Despite the recent advances in the field of cognitive neuroscience and the role of interoception in promoting behavioral regulation, few occupational therapy intervention practices have adopted the concept into their approach. This paper explores the impact of school-based occupational therapy intervention based on mindfulness and interoceptive awareness in promoting behavioral regulation among 3rd–5th-grade children with neurodevelopmental disorders (NDDs). The intervention program, titled Mind-Body Integration program (MBI), is delivered to a special education classroom via weekly 30-minute sessions for 26 weeks during the school year. The author completed a pilot study of the program in two elementary school special education classrooms. Twenty-three students with NDDs participated in the study and 17 completed the data collection. Data was collected on emotional and behavioral regulation as well as interoceptive bodily awareness. Assessment measures included Behavior Rating of Executive Functions, 2nd edition (BRIEF-2); Multidimensional Assessment of Interoceptive Awareness- youth (MAIA); and a teacher survey. The results demonstrate significant positive changes in student reported attentional regulation, emotional awareness, body listening, and self-regulation. There were no significant negative changes reported on the parent-reported BRIEF-2. However, the teacher survey indicated significant negative changes in behavioral regulation. Overall, the pilot study was found to be feasible to implement and cost-effective. These findings suggest that the MBI program holds promise as an effective intervention for enhancing behavioral regulation in children with NDDs and highlights the importance of incorporating mindfulness and interoceptive awareness in occupational therapy practice within school settings. Further research and modifications to the program are warranted to optimize its effectiveness and address potential challenges.

Every day there are somatosensory stimuli on our skin that we perceive one moment and the next not, despite their unchanged physical presence (e.g., insects, wind, clothing). Yet, which are the physiological determinants and neural correlates that accompany external stimuli to enter consciousness or not? To address this question and inform theories of consciousness, this dissertation presents three empirical studies that used weak electrical finger-nerve stimulation which led - despite being physically identical - to subjective experiences of stimulus presence and absence. The first two studies investigated the interaction of tactile conscious perception with two dominant body rhythms: the cardiac and respiratory cycle. The third study investigated the configuration of neural networks being involved in this near-threshold phenomenon. Tactile conscious perception changed over the course of the cardiac cycle (increased detection during diastole) and respiration was tuned such that stimuli occurred more likely during late inspiration / early expiration, resulting in increased detection during early expiration. On the neural level, conscious perception was accompanied by global broadcasting of sensory content across the brain without substantial reconfiguration of the whole-brain functional network in terms of graph metrics. The cardiac cycle effect on conscious tactile perception is a result of cognitive processes which model and predict our body’s internal state to inform perception and guide behavior (e.g., tuning respiration). This perceptual integration of interoceptive and exteroceptive 'beliefs' is also an explanation for widely distributed brain activity differences without whole-brain functional network changes when a tactile stimulus is perceived.

The ability to sense the internal state of one's body is the process of interoception and is a marker for positive emotional outcomes. The last five years have seen burgeoning research interest in interoception, including a call for more integrative and predictive biomarkers for interoceptive ability. While there is a robust literature purporting to measure interoception, there is also significant research challenging the content validity of the current methodology. Beyond these published challenges, I offer a broader critique that suggests that the current reductionist approach fails to capture the integrative nature of interoception. I introduce an alternate methodology to assess interoceptive ability that leverages the integrative nature of the autonomic nervous system. Thirty-four undergraduates provided real-time feedback about their subjective state of arousal while watching three videos of varying intensity. Across subjects, arousal feedback did not positively correlate with physiological indices of sympathetic arousal including electrodermal activity and the inverse of pre-ejection period. However, each subject appeared to have an idiographic pattern of physiological variables that correlated strongly, although often negatively, with the subjective slider feedback. These physiological patterns provide the foundation for investigating a new biomarker for interoception that relies on the autonomic nervous system to surmise interoceptive states. / Doctor of Philosophy / A person's sense of their body is called interoception. Research has shown that people who are good at interoception tend to live happier and more fulfilling lives. But current research techniques don't do a great job measuring whether someone is good at interoception. These techniques have faced a lot of criticism for the errors they are known to make. I add my concerns that the current techniques don't reflect how we naturally sense into our bodies when we're not in a lab. I explain why I think we need a new way of measuring interoception that captures how holistic this process is. I introduce a new measure that is based on the energy in our body. I believe that people use this energy system naturally and will also be better able to reflect this is a lab setting. The people in this study used a slider dial to indicate how much energy they felt while they watched videos with different excitement levels. While they watched the videos and moved the dial, we measured their bodily readings from their heart, breathing, and sweat to see if these readings matched their dial ratings. We were surprised that the typical body readings for excitement were not directly related to the slider movements when we averaged across people, but we did find that each person had their own unique way of responding that was similar in both mind and body. This research is the basis for a new way to understand how people read their own body, and how accurate this reading is.

