication-assisted treatment for opioid use disorder. The other is an imaging pilot study examining interoceptive function (via fMRI) as a mechanistic biomarker underlying MABT for men and women with elevated stress.

References

Craig, A. D. (2009). How do you feel--now? The anterior insula and human awareness. Nat Rev Neurosci, 10(1), 59-70.

de Jong M, Lazar SW, Hug K, Mehling WE, Hölzel BK, Sack AT, Peeters F, Ashih H, Mischoulon D and Gard T (2016) Effects of Mindfulness-Based Cognitive Therapy on Body Awareness in Patients with Chronic Pain and Comorbid Depression. Front. Psychol. 7:967. doi: 10.3389/fpsyg.2016.00967.

Farb, N., Daubenmier, J., Price, C., Gard, T., Kerr, C., Dunn, B., Klein, A., Paulus, M., Mehling, W. (2015). Interoception, Contemplation, and Health. Frontiers in Psychology, 6:763.

Garland EL. Restructuring reward processing with mindfulness oriented recovery enhancement: novel therapeutic mechanisms to remediate hedonic dysregulation in addiction, stress, and pain. (2016). Ann N Y Acad Sci. 1373(1):25–37.

Price C. (2005). Body-Oriented Therapy in Recovery from Childhood Sexual Abuse: An Efficacy Study. Alternative Therapies in Health and Medicine, 11, (5): 46-57.

Price, C. & Hooven. C. (2018). Interoceptive Awareness Skills for Emotion Regulation: Theory and Approach of Mindful Awareness in Body-oriented Therapy (MABT). Frontiers in Psychology, 9:798. doi: 10.3389/fpsyg.2018.00798.

Price, C. & Smith-DiJulio, K. (2016). Interoceptive Awareness is Important for Relapse Prevention: Perceptions of Women who Received Mindful Body Awareness in Substance Use Disorder Treatment. Journal of Addictions Nursing, 27 (1): 32-8. PMC4784109.

Price, C., Taibi, D., Smith Di-Julio, K., Voss, J. (2013). Developing Compassionate Self-Care Skills in Persons Living with HIV: a Pilot Study to Examine Mindful Awareness in Body-oriented Therapy Feasibility and Acceptability. International Journal of Therapeutic Massage and Bodywork, 6(2): 1-11.

Price, C., Thompson, E., Crowell, S., Pike, K., Cheng, S., Parent, S., Hooven, C. (2018). Immediate Effects of Mindful Awareness in Body-oriented Therapy (MABT) for Women in Substance Use Disorder Treatment: Improved Interoceptive Awareness and Emotion Regulation Indices. Substance Use Journal, doi: 10.1080/10826084.2018.1508297.

Price, C., Thompson, E., Crowell, S., Pike, K. Longitudinal effects of interoceptive awareness training through Mindful Awareness in Body-oriented Therapy (MABT) as an adjunct to women's substance use disorder treatment: A randomized controlled trial. J. Drug and Alcohol Dependence, forthcoming.

Price, C., Wells, E., Donovan, D., Rue, T. (2012). Mindful Awareness in Body-oriented Therapy as an Adjunct to Women's Substance Use Disorder Treatment: A Pilot Feasibility Study. Journal of Substance Abuse Treatment, 43: 94-107.

Schulz, A., and Vogele, C. (2015). Interoception and stress. Front. Psychol. 993.doi:10.3389/fpsyg.2015.00993.

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About the Author

Cynthia Price, Ph.D., is a research professor at the University of Washington and directs the Center for Mindful Body Awareness.