Interoception

1. Interoception The Gut-Brain Connection Do not use or distribute without written permission.

2. Objectives for Class • Identify 3 different functions of interoception that is instrumental for everyday functioning • List 5 building blocks of building self-regulation through the lense of interoception

3. What is it? • Allows us to “feel” our internal organs and skin, while giving us information regarding the internal state or condition of our body. (Craig 2002) • Pain, body temperature, itch, sexual arousal, hunger, thirst, heart rate, breathing rate, muscle tension, pleasant touch, sleepiness and bathroom urges • Also a variety of general and localized feelings: warmth or coldness, tickling or shivering, tension or relaxation, constriction or expansion, sinking or lifting, trembling or steadiness (Craig, 2002; Fuchs and Koch, 2014) • Key component of our emotional experience: the basis for how we view or feel emotions (think about when you feel anxious or tense) Do not use or distribute without written permission.

4. The Insular Cortex (Insula) • Lives in secluded hideaway in deepest part of Sylvian Fissure • Extends up to Frontal lobes • Falls on either side of Basal Ganglia • Borders on parital lobes, temporallobes and somatosensory cortex • The right and left insulae connects through the Corpus Callosum • Partners with Amygdala and Cingulate Gyrus • The voice of calm; rest and digest (as opposed to fight and flight) • Related to empathy • The only major parts of the brain that does not connect with insula Do not use or distribute without written permission.

5. Functions • Bridge between left and right side of brain; between feeling and thinking • Between expression and reception of speech and emotions • Predominant role: organize the balance between adaptation of external environment and internal homestasis • Acting as a brake for the Amygdala • Regulation of appetite and eating • Taste and visceral memory • Monitoring the body state • Provision of investment of emotion to language • Regulation of pain • Experience of disgust Do not use or distribute without written permission.

6. Monitoring the Body State • Provides experience of “how my body is” • Bridge between conscious thought, body image and visceral feedback system from inner organs • Also a connection between frontal and parietal lobes: awareness of the world around my body Do not use or distribute without written permission.

7. Emotional Connection • Connects specialized speech centers (reception and expression), adding clarity of speech with emotional tome and nuance (prosody) • The experience of “disgust” is intrinsic to insula • Primary disgust: an emotional experience as response to stimuli (anterior insula) • Secondary disgust: a learned experience (an experience in the past triggers same response (ventrolateral insula) Do not use or distribute without written permission.

8. Research • Individuals more accurate at feeling interoceptive sensations – thicker insula • A portion of the insula (anterior insular cortex) is part of salience network • Together with ACC works to select the most important or relevant sensory information from the massive amounts available Do not use or distribute without written permission.

9. Vagus Nerve • Most widely distributed of all the cranial nerves – wandering nerve • Parasympathetic traveling to thoracic and abdominal viscera • Most arise from dorsal motor nucleus of the vagus • Gag reflex involved • Small collection of somatic sensory fibers from the skin of the outer ear. • Also to Larynx and Pharynx • Taste buds of epiglottis and esophagus • Sternocleidomastoid and Trapezius muscle Do not use or distribute without written permission.

10. Polyvagal Theory – Stephen W. Porges • Links the neural integration of the heart to affective experience, emotional expression, facial gestures, vocal communication and social behavior • Neural control of the heart is linked to neural control of the muscles of face and head. • 3 major adaptive behavioral stages. Do not use or distribute without written permission.

11. 1. Immobilization • Feigning death, behavioral shutdown • Most primitive component • Oldest branch of the Vagus nerve (unmyelinated dorsal motor nucleus of the Vagus) Do not use or distribute without written permission.

12. 2. Mobilization • Fight-flight behaviors • Dependent on function of the sympathetic nervous system: increasing metabolic activity and cardiac output • Faster heart rate (greater ability to contract) Do not use or distribute without written permission.

13. 3. Social communication or social engagement • Facial expression, vocalization, listening • Dependent on myelinated vagus: from nucleus ambiguous • Fosters calm behavioral state through inhibiting the sympathetic nervous system Do not use or distribute without written permission.

14. Porges on Interoception • Functional awareness of inside of body (conscious and subconscious) • Cardiovascular and respiratory system provide conscious feedback • Alertness changes with shifts in blood pressure related to posture. • Further discusses the infrastructure of higher order behavior Do not use or distribute without written permission.

15. Hierarchical Model 1: homeostatic processes of physiological systems regulate the internal organs Requires the bidirectional interoceptive process of monitoring and regulating the internal organs 2.Require cortical, conscious, and often motivated influences on the brainstem regulation of homeostasis 3. Observable behaviors evaluated by quantity, quality, and appropriateness of human behavior 4. Coordination of behavior, emotional tone, bodily state to negotiate social interactions Do not use or distribute without written permission.

16. Interoception and Self Regulation 1 • Body state regulation • The ability to regulate basic body functions or conditions such as hunger, thirst, need for bathroom, temperature. Includes sensing illness and pain, and managing these states effectively • The role of IA • Feel hunger sensations, seek food; feel bladder sensations, seek bathroom; feel pain, seek help for injury. Do not use or distribute without written permission.

17. Regulation 2 • Sensory Regulation: • The ability to use sensory input to control the way we feel • Role of IA: • Feel discomfort from crowd, seek solitary break, feel distracted by background noise; feel comfort from firm hugs, seek when upset Do not use or distribute without written permission.

18. Regulation 3: • Attention regulation: • Ability to maintain focus and attention to a given task. • Role of IA: • Feel distracted by background music, turn off: feel sidetracked by high energy in body, go for a jog; feel focused, do extra work to capitalize on being “in the zone”. Do not use or distribute without written permission.

19. Regulation 4: • Energy regulation: • The ability to maintain an energy level that is a match for the activity at hand • Role of IA: • Feel high energy (antsy) during class, seek quick walk to water fountain; feel low energy during homework, seek a cold drink. Do not use or distribute without written permission.

20. Regulation 5: • Emotional Regulation: • Ability to monitor and control emotions • Role of IA: • Feel slightly frustrated, seek help; feel overwhelmed, take a deep breath; feel sad, seek comfort from family. Do not use or distribute without written permission.

21. Awareness of Self • The insula is very active during self reflection(Modinos, Ormel, and Aleman, 2009) • Also when we look at our reflection in the mirror or picture of ourselves • Interoception and self awareness form a social foundation for how we behave and interact with our surroundings (Seth, 2013) • Allows for development of a first person perspective, connecting our thoughts, feelings, intensions and body • When our self-perspective is solid then we can understand others Do not use or distribute without written permission.

22. Your brain hallucinates your conscious reality – Anil Seth Do not use or distribute without written permission.

23. When Interoception is not intact • Loss of perspective taking and ability to identify how someone else might be feeling (empathy). • Loss of social tact • Decreased ability to assess risk • Decreased awareness of social norms • Diminished self-control • Difficulty controlling emotions and corresponding behaviors • Inability or difficulty in gaining information of the gut. Do not use or distribute without written permission.

24. 9 Lacrue Avenue, Suite 103 Glen Mills, PA 19342 Maude Le Roux, OTR/L, SIPT, IMC Website www.atotalapproach.com Facebook https://www.facebook.com/ATAMaudeLerouxOT/ LinkedIn https://www.linkedin.com/company/a-total-approach Blog http://www.maude-leroux.com/ Do not use or distribute without written permission.