L’interocezione è definita come il senso della condizione fisiologica dell’intero organismo. Le sensazioni interocettive comprendono un ampio raggio di funzioni biologiche sia consce sia inconsce, e costituiscono la dimensione interna del nostro senso del Se. L’obiettivo primario di questa tesi è stato di capire come le percezioni interne del corpo siano in grado di modificare il nostro senso del se e come questi processi possano essere cambiati, modificati e alterati per migliorare il benessere psicofisiologico. Gli scopi di questa dissertazione sono stati 1) capire come gli input interocettivi sono processati e come contribuiscono al nostra percezione del se e al nostro benessere. 2) sviluppare nuove tecnologie per manipolare il sistema interocettivo al fine di promuovere il benessere. 3) testare queste nuove tecnologie interocettive su soggetti sani e su popolazioni cliniche. La tesi propone nuovi contributi sia teorici sia sperimentali. Nella sezione sperimentale, le tecnologie interocettive sono state testate per promuovere il benessere in popolazioni cliniche e non. I risultati hanno indicato che i trattamenti interocettivi possono promuovere il benessere nei soggetti sani e ridurre la severità dei sintomi in soggetti patologici (i.e., con dolore cronico) confermando la possibilità di manipolare la dimensione interocettiva per promuovere il benessere dell’individuo. / Interoception can be defined as the sense of the physiological condition of the entire organism (Craig, 2003). From this point of view interoceptive sensations entail a broad range of relevant biological functions that serve conscious and unconscious processes and constitute the embodied inner dimension of our sense of Self. The main objective of this thesis was to understand how the perceptions that arise from our body are able to shape our sense of Self and moreover, how these processes can be changed, modified, and altered to improve both our physiological both our psychological well-being. The purpose of this dissertation was 1) to understand how interoceptive inputs are processed and how they contribute to our self-perception and well-being. 2) to develop new interoceptive technologies to manipulate the interoceptive system to promote well-being. 3) to test these new technological applications on healthy and clinical populations. The thesis proposes both theoretical both experimental contributes. In the experimental section interoceptive technologies are tested to promote well-being in healthy and clinical populations. Results indicated that “interoceptive treatment” can both promote well-being in healthy subjects both reduce symptoms severity in clinical subjects (i.e. chronic pain) confirming the possibility to manipulate the interoceptive dimension to enhance healthy functioning.

