Original ArticleOpen Access

Interoception: Current Knowledge Gaps and Future Directions in Neuroscience, Psychopathology, and Clinical Applications

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DOI: 10.23958/ijirms/vol10-i03/2041· Pages: 99 - 117· Vol. 10, No. 03, (2025)· Published: March 6, 2025
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Abstract

Interoception, the process by which the nervous system senses, interprets, and regulates internal bodily states, is fundamental in maintaining physiological homeostasis, emotional regulation, and cognitive processing. Despite its significance, significant knowledge gaps persist regarding their underlying neural mechanisms, contributions to psychiatric and neurological disorders, methodological limitations in assessment, and potential clinical applications. This review synthesizes current findings and highlights unresolved questions in interoceptive research. The insular cortex, anterior cingulate cortex, brainstem, and autonomic nervous system are integral to interoceptive processing, yet the precise functional interactions among these regions remain unclear. Disruptions in interoceptive signaling have been implicated in psychiatric conditions such as anxiety, depression, schizophrenia, and autism spectrum disorder, as well as neurodegenerative diseases including Parkinson’s and Alzheimer’s. However, whether these interoceptive alterations are causative or consequential remains an open question. Inconsistencies in interoception assessment methods hinder progress, necessitating standardized, multimodal approaches that integrate behavioral, physiological, and computational metrics. Emerging evidence supports the clinical potential of interoception-based interventions, including mindfulness, vagus nerve stimulation, biofeedback, and cognitive behavioral therapy. Yet, their mechanisms of action and efficacy across diverse populations require further investigation. Advances in artificial intelligence and predictive modeling may enhance diagnostic precision and personalized treatment strategies. By addressing these challenges, future research can deepen our understanding of interoception’s role in health and disease, ultimately informing innovative therapeutic approaches.

Keywords

interoceptionalliesthesiaautonomic nervous systemneuroimagingpsychiatric disordersneurosciences

References

  1. Prescott SL, Liberles SD. Internal senses of the vagus nerve. Neuron. 2022 Feb 16;110(4):579-599. doi: 10.1016/j.neuron.2021.12.020.DOI ↗Google Scholar ↗
  2. Engelen T, Solcà M, Tallon-Baudry C. Interoceptive rhythms in the brain. Nat Neurosci. 2023 Oct;26(10):1670-1684. doi: 10.1038/s41593-023-01425-1.DOI ↗Google Scholar ↗
  3. Zhang R, Deng H, Xiao X. The Insular Cortex: An Interface Between Sensation, Emotion and Cognition. Neurosci Bull. 2024 Nov;40(11):1763-1773. doi: 10.1007/s12264-024-01211-4.DOI ↗Google Scholar ↗
  4. Molle L, Coste A. The respiratory modulation of interoception. J Neurophysiol. 2022 Apr 1;127(4):896-899. doi: 10.1152/jn.00027.2022.DOI ↗Google Scholar ↗
  5. Lovelock DF, Tyler RE, Besheer J. Interoception and alcohol: Mechanisms, networks, and implications. Neuropharmacology. 2021 Dec 1;200:108807. doi: 10.1016/j.neuropharm.2021.108807.DOI ↗Google Scholar ↗
  6. Damasio A, Damasio H. Homeostatic Feelings and the Emergence of Consciousness. J Cogn Neurosci. 2024 Jul 1;36(8):1653-1659. doi: 10.1162/jocn_a_02119.DOI ↗Google Scholar ↗
  7. Wiśniewski P, Maurage P, Jakubczyk A, Trucco EM, Suszek H, Kopera M. Alcohol use and interoception - A narrative review. Prog Neuropsychopharmacol Biol Psychiatry. 2021 Dec 20;111:110397. doi: 10.1016/j.pnpbp.2021.110397.DOI ↗Google Scholar ↗
  8. Gabriele E, Spooner R, Brewer R, Murphy J. Dissociations between self-reported interoceptive accuracy and attention: Evidence from the Interoceptive Attention Scale. Biol Psychol. 2022 Feb;168:108243. doi: 10.1016/j.biopsycho.2021.108243.DOI ↗Google Scholar ↗
