Interoception refers to awareness, interpretation, and integration of sensations in the body. While interoceptive accuracy has long been regarded as a core component of emotional experience, less is known about the relationship of interoceptive accuracy and related facets of interoception to emotion regulation deficits. This study explores how interoceptive accuracy and interoceptive sensibility relate to emotion regulation in a non-clinical sample.
Undergraduate participants completed a heartbeat perception task and the Multidimensional Assessment of Interoceptive Awareness (Noticing and Body Listening sub-scales), and rated their confidence in performance on the heartbeat perception task. Participants also completed self-report measures of emotional awareness and regulation (Profile of Emotional Competence, intrapersonal emotion identification and emotion regulation sub-scales), and rated their use of different coping strategies (Brief COPE).
Noticing predicted emotion identification, emotion regulation, and the use of adaptive but not maladaptive coping strategies. Heartbeat perception accuracy did not significantly contribute to the prediction of any outcome variables.
Future work is needed to extend these findings to clinical populations. The results from this study support the use of interoceptive training interventions to promote emotional wellbeing.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
Aldao, A., Gee, D. G., De Los Reyes, A., & Seager, I. (2016). Emotion regulation as a transdiagnostic factor in the development of internalizing and externalizing psychopathology: current and future directions. Devlopment and Psychopathology,28(4pt1), 927–946. https://doi.org/10.1017/s0954579416000638.
Beck, A. T. (1993). Cognitive therapy: past, present, and future. Journal of Consulting and Clinical Psychology,61(2), 194.
Betka, S., Pfeifer, G., Garfinkel, S., Prins, H., Bond, R., Sequeira, H., et al. (2018). how do self-assessment of alexithymia and sensitivity to bodily sensations relate to alcohol consumption? Alcoholism, Clinical and Experimental Research,42(1), 81–88. https://doi.org/10.1111/acer.13542.
BIOPAC (1997). BIOPAC MP100 psychophysiological data acquisition system: BIOPAC Systems, Inc.
Bornemann, B., Herbert, B. M., Mehling, W. E., & Singer, T. (2014). Differential changes in self-reported aspects of interoceptive awareness through 3 months of contemplative training. Frontiers in Psychology,5, 1504. https://doi.org/10.3389/fpsyg.2014.01504.
Brasseur, S., Grégoire, J., Bourdu, R., & Mikolajczak, M. (2013). The profile of emotional competence (PEC): development and validation of a self-reported measure that fits dimensions of emotional competence theory. PLoS ONE,8(5), e62635. https://doi.org/10.1371/journal.pone.0062635.
Cali, G., Ambrosini, E., Picconi, L., Mehling, W. E., & Committeri, G. (2015). Investigating the relationship between interoceptive accuracy, interoceptive awareness, and emotional susceptibility. Frontiers in Psychology,6, 1202. https://doi.org/10.3389/fpsyg.2015.01202.
Carver, C. S. (1997). You want to measure coping but your protocol is too long: consider the brief cope. International Journal of Behavioral Medicine,4(1), 92.
Ceunen, E., Van Diest, I., & Vlaeyen, J. W. (2013). Accuracy and awareness of perception: related, yet distinct (commentary on Herbert et al., 2012). Biological Psychology,92(2), 426–427. https://doi.org/10.1016/j.biopsycho.2012.09.012.
Coffey, E., Berenbaum, H., & Kerns, J. (2003). Brief report. Cognition and Emotion,17(4), 671–679. https://doi.org/10.1080/02699930302304.
Craig, A. (2002). How do you feel? Interoception: the sense of the physiological condition of the body. Nature Reviews Neuroscience,3(8), 655. https://doi.org/10.1038/nrn894.
Craig, A. (2008). Interoception and emotion: a neuroanatomical perspective. Handbook of Emotions,3(602), 272–288.
Craske, M. G., Lang, A. J., Tsao, J. C., Mystkowski, J. L., & Rowe, M. K. (2001). Reactivity to interoceptive cues in nocturnal panic. Journal of Behavior Therapy and Experimental Psychiatry,32(3), 173–190.
Damasio, A. R. (1996). The somatic marker hypothesis and the possible functions of the prefrontal cortex. Philosophical Transactions of the Royal Society of London B Series,351(1346), 1413–1420.
Dunn, B. D., Stefanovitch, I., Evans, D., Oliver, C., Hawkins, A., & Dalgleish, T. (2010). Can you feel the beat? Interoceptive awareness is an interactive function of anxiety- and depression-specific symptom dimensions. Behaviour Research and Therapy,48(11), 1133–1138. https://doi.org/10.1016/j.brat.2010.07.006.
Dworkin, B. R. (2007). Interoception. In J. T. Cacioppo, L. G. Tassinary, & G. G. Berntson (Eds.), Handbook of psychophysiology (pp. 482–506). UK: Cambridge University Press. https://doi.org/10.1017/CBO9780511546396.021.
Ehlers, A. (1998). Why Van der Does, Van Dyck and Spinhoven (1997) did not demonstrate that superior heartbeat perception in panic disorder is partly an artefact. Journal of Affective Disorders,49(3), 241–247.