This dissertation models the relationship between symptoms of heart rhythm fluctuations and cardiac measurements in order to better identify the probabilities of either a primarily organic or psychosomatic cause, and to better understand cognition of the internal body. The medical system needs to distinguish patients with actual cardiac problems from those who are misperceiving benign heart rhythms due to psychosomatic conditions. Cognitive neuroscience needs models showing how the brain processes sensations of palpitations. Psychologists and philosophers want data and analyses that address longstanding controversies about the validity of introspective methods. I therefore undertake a series of measurements to model how well patient descriptions of heartbeat fluctuations correspond to cardiac arrhythmias. First, I employ a formula for Bayesian inference and an initial probability for disease. The presence of particular phrases in symptom reports is shown to modify the probability that a patient has a clinically significant heart rhythm disorder. A second measure of body knowledge accuracy uses a corpus of one hundred symptom reports to estimate the positive predictive value for arrhythmias contained in language about palpitations. This produces a metric representing average predictivity for cardiac arrhythmias in a population. A third effort investigates the percentage of patients with palpitations report actually diagnosed with arrhythmias by examining data from a series of studies. The major finding suggests that phenomenological reports about heartbeats are as or are more predictive of clinically significant arrhythmias than non-introspection-based data sources. This calculation can help clinicians who must diagnose an organic or psychosomatic etiology. Secondly, examining a corpus of reports for how well they predict the presence of cardiac rhythm disorders yielded a mean positive predictive value of 0.491. Thirdly, I reviewed studies of palpitations reporters, half of which showed between 15% and 26% of patients had significant or serious arrhythmias. In addition, evidence is presented that psychosomatic-based palpitation reports are likely due to cognitive filtering and processing of cardiac afferents by brainstem, thalamic, and cortical neurons. A framework is proposed to model these results, integrating neurophysiological, cognitive, and clinical levels of explanation. Strategies for developing therapies for patients suffering from identifiably psychosomatic-based palpitations are outlined. / text

Body ownership is a complicated and multifaceted percept. Although we subjectively perceive body ownership to be a stable component of our identity, recent work has illustrated that body ownership is a dynamic construct that is constantly updated by the integration of current endogenous and exogenous body-related information. The goal of this study was to explore the relation between these endogenous (interoceptive) and exogenous (exteroceptive) channels of information. We investigated this by using a heartbeat perception (HBP) task to measure interoceptive accuracy, and the Rubber Hand Illusion (RHI) to measure malleability of body ownership. Based on prior findings, we hypothesized that the less accurate you are at counting your heartbeats, the more susceptible you will be to the RHI (i.e. the more malleable your sense of body ownership will be). In addition, we were also interested in exploring the relationship between interoception and emotion recognition ability (ERA). In this experiment, we failed to induce the RHI, and thus could not investigate the relationship between endogenous and exogenous body-related information. However, we successfully demonstrated the reliability of the interoceptive accuracy HBP task, as well as demonstrated that interoceptive accuracy is not related to ERA. / Thesis / Master of Science (MSc)

In der vorliegenden Studie wurde die Hypothese geprüft, daß Asthmatiker die Aufmerksamkeit von eigenen Körperprozessen ablenken und eine Ungenauigkeit bei der Interozeption relevanter Atemwegsobstruktionen aufweisen. Weiterhin prüften wir die Frage, inwieweit die postulierte Aufmerksamkeitsabwendung generalisiert ist und sich auch auf die nicht atemwegsbezogene Symptomwahrnehmung und die private Selbstaufmerksamkeit bezieht. Die Interozeptionsgenauigkeit wurde als Diskrepanz zwischen subjektivem Urteil und objektiver Atemfunktion bei spirometrischen Messungen berechnet, die anderen Variablen mittels Fragebögen operationalisiert. Es wurden insgesamt 91 Patienten einer Rehabilitationseinrichtung untersucht: 30 Asthmatiker, 30 Patienten mit chronisch obstruktiver Bronchitis (COB) und 31 Kontrollpatienten ohne Atemwegserkrankung. Die Ergebnisse deuten auf eine spezifisch atemwegsbezogene Aufmerksamkeitsablenkung sowie eine Überschätzung von Obstruktionen bei Asthmatikern hin. Überraschend zeigen auch die COB-Patienten auffällige Ergebnismuster in Richtung einer Unterschätzung von Obstruktionen sowie verminderter Selbstaufmerksamkeit. Die Ergebnisse lassen sich im Rahmen verhaltensmedizinischer Überlegungen interpretieren. / The hypothesis that asthmatic patients draw their attention away from bodily