  9. Coll MP, Hobson H, Bird G, Murphy J. Systematic review and meta-analysis of the relationship between the heartbeat-evoked potential and interoception. Neurosci Biobehav Rev. 2021 Mar;122:190-200. doi: 10.1016/j.neubiorev.2020.12.012.DOI ↗Google Scholar ↗
  10. Harrison OK, Marlow L, Finnegan SL, Ainsworth B, Pattinson KTS. Dissociating breathlessness symptoms from mood in asthma. Biol Psychol. 2021 Oct;165:108193. doi: 10.1016/j.biopsycho.2021.108193.DOI ↗Google Scholar ↗
  11. Shah T, Dunning JL, Contet C. At the heart of the interoception network: Influence of the parasubthalamic nucleus on autonomic functions and motivated behaviors. Neuropharmacology. 2022 Feb 15;204:108906. doi: 10.1016/j.neuropharm.2021.108906.DOI ↗Google Scholar ↗
  12. Fazekas C, Linder D, Matzer F, Jenewein J, Hanfstingl B. Interpreting physical sensations to guide health-related behavior: An introductory review on psychosomatic competence. Wien Klin Wochenschr. 2022 Jan;134(Suppl 1):3-10. doi: 10.1007/s00508-021-01988-8.DOI ↗Google Scholar ↗
  13. Meulders A. Fear in the context of pain: Lessons learned from 100 years of fear conditioning research. Behav Res Ther. 2020 Aug;131:103635. doi: 10.1016/j.brat.2020.103635.DOI ↗Google Scholar ↗
  14. Hazelton JL, Devenney E, Ahmed R, Burrell J, Hwang Y, Piguet O, Kumfor F. Hemispheric contributions toward interoception and emotion recognition in left- vs right-semantic dementia. Neuropsychologia. 2023 Sep 9; 188:108628. doi: 10.1016/j.neuropsychologia.2023.108628.DOI ↗Google Scholar ↗
  15. Salamone PC, Legaz A, Sedeño L, Moguilner S, Fraile-Vazquez M, Campo CG, Fittipaldi S, Yoris A, Miranda M, Birba A, Galiani A, Abrevaya S, Neely A, Caro MM, Alifano F, Villagra R, Anunziata F, Okada de Oliveira M, Pautassi RM, Slachevsky A, Serrano C, García AM, Ibañez A. Interoception Primes Emotional Processing: Multimodal Evidence from Neurodegeneration. J Neurosci. 2021 May 12;41(19):4276-4292. doi: 10.1523/JNEUROSCI.2578-20.2021.DOI ↗Google Scholar ↗
  16. Al-Zubaidi A, Iglesias S, Stephan KE, Buades-Rotger M, Heldmann M, Nolde JM, Kirchner H, Mertins A, Jauch-Chara K, Münte TF. Effects of hunger, satiety and oral glucose on effective connectivity between hypothalamus and insular cortex. Neuroimage. 2020 Aug 15; 217:116931. doi: 10.1016/j.neuroimage.2020.116931.DOI ↗Google Scholar ↗
  17. Livermore JJA, Skora LI, Adamatzky K, Garfinkel SN, Critchley HD, Campbell-Meiklejohn D. General and anxiety-linked influences of acute serotonin reuptake inhibition on neural responses associated with attended visceral sensation. Transl Psychiatry. 2024 Jun 6;14(1):241. doi: 10.1038/s41398-024-02971-3.DOI ↗Google Scholar ↗
  18. Osorio-Gómez D, Bermúdez-Rattoni F, Guzmán-Ramos KR. Cortical neurochemical signaling of gustatory stimuli and their visceral consequences during the acquisition and consolidation of taste aversion memory. Neurobiol Learn Mem. 2021 May; 181:107437. doi: 10.1016/j.nlm.2021.107437.DOI ↗Google Scholar ↗
  19. Schulz A, Köster S, Beutel ME, Schächinger H, Vögele C, Rost S, Rauh M, Michal M. Altered patterns of heartbeat-evoked potentials in depersonalization/derealization disorder: Neurophysiological evidence for impaired cortical representation of bodily signals. Psychosom Med. 2015 Jun;77(5):506-516. doi: 10.1097/PSY.0000000000000195.DOI ↗Google Scholar ↗
  20. García-Cordero I, Sedeño L, de la Fuente L, Slachevsky A, Forno G, Klein F, Lillo P, Ferrari J, Rodriguez C, Bustin J, Torralva T, Baez S, Yoris A, Esteves S, Melloni M, Salamone P, Huepe D, Manes F, García AM, Ibañez A. Feeling, learning from and being aware of inner states: interoceptive dimensions in neurodegeneration and stroke. Philos Trans R Soc Lond B Biol Sci. 2016 Nov 19;371(1708):20160006. doi: 10.1098/rstb.2016.0006.DOI ↗Google Scholar ↗