Ehlers, A., & Breuer, P. (1992). Increased cardiac awareness in panic disorder. Journal of Abnormal Psychology,101(3), 371–382.
Ehlers, A., Breuer, P., Dohn, D., & Fiegenbaum, W. (1995). Heartbeat perception and panic disorder: Possible explanations for discrepant findings. Behaviour Research and Therapy,33(1), 69–76.
Ernst, J., Boker, H., Hattenschwiler, J., Schupbach, D., Northoff, G., Seifritz, E., et al. (2014). The association of interoceptive awareness and alexithymia with neurotransmitter concentrations in insula and anterior cingulate. Social Cognitive and Affective Neuroscience,9(6), 857–863. https://doi.org/10.1093/scan/nst058.
Fairclough, S. H., & Goodwin, L. (2007). The effect of psychological stress and relaxation on interoceptive accuracy: implications for symptom perception. Journal of Psychosomatic Research,62(3), 289–295. https://doi.org/10.1016/j.jpsychores.2006.10.017.
Farb, N., Daubenmier, J., Price, C. J., Gard, T., Kerr, C., Dunn, B. D., et al. (2015). Interoception, contemplative practice, and health. Frontiers in Psychology,6, 763. https://doi.org/10.3389/fpsyg.2015.00763.
Faul, F., Erdfelder, E., Lang, A.-G., & Buchner, A. (2007). G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods,39(2), 175–191.
Fischer, D., Messner, M., & Pollatos, O. (2017). Improvement of interoceptive processes after an 8-week body scan intervention. Frontiers in Human Neuroscience,11, 452. https://doi.org/10.3389/fnhum.2017.00452.
Fissler, M., Winnebeck, E., Schroeter, T., Gummersbach, M., Huntenburg, J. M., Gaertner, M., et al. (2016). An investigation of the effects of brief mindfulness training on self-reported interoceptive awareness, the ability to decenter, and their role in the reduction of depressive symptoms. Mindfulness,7(5), 1170–1181.
Forkmann, T., Scherer, A., Meessen, J., Michal, M., Schachinger, H., Vogele, C., et al. (2016). Making sense of what you sense: Disentangling interoceptive awareness, sensibility and accuracy. International Journal of Psychophysiology,109, 71–80. https://doi.org/10.1016/j.ijpsycho.2016.09.019.
Furman, D. J., Waugh, C. E., Bhattacharjee, K., Thompson, R. J., & Gotlib, I. H. (2013). Interoceptive awareness, positive affect, and decision making in major depressive disorder. Journal of Affective Disorders,151(2), 780–785. https://doi.org/10.1016/j.jad.2013.06.044.
Füstös, J., Gramann, K., Herbert, B. M., & Pollatos, O. (2013). On the embodiment of emotion regulation: interoceptive awareness facilitates reappraisal. Social Cognitive and Affective Neuroscience,8(8), 911–917. https://doi.org/10.1093/scan/nss089.
Garfinkel, S. N., Seth, A. K., Barrett, A. B., Suzuki, K., & Critchley, H. D. (2015). Knowing your own heart: distinguishing interoceptive accuracy from interoceptive awareness. Biological Psychology,104, 65–74. https://doi.org/10.1016/j.biopsycho.2014.11.004.
Gross, J. J., & John, O. P. (2003). Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. Journal of Personality and Social Psychology,85(2), 348–362.
Gunther, V., Rufer, M., Kersting, A., & Suslow, T. (2016). Predicting symptoms in major depression after inpatient treatment: the role of alexithymia. Nordic Journal of Psychiatry,70(5), 392–398. https://doi.org/10.3109/08039488.2016.1146796.
Herbert, B. M., Herbert, C., & Pollatos, O. (2011). On the relationship between interoceptive awareness and alexithymia: is interoceptive awareness related to emotional awareness? Journal of Personality,79(5), 1149–1175. https://doi.org/10.1111/j.1467-6494.2011.00717.x.
Herbert, B. M., Muth, E. R., Pollatos, O., & Herbert, C. (2012). Interoception across modalities: on the relationship between cardiac awareness and the sensitivity for gastric functions. PLoS ONE,7(5), e36646. https://doi.org/10.1371/journal.pone.0036646.
Herbert, B. M., & Pollatos, O. (2012). The body in the mind: on the relationship between interoception and embodiment. Topics in Cognitive Science,4(4), 692–704. https://doi.org/10.1111/j.1756-8765.2012.01189.x.
Herbert, B. M., & Pollatos, O. (2014). Attenuated interoceptive sensitivity in overweight and obese individuals. Eating Behaviors,15(3), 445–448. https://doi.org/10.1016/j.eatbeh.2014.06.002.
IBM Corp. Released 2016. IBM SPSS Statistics for Windows, Version 24.0. NY: IBM Corp.
James, W. (1884). What is an emotion? Mind,9(34), 188–205.
Kever, A., Pollatos, O., Vermeulen, N., & Grynberg, D. (2015). Interoceptive sensitivity facilitates both antecedent-and response-focused emotion regulation strategies. Personality and Individual Differences,87, 20–23.