processes and show inaccurate interoception with regard to relevant airway obstructions was tested in this study. Additionally, we examined whether this postulated withdrawal of attention can also be generalized for the perception of non-airway related symptoms as well as for private self-consciousness. Accuracy of interoception was measured as the discrepancy between subjective judgement of obstruction and objective obstruction as shown in spirometric tests. Other variables were operationalized by self-reports. Ninetyone patients in a rehabilitation hospital were tested: 30 asthmatic patients, 30 patients with chronic obstructive bronchitis (COB), and 31 control subjects without any airway disease. Asthmatic patients showed attention withdrawal only with regard to bronchial airways. However, they also indicated an overestimation of airway obstruction. Surprisingly, deviant results were also found for the COB patients including underestimation of obstructions and lower self awareness. All results were interpreted from the perspective of behavioral medicine. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

In der vorliegenden Studie wurde die Hypothese geprüft, daß Asthmatiker die Aufmerksamkeit von eigenen Körperprozessen ablenken und eine Ungenauigkeit bei der Interozeption relevanter Atemwegsobstruktionen aufweisen. Weiterhin prüften wir die Frage, inwieweit die postulierte Aufmerksamkeitsabwendung generalisiert ist und sich auch auf die nicht atemwegsbezogene Symptomwahrnehmung und die private Selbstaufmerksamkeit bezieht. Die Interozeptionsgenauigkeit wurde als Diskrepanz zwischen subjektivem Urteil und objektiver Atemfunktion bei spirometrischen Messungen berechnet, die anderen Variablen mittels Fragebögen operationalisiert. Es wurden insgesamt 91 Patienten einer Rehabilitationseinrichtung untersucht: 30 Asthmatiker, 30 Patienten mit chronisch obstruktiver Bronchitis (COB) und 31 Kontrollpatienten ohne Atemwegserkrankung. Die Ergebnisse deuten auf eine spezifisch atemwegsbezogene Aufmerksamkeitsablenkung sowie eine Überschätzung von Obstruktionen bei Asthmatikern hin. Überraschend zeigen auch die COB-Patienten auffällige Ergebnismuster in Richtung einer Unterschätzung von Obstruktionen sowie verminderter Selbstaufmerksamkeit. Die Ergebnisse lassen sich im Rahmen verhaltensmedizinischer Überlegungen interpretieren. / The hypothesis that asthmatic patients draw their attention away from bodily processes and show inaccurate interoception with regard to relevant airway obstructions was tested in this study. Additionally, we examined whether this postulated withdrawal of attention can also be generalized for the perception of non-airway related symptoms as well as for private self-consciousness. Accuracy of interoception was measured as the discrepancy between subjective judgement of obstruction and objective obstruction as shown in spirometric tests. Other variables were operationalized by self-reports. Ninetyone patients in a rehabilitation hospital were tested: 30 asthmatic patients, 30 patients with chronic obstructive bronchitis (COB), and 31 control subjects without any airway disease. Asthmatic patients showed attention withdrawal only with regard to bronchial airways. However, they also indicated an overestimation of airway obstruction. Surprisingly, deviant results were also found for the COB patients including underestimation of obstructions and lower self awareness. All results were interpreted from the perspective of behavioral medicine. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Interoception, the signalling, processing, and perceptual representation of the visceral organs, together with trait impulsivity are in the present study examined using the Novel Controllability task (Mancinelli et al., 2021) as individual factors in coping behavior in response to stress. The coping process is conceptualized using the model of regulatory flexibility developed by Bonanno and Burton (2013). The results based on a sample of 39 healthy adults (M = 23,64 years, 22f/17m) do not support the hypothesis that the combined UPPS-P constructs are significantly related to interoception. For the coping process, the results suggest that: Negative Urgency is related to a negative initial appraisal of the stressor context leading to coping rigidity, by limiting the repertoire of strategies and the dynamic function of feedback; Positive Urgency is related to a larger dependency on emotions to guide decision making, motivating a “trial-and-error” coping approach; Sensation Seeking is related with an opposing style of emotion-focused coping where diminished threat perception and reduced sensitivity towards stimulus valence motivate a risk-taking approach, likely to pursue stimulation; Lack of Premeditation, the only facet of impulsivity convincingly related to interoception, is speculated to be associated with a dysregulation of interoceptive afferents facilitating a “here-and-now” attentional and coping focus. Despite lacking full support, the potential involvement of interoception as an internal stressor is discussed as a mediator in impulsive behavior, alongside general methodological issues with measuring interoception.