  21. Pinna G, Johnson G, Costa E, Guidotti A. Endogenous brain neurosteroids and benzodiazepine pharmacology. Neuropharmacology. 2020 Jun; 168:108010. doi: 10.1016/j.neuropharm.2020.108010.DOI ↗Google Scholar ↗
  22. Seth AK, Suzuki K, Critchley HD. An interoceptive predictive coding model of conscious presence. Front Psychol. 2012 Oct 15; 2:395. doi: 10.3389/fpsyg.2011.00395.DOI ↗Google Scholar ↗
  23. Barrett LF, Simmons WK. Interoceptive predictions in the brain. Nat Rev Neurosci. 2015 Jul;16(7):419-429. doi: 10.1038/nrn3950.DOI ↗Google Scholar ↗
  24. Quadt L, Critchley HD, Garfinkel SN. The neurobiology of interoception in health and disease. Ann N Y Acad Sci. 2018 May;1428(1):112-128. doi: 10.1111/nyas.13915.DOI ↗Google Scholar ↗
  25. Allen M, Friston KJ. From cognitivism to autopoiesis: towards a computational framework for the embodied mind. Synthese. 2018;195(6):2459-2482. doi: 10.1007/s11229-016-1288-5.DOI ↗Google Scholar ↗
  26. Khalsa SS, Adolphs R, Cameron OG, Critchley HD, Davenport PW, Feinstein JS, Feusner JD, Garfinkel SN, Lane RD, Mehling WE, Meuret AE, Nemeroff CB, Oppenheimer SM, Petzschner FH, Pollatos O, Rhudy JL, Schramm LP, Simmons WK, Stein MB, Stephan KE, Van den Bergh O, Van Diest I, von Leupoldt A, Paulus MP. Interoception and Mental Health: A Roadmap. Biol Psychiatry Cogn Neurosci Neuroimaging. 2018 Jun;3(6):501-513. doi: 10.1016/j.bpsc.2017.12.004.DOI ↗Google Scholar ↗
  27. Craig AD. How do you feel--now? The anterior insula and human awareness. Nat Rev Neurosci. 2009 Jan;10(1):59-70. doi: 10.1038/nrn2555.DOI ↗Google Scholar ↗
  28. Paulus MP, Feinstein JS, Khalsa SS. An Active Inference Approach to Interoceptive Psychopathology. Annu Rev Clin Psychol. 2019 May 7; 15:97-122. doi: 10.1146/annurev-clinpsy-050718-095634.DOI ↗Google Scholar ↗
  29. Critchley HD, Nagai Y, Gray MA, Mathias CJ. Dissecting axes of autonomic control in humans: Insights from neuroimaging. Auton Neurosci. 2011 Oct 27;162(1-2):34-42. doi: 10.1016/j.autneu.2010.06.002.DOI ↗Google Scholar ↗
  30. Ainley V, Apps MA, Fotopoulou A, Tsakiris M. 'Bodily precision': a predictive coding account of individual differences in interoceptive accuracy. Philos Trans R Soc Lond B Biol Sci. 2016 Nov 19;371(1708):20160003. doi: 10.1098/rstb.2016.0003.DOI ↗Google Scholar ↗
  31. Van den Bergh O, Witthöft M, Petersen S, Brown RJ. Symptoms and the body: Taking the inferential leap. Neurosci Biobehav Rev. 2017 Nov;74(Pt A):185-203. doi: 10.1016/j.neubiorev.2017.01.015.DOI ↗Google Scholar ↗
  32. Petzschner FH, Weber LAE, Gard T, Stephan KE. Computational Psychosomatics and Computational Psychiatry: Toward a Joint Framework for Differential Diagnosis. Biol Psychiatry. 2017 Aug 15;82(4):421-430. doi: 10.1016/j.biopsych.2017.05.012.DOI ↗Google Scholar ↗
  33. Seth AK. The cybernetic Bayesian brain: from interoceptive inference to sensorimotor contingencies. Open MIND. 2015; 35:1-24. doi: 10.15502/9783958571038.DOI ↗Google Scholar ↗
  34. Murphy J, Brewer R, Catmur C, Bird G. Interoception and psychopathology: A developmental neuroscience perspective. Dev Cogn Neurosci. 2017 Feb; 23:45-56. doi: 10.1016/j.dcn.2016.12.006.DOI ↗Google Scholar ↗
  35. Park HD, Correia S, Ducorps A, Tallon-Baudry C. Spontaneous fluctuations in neural responses to heartbeats predict visual detection. Nat Neurosci. 2014 Jul;17(4):612-618. doi: 10.1038/nn.3671.DOI ↗Google Scholar ↗
  36. Garfinkel SN, Seth AK, Barrett AB, Suzuki K, Critchley HD. Knowing your own heart: Distinguishing interoceptive accuracy from interoceptive awareness. Biol Psychol. 2015 Jan; 104:65-74. doi: 10.1016/j.biopsycho.2014.11.004.DOI ↗Google Scholar ↗
  37. Weng HY, Feldman JL, Leggio L, Napadow V, Park J. Interventions and Manipulations of Interoception. Trends Neurosci. 2021 Jan;44(1):52-62. doi: 10.1016/j.tins.2020.09.010.DOI ↗Google Scholar ↗
  38. Critchley HD, Garfinkel SN. Interoception and emotion. Curr Opin Psychol. 2017 Apr; 17:7-14. doi: 10.1016/j.copsyc.2017.04.020.DOI ↗Google Scholar ↗
