Interoception, contemplative practice, and health

Abstract

Interoception can be broadly defined as the sense of signals originating within the body. As such, interoception is critical for our sense of embodiment, motivation, and well-being. And yet, despite its importance, interoception remains poorly understood within modern science. This paper reviews interdisciplinary perspectives on interoception, with the goal of presenting a unified perspective from diverse fields such as neuroscience, clinical practice, and contemplative studies. It is hoped that this integrative effort will advance our understanding of how interoception determines well-being, and identify the central challenges to such understanding. To this end, we introduce an expanded taxonomy of interoceptive processes, arguing that many of these processes can be understood through an emerging predictive coding model for mind-body integration. The model, which describes the tension between expected and felt body sensation, parallels contemplative theories, and implicates interoception in a variety of affective and psychosomatic disorders. We conclude that maladaptive construal of bodily sensations may lie at the heart of many contemporary maladies, and that contemplative practices may attenuate these interpretative biases, restoring a person's sense of presence and agency in the world.

Keywords: body awareness; contemplative practice; interoception; meditation; mindfulness; mind–body therapies; yoga.

FIGURE 1

A prediction error (PE) model of interoceptive inference, adapted from (Seth, 2013), in which interoceptive knowledge is represented by three terms: priors (blue lines), i.e., the probable body state as informed by prior events; sensation (black lines), the current sensory input from the body; and simulation (green lines), the current predicted body state based upon integration of current bodily feedback and prior learned contextual influences. Critically, our model suggests that simulation rather than raw sensation is the closest construct to interoceptive awareness. (A) Unexpected interoceptive events, such as a stomach ache, are represented as a PE signal that motivates a regulatory response to minimize the error signal. The simulation distribution is displayed as equidistant from the sensation and prior distributions to indicate the potential for updating from both of these information sources. (B) Active inference reduces PE by weighting priors over current sensation. A high-specificity range of expected body states leads to large PEs from unexpected sensations, motivating attempts to modify internal states indirectly through cognition or behavior. Successful inference reduces PE by aligning incoming sensation to match the prior. (C) Perceptual inference reduces simulation error by weighting current sensation over priors, updating the simulation to fit sensation. A low-specificity range of expected body states lessens immediate PEs from unexpected sensations, lending interoceptive simulations (i.e., future priors) greater sensory accuracy. Successful perceptual inference reduces PE by updating the prior to match incoming sensation. Active and perceptual inference may co-occur dynamically over time, shifting attention between sensory updating and regulatory response.