In dieser Dissertation untersuche ich das Zusammenspiel mentaler und körperlicher Prozesse, insbesondere den Einfluss von kontemplativem Mentaltraining (KMT) auf Interozeption (innerliches Spüren des Körpers) und physiologische Regulation. In einer großangelegten Trainingsstudie (n = 332, Trainingsdauer 3-9 Monate), der ReSource-Studie, zeige ich, dass KMT die interozeptive Genauigkeit in den Trainingskohorten erhöht, nicht jedoch in einer Retest-Kontrollgruppe. Die Steigerungen in interozeptiver Genauigkeit gehen mit Veränderungen im emotionalen Gewahrsein einher und sagen diese voraus. Im Einklang mit diesen Befunden berichten die Studienteilnehmenden von positiven Veränderungen in verschiedenen Dimensionen des Körpergewahrseins. Diese betreffen vor allem die Fähigkeit, Aufmerksamkeit auf Körperempfindungen aufrechtzuerhalten sowie deren Gebrauch zur Emotionserkennung und -regulation. Ich beschreibe eine neuentwickelte Biofeedback-Aufgabe, welche die Fähigkeit misst, willentlich die hochfrequente Herzratenvariabilität (HF-HRV) hochzuregulieren, wodurch die willentliche parasympathische Kontrollfähigkeit (WPK) indiziert wird. Ich zeige, dass individuelle Unterschiede in WPK mit dem Oxytocin-Rezeptorgen-Polymorphismus rs53576 zusammenhängen und mit individuellen Unterschieden im altruistisch motivierten Verhalten korrelieren. WPK wird durch KMT verbessert, wobei diese Verbesserungen durch den rs53576 Genotyp moduliert werden. In einer weiteren Untersuchung zeige ich, dass retrospektive, subjektive Berichte über eine emotional erregende Erfahrung teilweise die objektiv gemessene körperliche Erregung widerspiegeln. Das Ausmaß dieser körperlich-mentalen Kohärenz ist abhängig von der interozeptiven Genauigkeit. Zusammengenommen vertiefen diese Studien unser Verständnis des Zusammenspiels von physiologischen und mentalen Prozessen und zeigen wie KMT das innerliche Spüren des Körpers und die willentliche physiologische Regulation verbessert. / In this dissertation, I investigate interactions between mental and bodily processes, specifically by studying the influence of contemplative mental training (CMT) on interoception (inner body sensing) and physiological regulation. In a large-scale mental training study (n = 332, training durations 3–9 months), the ReSource Project, I find that CMT increases interoceptive accuracy in the training cohorts, but not in a retest control cohort. These increases in interoceptive accuracy co-occur with and predict improvements in emotional awareness. In line with these objective data on interoception, participants self-report training-related benefits on multiple dimensions of body awareness. The strongest changes occur in the ability to sustain attention to body sensations and the use of this ability to identify and regulate emotions. I also introduce a novel biofeedback task that measures the ability to voluntarily upregulate high frequency heart rate variability (HF-HRV), indicative of voluntary parasympathetic control. Cross-sectional data of the ReSource Project show that individual differences in voluntary parasympathetic control are related to the oxytocin receptor gene rs53576 polymorphism and correlate to individual differences in altruistically motivated behavior. Furthermore, CMT improves various aspects of voluntary HF-HRV regulation, with modulation of these improvements by rs53576 genotype. An additional investigation in cross-sectional data shows that subjective retrospective reports of an emotionally arousing experience partially mirror the objectively measured bodily arousal during the actual experience. Individual differences in this mind–body coherence are related to individual differences in interoceptive accuracy. Together, these studies highlight the tight interplay between physiological and mental processes and show how CMT improves inner body sensing and voluntary physiological regulation.