  39. Damasio A. The Strange Order of Things: Life, Feeling, and the Making of Cultures. New York: Pantheon Books; 2018.Google Scholar ↗
  40. Seth AK, Tsakiris M. Being a Beast Machine: The Somatic Basis of Selfhood. Trends Cogn Sci. 2018 Jun;22(6):486-498. doi: 10.1016/j.tics.2018.03.008.DOI ↗Google Scholar ↗
  41. Barrett LF. How emotions are made: The secret life of the brain. Boston: Houghton Mifflin Harcourt; 2017.Google Scholar ↗
  42. Petzschner FH, Stephan KE. Computational models of interoception and body regulation. Curr Opin Neurobiol. 2022 Feb;72:84-91. doi: 10.1016/j.conb.2021.09.009.DOI ↗Google Scholar ↗
  43. Paulus MP, Stein MB. Interoception in anxiety and depression. Brain Struct Funct. 2010 Jun;214(5-6):451-463. doi: 10.1007/s00429-010-0258-9.DOI ↗Google Scholar ↗
  44. Murphy J, Geary H, Millgate E, Catmur C, Bird G. Direct and indirect effects of interoception on social cognition. Emotion. 2022 May;22(3):463-477. doi: 10.1037/emo0001060.DOI ↗Google Scholar ↗
  45. Nicholson TM, Mathias CJ, Critchley HD. Autonomic dysfunction in psychiatric disorders: Interoception, attention, and emotion. Psychophysiology. 2020 Dec;57(12):e13657. doi: 10.1111/psyp.13657.DOI ↗Google Scholar ↗
  46. Fotopoulou A, Tsakiris M. Mentalizing homeostasis: The social origins of interoceptive inference. Neuropsychoanalysis. 2017 Jan;19(1):3-28. doi: 10.1080/15294145.2017.1295212.DOI ↗Google Scholar ↗
  47. Van den Bergh O, Brown RJ, Petersen S, Witthöft M. Interoception and somatization: A network approach. Neurosci Biobehav Rev. 2021 Jul;131:102-110. doi: 10.1016/j.neubiorev.2021.06.010.DOI ↗Google Scholar ↗
  48. Harshaw C. Interoceptive dysfunction: Toward an integrated framework for understanding somatic and affective disturbance in depression. Psychol Bull. 2015 Sep;141(5):990-1019. doi: 10.1037/bul0000016.DOI ↗Google Scholar ↗
  49. Khalsa SS, Rudrauf D, Sandesara R, Olshansky B, Tranel D. Bolstering cardiac regulation through interoceptive training. Auton Neurosci. 2022 Apr;236:102898. doi: 10.1016/j.autneu.2022.102898.DOI ↗Google Scholar ↗
  50. Farb NA, Segal ZV, Anderson AK. Mindfulness meditation training alters cortical representations of interoceptive attention. Soc Cogn Affect Neurosci. 2013 Jan;8(1):15-26. doi: 10.1093/scan/nss066.DOI ↗Google Scholar ↗
  51. Garfinkel SN, Critchley HD. Interoception, emotion and brain: New insights link internal physiology to social behaviour. Nat Rev Neurosci. 2013 Oct;14(10):571-582. doi: 10.1038/nrn3499.DOI ↗Google Scholar ↗
  52. Murphy J, Brewer R, Bird G, Catmur C. Developmental perspectives on interoception and self-representation. Dev Cogn Neurosci. 2020 Apr; 44:100783. doi: 10.1016/j.dcn.2020.100783.DOI ↗Google Scholar ↗
  53. Allen M, Tsakiris M. The body as first prior: Interoceptive predictive processing and the primacy of self-models. Soc Cogn Affect Neurosci. 2018 Jul 1;13(2):166-173. doi: 10.1093/scan/nsx075.DOI ↗Google Scholar ↗
  54. Sterling P. Predictive regulation: A new paradigm for understanding the stress response. Front Neuroendocrinol. 2012 Jul;33(3):221-230. doi: 10.1016/j.yfrne.2012.06.002.DOI ↗Google Scholar ↗
  55. Seth AK, Friston KJ. Active interoceptive inference and the emotional brain. Philos Trans R Soc Lond B Biol Sci. 2016 Nov 19;371(1708):20160007. doi: 10.1098/rstb.2016.0007.DOI ↗Google Scholar ↗
  56. Schulz A, Vögele C. Interoception and stress. Front Psychol. 2015 Feb 10; 6:993. doi: 10.3389/fpsyg.2015.00993.DOI ↗Google Scholar ↗
  57. Critchley HD, Garfinkel SN. The influence of interoception on affective experience. Curr Opin Behav Sci. 2017 Aug; 19:38-43. doi: 10.1016/j.cobeha.2017.07.010.DOI ↗Google Scholar ↗
  58. Park HD, Tallon-Baudry C. The neural subjective frame: From bodily signals to perceptual consciousness. Philos Trans R Soc Lond B Biol Sci. 2014 Nov 19;369(1641):20130208. doi: 10.1098/rstb.2013.0208.DOI ↗Google Scholar ↗
