Interoceptive awareness is the ability to consciously integrate and interpret the signals from the body, such as what they mean, how they relate to the context, and how they influence behavior and emotions. Interoceptive awareness is more than just sensing or perceiving the body's internal states; it also involves a higher-order cognitive process that allows us to make sense of our interoceptive experiences and use them to guide our actions and feelings. For example, when we feel our heart racing, we can interpret this signal as a sign of anxiety, excitement, or physical exertion, depending on the situation and our expectations. Interoceptive awareness can also affect how we regulate our emotions, cope with stress, and empathize with others, among other psychological functions.
Researchers have used various tasks requiring participants to reflect on their interoceptive experiences and report their metacognitive judgments or insights to measure interoceptive awareness. For instance, one commonly used task is the heartbeat perception task, in which the participants count their heartbeats without using external aids, such as feeling their pulse or looking at a clock. Then, they compare their estimates with their actual heart rate, measured by an electrocardiogram. The accuracy of their estimates reflects their interoceptive accuracy, while the confidence in their estimates reflects their interoceptive confidence. Other tasks include the heartbeat discrimination task, in which the participants must judge whether a series of tones are synchronous or asynchronous with their heartbeats, and the heartbeat tracking task, in which the participants must indicate when they feel each heartbeat by pressing a button.
One factor that can influence interoceptive awareness is heart rate variability (HRV), which is the variation in the time intervals between consecutive heartbeats. HRV reflects the balance between the sympathetic and parasympathetic branches of the autonomic nervous system, which regulate the body's response to stress and relaxation. Higher HRV indicates greater flexibility and adaptability of the cardiovascular system and is associated with better emotional regulation, cognitive performance, and mental health. Lower HRV, on the other hand, indicates more rigidity and stress and is linked to poorer outcomes in various domains, such as chronic pain, anxiety, depression, and cardiovascular disease.
One way to improve HRV and interoceptive awareness is through heart rate variability biofeedback (HRVB). This technique teaches the participants how to voluntarily modulate their breathing patterns and heart rhythms. By using a device that monitors their heart rate and provides real-time feedback, the participants can learn how to breathe to maximize their HRV and synchronize their heartbeats with their inhalations and exhalations. This practice can enhance their interoceptive awareness as they become more aware of their bodily sensations and their effects on their emotions and cognition. HRVB can also reduce stress, improve mood, and alleviate pain by promoting a state of calm and relaxation.
Several studies have shown the benefits of HRVB for interoceptive awareness and related outcomes. For example, Zamariola et al. (2019) conducted a registered report randomly assigning 79 healthy participants to either an HRVB training or a control group. The HRVB group received four sessions of HRVB training over two weeks, while the control group received four sessions of sham biofeedback training, in which they received random feedback unrelated to their heart rate. The results showed that the HRVB group improved interoceptive accuracy, confidence, and awareness, as measured by the heartbeat perception task and the Multidimensional Assessment of Interoceptive Awareness (MAIA) questionnaire. The HRVB group also reported lower levels of anxiety and negative affect and higher levels of positive affect and self-compassion compared to the control group.
In another study, Zamariola et al. (2020) examined the effect of HRVB on chronic pain patients, who often suffer from low HRV and impaired interoceptive awareness. They randomly assigned 60 patients with fibromyalgia or chronic fatigue syndrome to either an HRVB group or a waiting list control group. The HRVB group received eight sessions of HRVB training over four weeks, while the control group received no intervention. The results showed that the HRVB group increased their HRV and improved their interoceptive awareness, as measured by the MAIA questionnaire. The HRVB group also reported lower pain intensity, pain interference, pain catastrophizing levels, and higher pain acceptance and quality of life than the control group.
These studies suggest that HRVB is a promising technique to enhance interoceptive awareness and its associated benefits for psychological and physical well-being. By learning how to regulate their breathing and heart rhythms, the participants can gain more insight and control over their bodily signals and their impact on their emotions and cognition. Apps like Optimal HRV can help people cope better with stress, pain, and other challenges and improve their health and happiness.
References
Mehling, W. E., Price, C., Daubenmier, J. J., Acree, M., Bartmess, E., & Stewart, A. (2012). The Multidimensional Assessment of Interoceptive Awareness (MAIA). PloS one, 7(11), e48230.
Zamariola, G., Maurage, P., Luminet, O., & Corneille, O. (2019). Improving interoceptive sensibility through heart rate variability biofeedback: A registered report. International Journal of Psychophysiology, 138, 66-77.
Zamariola, G., Vlemincx, E., Luminet, O., Van den Bergh, O., & Corneille, O. (2020). Effect of Heart Rate Variability Biofeedback on the Perception and Management of Chronic Pain: A Randomized Controlled Trial. Psychological Medicine, 1-14.