Abstract
This study describes interoceptive processing in a sample of 706 adults, including those with no mental-health diagnosis and those with a diagnosis, including depression, anxiety, eating disorder, or attention deficit hyperactivity disorder. Significant differences on the Multidimensional Scale of Interoceptive Awareness-2 (MAIA) and the Interoception Sensory Questionnaire (ISQ) were seen across levels of mental-health wellness. Implications for future research and practice are provided.
Primary Author and Speaker: Kelly Mahler
Additional Authors and Speakers: Ellen McLaughlin
Contributing Authors: Denis Anson
Occupational therapists are concerned with the impact of interoception on occupational performance, and are applying interventions to facilitate change for children with sensory processing disorders (Mahler, 2015). A second population with interoceptive challenges are those with atypical mental health (Murphy, Brewer, Catmur & Bird, 2017). Interoception is the reception and awareness to internal sensory stimuli, allowing us to know our body, our consciousness, and our sense of self. It enables recognition of the need to eat, sleep, retreat, defecate, urinate, meditate, or seek the emotional comfort of a loved one. Researchers, recently identified four comprehensive features of interoception, including afferent signals; neural coding and integration; the impact on perception and cognition; and lastly, the manifestation of sensations and feelings through psychological expression (Quadt, Critchley & Garfinkle, 2018).The purpose of this study was to describe the nature of interoceptive processing across a population of adults, including those with no mental health diagnosis, and those who have identified a mental health diagnosis, including depression, anxiety, eating disorder, attention deficit/hyperactivity disorder, or autism.
This descriptive study is part of a larger venture which sought participants through social media, inviting them to complete scales designed to measure interoceptive abilities, broader sensory processing, and autistic traits. The focus of this particular study was to explore the variation in interoceptive functioning across a well population and those with varying mental health diagnoses. Participants (N=706) were required to at least 18 years of age and english-speaking, The sample was 82% female, 17.7% male, with the remaining choosing not to gender identify. Participants represented 18 countries, with the United States (81.8%), the United Kingdom (7.4%), Canada (3.1%) and Australia (3.1%) the most highly represented. Half of respondents (50%) did not identify any mental illness, 21% identified one mental health diagnosis, and 29% identified more than one mental health diagnosis.
The Multidimensional Scale of Interoceptive Awareness-2 (MAIA-2) (Mehling, Acree Stewart, Silas & Jones, 2018) and the Interoception Sensory Questionnaire (ISQ) (Fiene, Ireland and Brownlowe, 2017) were completed by participants in an online format and data processed in SPSS. Descriptive data was explored to examine variations in interoceptive processing across varying states of mental health wellness. Analysis of variance and t-tests, with an alpha of .05 and a Bonferroni correction, were utilized.
ANOVA revealed significant differences in ISQ scores based on mental health categories of Well, One Diagnosis, or Multiple Diagnoses (F = 45.5, df = 2, p =.000), with post hoc results significant for each level of distinction. A significant difference was also found between those with no mental health diagnosis as compared to one or more diagnoses for six of the eight categories of the MAIA-2, including Noticing, Not Worrying, Attention Regulation, Emotion Awareness, Self- Regulation, and Trusting, and not for the categories of Not Distracting and Body Listening.
Results support the conception that interoceptive processing varies with mental health wellness. Deeper analysis of these relationships to fully realize the implications of faulty processing for each diagnostic category will strengthen our fidelity in designing theoretically sound interventions for clinical testing. Moving in this direction enhances the interprofessional recommendations to clarify the important role of “perceptual signaling, including interoception… ”, as identified in the Research Domain Criteria (RDoC) of the NIH. (Harrison, Kats, Williams & Aziz-Zadeh, 2019).
Harrison, L. A., Kats, A., Williams, M. E., & Aziz-Zadeh, L. (2019). The importance of sensory processing in mental health: A proposed addition to the Research Domain Criteria (RDoC) and suggestions for RDoC 20. Frontiers in Psychology, 10. https://doi.org/10.3389/fpsyg.2019.00103
Murphy, J., Brewer, R., Catmur, C., Bird, G. (2017). Interoception and psychopathology: A developmental neuroscience perspective. Developmental Cognitive Neuroscience, 23, 45-56,
Mahler, K. (2018). The Interoception Curriculum: A Step-by-Step Guide to Developing Mindful Self-Regulation. AAPC Publishing.
Quadt, L., Critchley, H. D., and Garfinkel, S. N. (2018). The neurobiology of interoception in health and disease. Annals of the New York Academy of the Sciences, 1428, 112–128. doi: 10.1111/nyas.13915