  59. Ainley V, Tsakiris M. Body-conscious? Interoceptive awareness, measured by heartbeat perception, is negatively correlated with self-objectification. PLoS One. 2013 Feb 6;8(2):e55568. doi: 10.1371/journal.pone.0055568.DOI ↗Google Scholar ↗
  60. Herbert BM, Pollatos O. The body in the mind: On the relationship between interoception and embodiment. Top Cogn Sci. 2012 Oct;4(4):692-704. doi: 10.1111/j.1756-8765.2012.01189.x.DOI ↗Google Scholar ↗
  61. Dunn BD, Evans D, Makarova D, White J, Clark L. Gut feelings and the body: Integration of interoceptive information in decision making. Psychol Sci. 2012 Nov;23(10):1289-1297. doi: 10.1177/0956797612442398.DOI ↗Google Scholar ↗
  62. Ebrat B, Fogel S, Parvaresh N, Sadeghi-Bazargani H, Lavasani FF, Ahmadi F, Ghasemi M, van den Heuvel MP, Duerden EG. Interoceptive dysfunction in psychiatric and neurological disorders: A meta-analysis of brain functional connectivity. Neurosci Biobehav Rev. 2023 Aug;152:104487. doi: 10.1016/j.neubiorev.2023.104487.DOI ↗Google Scholar ↗
  63. Paulus MP, Stein MB. An insular view of anxiety. Biol Psychiatry. 2006 Jul 15;60(4):383-387. doi: 10.1016/j.biopsych.2006.03.042.DOI ↗Google Scholar ↗
  64. Barrett LF, Quigley KS, Hamilton P. An active inference theory of allostasis and interoception in depression. Psychol Rev. 2016 Oct;123(4):425-451. doi: 10.1037/rev0000045.DOI ↗Google Scholar ↗
  65. Seth AK, Friston KJ. Predictive coding within interoceptive inference. Philos Trans R Soc Lond B Biol Sci. 2016 Nov 19;371(1708):20160007. doi: 10.1098/rstb.2016.0007.DOI ↗Google Scholar ↗
  66. Garfinkel SN, Critchley HD. Threat and the body: How the heart supports fear processing. Trends Cogn Sci. 2016 Feb;20(1):34-46. doi: 10.1016/j.tics.2015.10.005.DOI ↗Google Scholar ↗
  67. Quigley KS, Kanoski SE, Grill WM, Barrett LF. Allostasis and interoception: perspectives on self-regulation. Front Psychol. 2021 Mar 9; 12:619950. doi: 10.3389/fpsyg.2021.619950.DOI ↗Google Scholar ↗
  68. Porges SW. The polyvagal perspective. Biol Psychol. 2007 Feb;74(2):116-143. doi: 10.1016/j.biopsycho.2006.06.009.DOI ↗Google Scholar ↗
  69. Tsakiris M. The multisensory basis of the self: From body to identity to others. Q J Exp Psychol (Hove). 2017 Sep;70(4):597-609. doi: 10.1080/17470218.2016.1181768.DOI ↗Google Scholar ↗
  70. Farb NA, Segal ZV, Mayberg H, Bean J, McKeon D, Fatima Z, Anderson AK. Attending to the present: Mindfulness meditation reveals distinct neural modes of self-reference. Soc Cogn Affect Neurosci. 2007 Jun;2(4):313-322. doi: 10.1093/scan/nsm030.DOI ↗Google Scholar ↗
  71. Mechsner F. A psychological approach to human voluntary movements. J Mot Behav. 2004 Mar;36(4):355-370. doi: 10.3200/JMBR.36.4.355-370.DOI ↗Google Scholar ↗
  72. Critchley HD, Harrison NA. Visceral influences on brain and behavior. Neuron. 2013 May 22;77(4):624-638. doi: 10.1016/j.neuron.2013.02.008.DOI ↗Google Scholar ↗
  73. Khalsa SS, Lapidus RC. Can interoception improve the pragmatic search for biomarkers in psychiatry? Front Psychiatry. 2016 Jul 28;7:121. doi: 10.3389/fpsyt.2016.00121.DOI ↗Google Scholar ↗
  74. Seth AK. Interoceptive inference, emotion, and the embodied self. Trends Cogn Sci. 2013 Nov;17(11):565-573. doi: 10.1016/j.tics.2013.09.007.DOI ↗Google Scholar ↗
  75. Barrett LF. The theory of constructed emotion: An active inference account of interoception and categorization. Soc Cogn Affect Neurosci. 2017 Jan;12(1):1-23. doi: 10.1093/scan/nsw154.DOI ↗Google Scholar ↗
  76. Harshaw C. Interoception and the conditioning of appetitive behavior in infancy: Implications for obesity and addiction. Front Psychol. 2012 Nov 13;3:440. doi: 10.3389/fpsyg.2012.00440.DOI ↗Google Scholar ↗
  77. Damasio A, Carvalho GB. The nature of feelings: Evolutionary and neurobiological origins. Nat Rev Neurosci. 2013 Feb;14(2):143-152. doi: 10.1038/nrn3403.DOI ↗Google Scholar ↗
