PFA Tips: Interoception

“I love you” may be the sweetest three words in the English language but “I don’t know” are often the most frustrating. This is the response that parents, partners and therapists often hear from autistic progeny, significant others and clients when they ask about their feelings. Often, they misconstrue these answers, believing that it is an attempt to obfuscate their feelings or emerges as a result of lack of effort in introspection. But “I don’t know” is often the most accurate answer to questions asked about feelings because autistic individuals truly struggle to understand, identify and communicate their emotions.

The forgotten senses
There are more than the five senses that we readily identify. The most often overlooked, yet vital senses, are the Vestibular, Proprioceptive and Interoceptive senses. The Vestibular sense is the sense that provides information regarding the position of our bodies and is responsible for balance. The Proprioceptive sense is the sense that provides us information in regard to the whereabouts, kinetics and actions of our bodies. But I’d like to focus on the Interoception sense because of the prominent and often missed role it plays in the autistic community.

Interoception
Interoception, known as the eighth sense, is the ability to recognize internal cues coming from organs. This is the sense that allows us to know when we are hungry, when we need to go to the bathroom, when we experience pain and so much more. But Interoception is also the sense responsible for allowing us to understand, identify and communicate our emotions. As such, Interoceptive awareness plays a key role in mood and behavior regulation.

Emotional interoceptive challenges in autism
Autistic individuals can struggle to perceive the signals that a bodily need is not being met. This can lead to becoming emotionally dysregulated because of hunger or due to pain generated by an illness or injury. But further, perceiving emotions themselves can be difficult. In response to “how are you feeling?” the answer, “I don’t know” is often the most accurate response.

What do we do to improve the interoceptive sense?
When it comes to the physical aspects of Interoception, Occupational Therapy is the best intervention. OT professionals can help an autistic individual of any age better recognize and manage internal stimuli that they struggle to identify. But when it comes to emotional interoception challenges in autism, a therapist with a significant knowledge of interoception and methodologies of strengthening it, can be a great resource. In my practice we utilize the knowledge base and strategies found in “Interoception: The Eighth Sensory System,” by Kelly Mahler, MS, OTR/L. In this book she not only explains Interoception and its impact on autistic individuals, she provides
step by step, concrete interventions for improving Interoception.

How you can improve your own interoception
Although it is often best worked on
in the therapeutic setting, I do believe that individuals can engage in activities on their own that can help improve their own Interoceptive abilities. First, I encourage individuals to read Mahler’s book themselves. Mindfulness meditation, a form of meditation that increases awareness of the present moment, can be extremely helpful. I would specifically recommend mindfulness meditations called “Body Scans” as those focus on developing awareness of physical sensations. Paying attention to and recording circumstances and stimuli associated with times when emotions are clear can help give useful information for times when they are not. I like to teach the following equation as a way to categorize and conceptualize emotions:

Muscles + breathing + thoughts + circumstances = The Best Guess As To How I Am Feeling

Paying attention to what one’s muscles and breathing are doing can be helpful in paying attention to two aspects of the body that often react noticeably to emotions. Giving attention to the automatic thoughts in the mind using attention to cognitive signals can be helpful. Giving attention to the circumstances in which one finds oneself can provide context clues that can assist in identifying emotions as well.

One last important note
We often focus on helping autistic individuals identify emotions in others. However, if one does not comprehend their own emotions or emotions in general, identifying them in others can be difficult. Emotional Interoception is not just an important skill in of itself; it can play a key role in the skill of identifying and reacting to emotions in others as well.

Additional Resources

Interoception resources from Kelly Maher, MS, OTR/L

Interoception and Autism: Body Awareness Challenges

Guided mindfulness meditations and body scans from San Diego State University

Body Scan Meditation for kids with Autism

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