Why is interoception (feeling your body) such an important aspect of trauma healing?

“Our bodies know that they belong; it is our minds that make our lives so homeless.” - John O'Donohue

The core of the self is bodily. Severe trauma is felt in the “totality of self, which includes the body” Meares (2005).

Traumatic memories are recorded largely in a bodily way, as affects, sensory impressions and impulses to act (Howell, 2020) rather than narratives. Trauma results in a loss of the stream of consciousness, whereby we lose reflective process and become aware only of the traumatizer and the affective sensations in the body, such as a beating heart and constricting gut. When contextual cues trigger memories of similar traumatic events, we’re not always aware they are memories and they can be re-experienced as present events in the body. The traumatic memory system is deeply embodied and ‘remembered’ without words (Shapiro, 2001; Heim et al., 2023).

The nuanced complexities of the body and nervous system tell a story about how one learned to adapt and survive within early relationships. There is growing evidence that interoception develops initially in the attachment relationship and that childhood trauma shapes the development of neural circuits responsible for body feeling. Incremental trauma affects both the strength of interoceptive signals and how these signals are perceived (Shapiro, 2001). Modern neuroscience finds that trauma interferes with functioning of brain areas that manage and interpret experience including the insula and HPA axis (Van der Kolk, 2014).

Traumatic experiences create altered neurobiology as described as a dorsal vagal response by Stephen Porges in his polyvagal theory, a hypoaroused “dissociative” response by Allan Schore, “tonic immobility” by Bruce Perry and “total submission” by Van der Hart and colleagues. In early, severe or chronic trauma, these responses become more pronounced and change the nervous system (Howell, 2020).

Understandably, the body keeps the score. As described by Bessel van der Kolk, traumatised people chronically feel unsafe inside their bodies. Their bodies are constantly bombarded by visceral warning signs, and in an attempt to control these processes, they often become expert at ignoring their gut feelings and in numbing awareness of what is played out inside. They learn to hide from their selves.

It would seem that the ability to reliably detect inner body signals can be blocked, absent or compromised as a consequence of surviving overwhelming experiences, including early social experiences. Our interoceptive capacity grows in safe relationship and our ability to feel in our bodies is disrupted when we are unfelt, unseen or harmed in relationship.

Hiding, dissociating or disconnecting from the felt sense of the body is understandable when an environment is unsafe, and when one’s own body sensations are intolerable, alienating or uncontrollable. As trauma survivors have described, their senses had to become remarkably perceptive and vigilant to nuanced threats in the outer environment (exteroception) in an attempt to protect themselves from further harm.

… listening attentively for the sound of footsteps.

… the sound of a car driving up the driveway.

… subtle changes in facial expression or tone of voice of a caregiver.

When exposed to threatening events, the brain and body learn to look outwards, literally and figuratively hiding.

However even when the threat is over, our bodies can continue to fire. The sound of that car sends the body into panic. And if the brain is organised to turn towards the external environment, the ability to turn towards cues in ones inner environment can, and often becomes compromised. One of the common coping patterns of being human is to disconnect or dissociate.

This process of disconnecting can be a brilliant coping mechanism during periods of overwhelm. When events happen that feel unsafe and threatening, we naturally turn outwards and disconnect from our inner world. We become hyper-vigilant or externally oriented to sources of threat in order to protect ourselves. However, in the process of protecting ourselves, we detach from the sensations of our own body. 

This pattern can be a response to both external threats, and to threats within ones own body. Disconnecting from the felt sense of the body also happens when sensations of the body are intolerable. When these conditions happen repeatedly or are unpredictable, interoceptive capacity can be in an “off” state. This is referred to as dissociation. For very good reason, the felt sense of the body is turned off.

How can we expect people to successfully engage in talk therapy when they disconnect from their inner experiences and have difficulty tolerating affect elicited by traumatic memories? That’s why interoceptively attuned psychotherapy and somatic approaches can play a pivitol role in the conversation by fostering a new language and an experiential or embodied self in safe relationship.