  78. Gendron M, Barrett LF. Reconstructing the past: A century of ideas about emotion in psychology. Emot Rev. 2009 Apr;1(4):316-339. doi: 10.1177/1754073909338877.DOI ↗Google Scholar ↗
  79. Petzschner FH, Weber LAE, Stephan KE, Gard T. Computational psychosomatics and psychiatry: Toward a joint framework for differential diagnosis. Biol Psychiatry. 2017 Aug 15;82(4):421-430. doi: 10.1016/j.biopsych.2017.05.012.DOI ↗Google Scholar ↗
  80. Craig AD. How do you feel? Interoception: The sense of the physiological condition of the body. Nat Rev Neurosci. 2002 Aug;3(8):655-666. doi: 10.1038/nrn894.DOI ↗Google Scholar ↗
  81. Critchley HD, Wiens S, Rotshtein P, Ohman A, Dolan RJ. Neural systems supporting interoceptive awareness. Nat Neurosci. 2004 Feb;7(2):189-195. doi: 10.1038/nn1176.DOI ↗Google Scholar ↗
  82. Garfinkel SN, Minati L, Gray MA, Seth AK, Dolan RJ, Critchley HD. Fear from the heart: Sensitivity to fear stimuli depends on individual heartbeats. J Neurosci. 2014 Nov 5;34(45):15118-15126. doi: 10.1523/JNEUROSCI.5134-13.2014.DOI ↗Google Scholar ↗
  83. Harrison NA, Gray MA, Gianaros PJ, Critchley HD. The embodiment of emotional feelings in the brain. J Neurosci. 2010 Dec 1;30(48):12878-12884. doi: 10.1523/JNEUROSCI.1726-10.2010.DOI ↗Google Scholar ↗
  84. Khalsa SS, Craske MG, Li W, Feusner JD, Biased DM, El-Gabalawy R, Nemeroff CB, Paulus MP. Predicting anxiety states with individual differences in interoceptive processing: An integrative model. Biol Psychiatry Cogn Neurosci Neuroimaging. 2023 Mar;8(3):345-357. doi: 10.1016/j.bpsc.2022.07.005.DOI ↗Google Scholar ↗
  85. Seth AK. Interoceptive inference, active inference, and the self. Trends Cogn Sci. 2021 Sep;25(9):726-739. doi: 10.1016/j.tics.2021.06.008.DOI ↗Google Scholar ↗
  86. Barrett LF. The theory of constructed emotion: Active inference and the experience of emotion. Curr Opin Psychol. 2017 Feb;17:115-120. doi: 10.1016/j.copsyc.2017.07.001.DOI ↗Google Scholar ↗
  87. Tsakiris M, Critchley H. Interoception beyond homeostasis: Affect, cognition, and mental health. Philos Trans R Soc Lond B Biol Sci. 2016 Nov 19;371(1708):20160002. doi: 10.1098/rstb.2016.0002.DOI ↗Google Scholar ↗
  88. Ainley V, Apps MAJ, Fotopoulou A, Tsakiris M. 'Bodily precision': A predictive coding account of individual differences in interoceptive accuracy. Philos Trans R Soc Lond B Biol Sci. 2016 Nov 19;371(1708):20160003. doi: 10.1098/rstb.2016.0003.DOI ↗Google Scholar ↗
  89. Quigley KS, Barrett LF. Is interoception an overlooked superpower for self-regulation? Curr Dir Psychol Sci. 2022 Oct;31(5):392-398. doi: 10.1177/09637214221109081.DOI ↗Google Scholar ↗
  90. Farb NA, Anderson AK, Mayberg H, Bean J, McKeon D, Segal ZV. Minding one's emotions: Mindfulness training alters the neural expression of sadness. Emotion. 2010 Oct;10(1):25-33. doi: 10.1037/a0017151.DOI ↗Google Scholar ↗
  91. Seth AK, Tsakiris M. The cybernetic brain: From interoceptive inference to self-awareness. Trends Cogn Sci. 2018 Oct;22(10):846-860. doi: 10.1016/j.tics.2018.07.015.DOI ↗Google Scholar ↗
  92. Porges SW. The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. New York: Norton; 2011.Google Scholar ↗
  93. Craig AD. Interoception: The sense of the physiological condition of the body. Curr Opin Neurobiol. 2003 Aug;13(4):500-505. doi: 10.1016/S0959-4388(03)00090-4.DOI ↗Google Scholar ↗
  94. Adolphs R, Anderson DJ. The neuroscience of emotion: A new synthesis. Princeton: Princeton University Press; 2018.Google Scholar ↗
  95. Gu X, Hof PR, Friston KJ, Fan J. Anterior insular cortex and emotional awareness. J Comp Neurol. 2013 May 20;521(15):3371-3388. doi: 10.1002/cne.23368.DOI ↗Google Scholar ↗
  96. Barrett LF. How emotions are made: The secret life of the brain. New York: Houghton Mifflin Harcourt; 2017.Google Scholar ↗
  97. Craig AD. How do you feel now? The anterior insula and human awareness. Nat Rev Neurosci. 2009 Jan;10(1):59-70. doi: 10.1038/nrn2555.DOI ↗Google Scholar ↗
