Interoceptive training in clinical practice

Four clinical vignettes assembled in Farb et al. (2015) as examples of dysfunctional interoceptive integration and its remediation — presented together because they share the common thread of restoring tolerated access to interoceptive signals under skillful guidance, rather than avoidance or catastrophic reactivity.

Interpersonal/sexual trauma

Women with a history of interpersonal sexual violence, treated with Mindful Awareness in Body-oriented Therapy (MABT; Price 2005, 2007), learn to engage perceptual-inference: recognizing when sensory cues of dissociation are emotionally triggered, and maintaining awareness of the body rather than dissociating into habitual active-regulatory avoidance. Outcomes reported: bodies experienced as informative resources rather than threat, greater safety, improved intimate engagement without dissociation, and wholeness/empowerment. It remains undetermined whether this reflects a direct increase in interoceptive accuracy or other taxonomy elements (sensitivity, regulation) — see interoceptive-taxonomy.

Chronic pain

The standard approach (cognitive reframing + attentional distraction) is questioned: chronic pain pathology may involve fear-conditioned interoceptive avoidance that distraction reinforces rather than challenges (Zaman et al. 2015). interoceptive-exposure is offered as an alternative, alongside yoga (associated with decreased prefrontal activity and improved pain tolerance; Villemure et al. 2013).

Substance use disorder

Women in substance-use treatment taught to connect physiological and emotional distress report increased capacity to attend to and negotiate emotional stress, facilitating sobriety (Bowen et al. 2007; Price et al. 2012b) — interoceptive awareness reframed as a self-care resource rather than a trigger to be numbed.

Anorexia nervosa — an explicit caution

Unlike the other three cases, anorexia is flagged as a case where naive application of interoceptive training can backfire: patients often hold powerful associations between bodily-state awareness (linked to starvation) and a “doing” mode focused on controlling eating, shape, and weight. Bringing awareness to the body is initially met with an increase, not decrease, in maladaptive behavior. The paper is explicit that skillful, condition-specific guidance is necessary before advocating body-awareness interventions in this population — a direct counter-example to any assumption that “more interoceptive awareness is always better.”