What is interoception?

Interoception is the awareness of our subtle sensory, body-based feelings. It lets us know when we’re hungry or thirsty, and when we need a break due to feeling pain or overwhelm. It lets us know, sometimes subtlety, when we need to regulate or find balance in our breath or body tissues. Interoception also relates to how we interpret feelings from our bodies that determine our mood, sense of well-being and emotions. When we can reliably detect the cues from within our body we take care of ourselves.

This bi-directional and body-based influence in emotion has been found to be relevant in the treatment of trauma. Research evidence has found disrupted interoception (the sensing, awareness and regulation of internal body signals) across several mental disorders including post-traumatic stress disorder (PTSD), dissociative disorders and borderline personality disorder (Heim et al, 2023).

While disconnection has a useful purpose when overwhelmed, by re-connecting and becoming aware of the body we can notice and make choices based on an embodied felt sense. Research shows that interoception influences many areas of health such as self care, body awareness, embodied cognition, emotional regulation and social participation. By connecting with our inner body sensations, we can connect with ourselves. We can identify emotions, become more aware, show greater attunement with others, make choices based on how we feel and heighten our resiliency. Interoception is also connected with intuition, the felt sense of what feels “right” for us.

Learning to be in the body and to gradually build interoceptive capacity seems to me to be an antidote to dissociation and can become a pathway to awareness, resiliency and healing.

When does interoceptive capacity become compromised?

• Those who have had to be on ‘alert’ to sources of threat outside of themselves will learn to turn away from needs inside.

• Those who’s needs are consistently unmet will learn their needs are not worth turning towards.

• Those who learn that having needs will make others angry or upset will learn to suppress their needs.

If you’re not aware of what you need, it becomes hard to care for yourself.

If you don’t feel thirsty you won’t replenish yourself.

If you can’t feel when you’re full you’ll keep eating.

If you can’t feel when it’s too much you’ll keep going, maybe even getting hurt in the process.

If you don’t feel that inner intuitive knowing of ‘stay away from this person’ you might get too close.

That is why building interoceptive capacity can be a useful, almost essential aspect of trauma healing and recovery.

How to cultivate interoception

Just like we can train our physical body, we can train our brain to bring awareness within. We can re-build a sense of feeling in a safe, tolerable way.

Cultivating interoception is a practice of noticing and slowly tolerating body sensations. By noticing sensation purely as sensation and not connected with past threats, we begin to trust in our body as safe and reliable rather than something to be avoided or unwanted. Building inner awareness of body sensation fosters self regulation, or the ability to have greater control over our inner state.

Trauma Sensitive Yoga is an opportunity to practice re-connecting with the felt sense of the body and building interoceptive capacity. Through gentle, choice-based facilitation, we practice noticing sensations within our bodies and making choices based on how we feel.

Over the last two years facilitating TC-TSY group therapy for survivors of sexual abuse and in my therapy practice, I have heard that the practice of noticing sensation, while uncomfortable at first, can be empowering and deeply healing.

Body-based therapeutic practices can help to link the brain and body with a greater capacity, bit by bit, to notice sensation in a way that feels safe and manageable. This is not to say that noticing sensation is easy. While best attempts are made to create conditions for safe exploration, at times, any asana or movement of the body such as opening of the pelvis or hips could lead to panic or even flashbacks. This is why working with interoception requires a personalised, gentle approach where the intensity of the noticing practice is cultivated gradually and at your own pace.

By noticing the physiological sensations created by a strong form such as a warrior, you experience how sensation has a beginning, a middle and an end. By trusting what you sense as it arises, and making choices with your body, you build neural pathways in body, mind and brain that can heal the impacts of trauma.

By experimenting with feeling and being with sensation, our sense of self becomes more firmly rooted in a connection with our bodies.

You’re welcome to get in touch if this resonates for you.