  98. Seth AK. Being you: A new science of consciousness. New York: Dutton; 2021.Google Scholar ↗
  99. Critchley HD, Garfinkel SN. The influence of interoception on affective experience. Curr Opin Behav Sci. 2017 Aug;19:38-43. doi: 10.1016/j.cobeha.2017.07.010.DOI ↗Google Scholar ↗
  100. Barrett LF. The science of emotion: What people believe, what the evidence shows, and where to go from here. Emotion. 2017 Feb;17(3):431-436. doi: 10.1037/emo0000136.DOI ↗Google Scholar ↗
  101. Seth AK, Suzuki K, Critchley HD. An interoceptive predictive coding model of conscious presence. Front Psychol. 2012 Oct 15;2:395. doi: 10.3389/fpsyg.2011.00395.DOI ↗Google Scholar ↗
  102. Garfinkel SN, Eccles JA, Critchley HD. The extended autonomic network: Interoception and regulation of blood pressure. Front Neurosci. 2021 Mar 18;15:674120. doi: 10.3389/fnins.2021.674120.DOI ↗Google Scholar ↗
  103. Barrett LF, Quigley KS, Hamilton P. Interoception and emotion: The role of prediction and error correction. Trends Cogn Sci. 2016 Oct;20(10):495-496. doi: 10.1016/j.tics.2016.07.002.DOI ↗Google Scholar ↗
  104. Klabunde M, Acheson D, Boutelle K, Matthews SC, Kaye WH. Interoceptive sensitivity deficits in women recovered from bulimia nervosa. Eat Behav. 2013 Aug;14(3):488-492. doi: 10.1016/j.eatbeh.2013.09.002.DOI ↗Google Scholar ↗
  105. Paulus MP, Feinstein JS, Khalsa SS. An Active Inference Approach to Interoceptive Psychopathology. Annu Rev Clin Psychol. 2019 May 7;15:97-122. doi: 10.1146/annurev-clinpsy-050718-095634.DOI ↗Google Scholar ↗
  106. Porges SW, Doussard-Roosevelt JA, Maiti AK. Vagal tone and the physiological regulation of emotion. Monogr Soc Res Child Dev. 1994;59(2-3):167-186. doi: 10.1111/j.1540-5834.1994.tb01283.x.DOI ↗Google Scholar ↗
  107. Ainley V, Tsakiris M, Pollatos O, Herbert BM. The interplay between interoceptive awareness and emotional regulation. Front Psychol. 2014 Jul 8;5:531. doi: 10.3389/fpsyg.2014.00531.DOI ↗Google Scholar ↗
  108. Owens AP, Allen M, Ondobaka S, Friston KJ. Interoceptive inference: From computational neuroscience to clinic. Neurosci Biobehav Rev. 2018 Aug;90:174-183. doi: 10.1016/j.neubiorev.2018.04.017.DOI ↗Google Scholar ↗
  109. Critchley HD, Garfinkel SN. Mind, body, and the predictive brain. In: Barrett LF, Lewis M, Haviland-Jones JM, editors. Handbook of emotions. 4th ed. New York: Guilford Press; 2016. p. 64-77.Google Scholar ↗
  110. Seth AK, Tsakiris M. The multisensory basis of selfhood. Trends Cogn Sci. 2018 Jun;22(6):566-578. doi: 10.1016/j.tics.2018.03.013.DOI ↗Google Scholar ↗
  111. Damasio A. The feeling of what happens: Body and emotion in the making of consciousness. New York: Houghton Mifflin Harcourt; 1999.Google Scholar ↗
  112. Garfinkel SN, Manassei MF, Hamilton-Fletcher G, In den Bosch R, Critchley HD, Engels M. Interoceptive dimensions across cardiac and respiratory axes. Philos Trans R Soc Lond B Biol Sci. 2016 Nov 19;371(1708):20160014. doi: 10.1098/rstb.2016.0014.DOI ↗Google Scholar ↗
  113. Tsakiris M, Critchley HD. The neuropsychology of interoception: Current evidence and future directions. Curr Opin Psychol. 2017 Apr; 17:129-134. doi: 10.1016/j.copsyc.2017.06.014.DOI ↗Google Scholar ↗
  114. Barrett LF. Affective neuroscience: Science of the heart or science of the soul? Annu Rev Psychol. 2019 Jan 4;70:1-24. doi: 10.1146/annurev-psych-122216-011521.DOI ↗Google Scholar ↗
  115. Sterling P. Predictive regulation and human design. Front Hum Neurosci. 2012 Oct 15;6:307. doi: 10.3389/fnhum.2012.00307.DOI ↗Google Scholar ↗
  116. Farb NA, Segal ZV, Anderson AK. The mindful brain and emotion regulation in mood disorders. Can J Psychiatry. 2013 Feb;58(2):70-77. doi: 10.1177/070674371305800203.DOI ↗Google Scholar ↗
  117. Seth AK, Critchley HD. Extending predictive processing to the mind, self, and consciousness. Trends Cogn Sci. 2016 Nov;20(11):763-764. doi: 10.1016/j.tics.2016.09.013.DOI ↗Google Scholar ↗
