Development of a Participation-Focused Measure of Interoception

PURPOSE: The Adolescent/Adult Sensory Profile (A/ASP, Brown & Dunn, 2002) is widely accepted within and outside of occupational therapy as an important measure for assessing sensory processing. The A/ASP uses Dunn’s Sensory Processing Framework to characterize four sensory processing preferences: sensory sensitivity, sensation avoiding, low registration and sensation seeking. When the A/ASP was developed seven senses were included: vision, hearing, taste, smell, touch, vestibular and proprioception. Many interested in sensory processing are now addressing an eighth sense: interoception. Interoception refers to the awareness of one’s own internal bodily states (e.g. heartbeat, respiration, hunger/thirst, bowel function, temperature) (Ceuhen, Vlaeyen & Van Diest, 2016). Evidence is accumulating that interoception is associated with many psychiatric conditions resulting in interoception being identified as a target for assessment and intervention (Khoury, Lutz & Schuman-Olivier, 2018).

Although scholars believe that interventions targeting interoception are viable, intervention planning requires reliable and valid assessment data. The availability of an interoceptive measure based on Dunn’s Sensory Processing Framework provides a structure for intervention planning in occupational therapy. Currently practitioners are working without that structure. The focus of this study is on the item development of an interoceptive measure grounded in Dunn’s Sensory Processing Framework and participation.

DESIGN: Reliability study. A convenience sample of adults was recruited to insure gender and age representation.

METHOD: Preliminary items were developed using a review of existing scales and discussions with experts in the field. The preliminary version of 101 items addresses interoception from an occupational therapy perspective; meaning the sensory experiences are embedded in everyday life. Furthermore, the scale covers the various internal bodily states commonly associated with interoception and also includes items assessing each sensory processing preference: sensory sensitivity, sensation avoiding, low registration and sensation seeking.

The pilot study of the interoception scale was conducted with a sample of 55 individuals. Participants completed an on-line version of the measure. The primary purpose was to identify the items that best reflect the four sensory processing preferences and contribute to the scales internal consistency. We examined the correlations between each item on the interoception scale to the corresponding subscale score. Items that correlate most strongly with the hypothesized subscale were maintained. A Cronbach’s alpha was calculated to examine the internal consistency for each subscale.

RESULTS: Of the initial 101 items, a total of 69 items were maintained that fulfilled the criteria of correlating most strongly with the intended subscale. The breakdown by subscale was as follows:

Sensory seeking: 14 items (r = .342 - .654)

Low registration: 15 items (r = .293 - .572)

Sensory sensitivity: 25 items (r = .388 - .7590

Sensation avoiding: 16 items (r = .302 - .533)

Good internal consistency using Cronbach’s alpha was found for all subscales: (sensation seeking α = .801, low registration α = .631, sensory sensitivity, – = .882, sensation avoiding – = .717).

CONCLUSION: This preliminary study supports the concept that interoception as measured by items assessing participation can be conceptualized using Dunn’s Sensory Processing Framework. Occupational therapy’s contribution to the measurement of interoception includes embedding the construct in participation. These initial findings will be valuable for the further development of an interoception scale that occupational therapists can use for intervention planning.

References

Brown, C. & Dunn, W. (2002) Adolescent/Adult Sensory Profile. San Antonio, TX: Psychological Corporation.

Ceuhen, E., Vlaeyen, J. W. S. & Van Diest, I. (2016). On the origin of interoception. Frontiers of psychology, 7, article 743. doi:10.3389/fpsyg.2016.00743

Khoury, N. M., Lutz, J. & Schuman-Olivier, Z. (2018). Interoception in psychiatric disorders: A review of randomized, controlled trials with interoception-based interventions. Harvard Review of Psychiatry, 26, 250-263. doi: 10.1097/HRP.0000000000000170