  118. Craig AD. Topographically organized projection to the limbic forebrain from the posterior thalamic region in the rat. J Comp Neurol. 1993 May 8;337(1):143-155. doi: 10.1002/cne.903370110.DOI ↗Google Scholar ↗
  119. Pollatos O, Traut-Mattausch E, Schandry R. Differential effects of anxiety and depression on interoceptive accuracy. Depress Anxiety. 2009;26(2):167-173. doi: 10.1002/da.20504.DOI ↗Google Scholar ↗
  120. Garfinkel SN, Tiley C, O’Keeffe S, Harrison NA, Seth AK, Critchley HD. Discrepancies between dimensions of interoception in autism: Implications for emotion and anxiety. Biol Psychol. 2016 Jan; 114:117-126. doi: 10.1016/j.biopsycho.2015.12.003.DOI ↗Google Scholar ↗
  121. Owens AP, Allen M, Ondobaka S, Friston KJ. Interoceptive inference: From computational neuroscience to clinic. Neurosci Biobehav Rev. 2018 Aug; 90:174-183. doi: 10.1016/j.neubiorev.2018.04.017.DOI ↗Google Scholar ↗
  122. Tsakiris M, De Preester H, editors. The interoceptive mind: From homeostasis to awareness. Oxford: Oxford University Press; 2018.Google Scholar ↗
  123. Murphy J, Brewer R, Catmur C, Bird G. Developmental perspectives on interoception and self-representation. Dev Cogn Neurosci. 2020 Apr; 44:100783. doi: 10.1016/j.dcn.2020.100783.DOI ↗Google Scholar ↗
  124. Park HD, Tallon-Baudry C. Spontaneous fluctuations in neural responses to heartbeats predict visual detection. Nat Neurosci. 2014 Jul;17(4):612-618. doi: 10.1038/nn.3671.DOI ↗Google Scholar ↗
  125. Khalsa SS, Rudrauf D, Sandesara R, Olshansky B, Tranel D. Bolstering cardiac regulation through interoceptive training. Auton Neurosci. 2022 Apr; 236:102898. doi: 10.1016/j.autneu.2022.102898.DOI ↗Google Scholar ↗
  126. Azzalini D, Rebollo I, Tallon-Baudry C. Visceral signals shape brain dynamics and cognition. Trends Cogn Sci. 2019 Jun;23(6):488-509. doi: 10.1016/j.tics.2019.03.007.DOI ↗Google Scholar ↗
  127. Pollatos O, Kirsch W, Schandry R. Brain structures involved in interoceptive awareness and cardiovascular reactivity: A functional magnetic resonance imaging study. Neurosci Lett. 2005 May 6;382(1-2):89-93. doi: 10.1016/j.neulet.2005.02.043.DOI ↗Google Scholar ↗
  128. Suzuki K, Garfinkel SN, Critchley HD, Seth AK. Multisensory integration across interoceptive and exteroceptive domains modulates self-experience in the rubber-hand illusion. Neuropsychologia. 2013 Sep;51(13):2909-2917. doi: 10.1016/j.neuropsychologia.2013.08.014.DOI ↗Google Scholar ↗
  129. Herbert BM, Ulbrich P, Schandry R. Interoceptive sensitivity and physical activity. J Sports Sci. 2007 Jan;25(9):1027-1033. doi: 10.1080/02640410600843026.DOI ↗Google Scholar ↗
  130. Marshall TR, Gentsch A, Schütz-Bosbach S. Interoceptive cardiac rhythms influence perceptual and cognitive processes. J Cogn Neurosci. 2018 Oct;30(9):1207-1221. doi: 10.1162/jocn_a_01263.DOI ↗Google Scholar ↗
Author details
Larissa Medeiros Maia Leão
Undergraduate Student, Medical School, Faculdade de Ciências Médicas da Paraíba-AFYA, Paraíba/PB, Brazil; Scientific Initiation Program at Faculdade de Ciências Médicas da Paraíba/PB-AFYA.
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Amalia Cinthia Meneses Rêgo
Institute of Teaching, Research, and Innovation, Liga Contra o Câncer - Natal - Brazil; Full Professor of the Postgraduate Program in Biotechnology at Potiguar University, Potiguar University (UnP) - Natal/RN - Brazil.
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Irami Araújo-Filho
Institute of Teaching, Research, and Innovation, Liga Contra o Câncer - Natal - Brazil; Full Professor of the Postgraduate Program in Biotechnology at Potiguar University, Potiguar University (UnP) - Natal/RN - Brazil. Full Professor, Department of Surgery, Potiguar University. Ph.D. in Health Science/ Natal-RN - Brazil.
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