Khalsa, S. S., Adolphs, R., Cameron, O. G., Critchley, H. D., Davenport, P. W., Feinstein, J. S., et al. (2018). Interoception and mental health: a roadmap. Biological Psychiatry Cognitive Neuroscience and Neuroimaging,3(6), 501–513. https://doi.org/10.1016/j.bpsc.2017.12.004.
Knoll, J. F., & Hodapp, V. (1992). A comparison between two methods for assessing heartbeat perception. Psychophysiology,29(2), 218–222.
Lackner, R. J., & Fresco, D. M. (2016). Interaction effect of brooding rumination and interoceptive awareness on depression and anxiety symptoms. Behaviour Research and Therapy,85, 43–52. https://doi.org/10.1016/j.brat.2016.08.007.
Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. USA: Springer Publishing Company.
Leweke, F., Leichsenring, F., Kruse, J., & Hermes, S. (2012). Is alexithymia associated with specific mental disorders? Psychopathology,45(1), 22–28. https://doi.org/10.1159/000325170.
Limmer, J., Kornhuber, J., & Martin, A. (2015). Panic and comorbid depression and their associations with stress reactivity, interoceptive awareness and interoceptive accuracy of various bioparameters. Journal of Affective Disorders,185, 170–179. https://doi.org/10.1016/j.jad.2015.07.010.
Lumley, M. A., Neely, L. C., & Burger, A. J. (2007). The assessment of alexithymia in medical settings: implications for understanding and treating health problems. Journal of Personality Assessment,89(3), 230–246. https://doi.org/10.1080/00223890701629698.
Mahmoud, J. S., Staten, R., Hall, L. A., & Lennie, T. A. (2012). The relationship among young adult college students’ depression, anxiety, stress, demographics, life satisfaction, and coping styles. Issues in Mental Health Nursing,33(3), 149–156. https://doi.org/10.3109/01612840.2011.632708.
Mallorquí-Bagué, N., Garfinkel, S. N., Engels, M., Eccles, J. A., Pailhez, G., Bulbena, A., et al. (2014). Neuroimaging and psychophysiological investigation of the link between anxiety, enhanced affective reactivity and interoception in people with joint hypermobility. Frontiers in Psychology,5, 1162. https://doi.org/10.3389/fpsyg.2014.01162.
Mehling, W. (2016). Differentiating attention styles and regulatory aspects of self-reported interoceptive sensibility. Philosophical Transactions of the Royal Society of London Series B Biological Science,371(1708), 20160013. https://doi.org/10.1098/rstb.2016.0013.
Mehling, W. E., Acree, M., Stewart, A., Silas, J., & Jones, A. (2018). The Multidimensional Assessment of Interoceptive Awareness, Version 2 (MAIA-2). PLoS ONE,13(12), e0208034. https://doi.org/10.1371/journal.pone.0208034.
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. https://doi.org/10.1371/journal.pone.0048230.
Murphy, J., Brewer, R., Hobson, H., Catmur, C., & Bird, G. (2018). Is alexithymia characterised by impaired interoception? Further evidence, the importance of control variables, and the problems with the heartbeat counting task. Biological Psychology,136, 189–197. https://doi.org/10.1016/j.biopsycho.2018.05.010.
Murphy, J., Catmur, C., & Bird, G. (2019). Classifying individual differences in interoception: Implications for the measurement of interoceptive awareness. Psychonomic Bulletin and Review,26(5), 1467–1471. https://doi.org/10.3758/s13423-019-01632-7.
Palser, E. R., Fotopoulou, A., Pellicano, E., & Kilner, J. M. (2020). Dissociation in how core autism features relate to interoceptive dimensions: evidence from cardiac awareness in children. Journal of Autism Developmental Disorders,50, 572–582. https://doi.org/10.1007/s10803-019-04279-4.
Palser, E. R., Fotopoulou, A., Pellicano, E., & Kilner, J. M. (2018). The link between interoceptive processing and anxiety in children diagnosed with autism spectrum disorder: extending adult findings into a developmental sample. Biological Psychology,136, 13–21. https://doi.org/10.1016/j.biopsycho.2018.05.003.
Pollatos, O., Kurz, A. L., Albrecht, J., Schreder, T., Kleemann, A. M., Schopf, V., et al. (2008). Reduced perception of bodily signals in anorexia nervosa. Eating Behaviors,9(4), 381–388. https://doi.org/10.1016/j.eatbeh.2008.02.001.
Pollatos, O., Traut-Mattausch, E., & Schandry, R. (2009). Differential effects of anxiety and depression on interoceptive accuracy. Depress Anxiety,26(2), 167–173. https://doi.org/10.1002/da.20504.
Porges, S. (1993). Body perception questionnaire. Laboratory of Developmental Assessment: University of Maryland.
Price, C. J., & Hooven, C. (2018). Interoceptive awareness skills for emotion regulation: theory and approach of mindful awareness in body-oriented therapy (MABT). Frontiers Psychology,9, 798. https://doi.org/10.3389/fpsyg.2018.00798.
Price, C. J., & Thompson, E. A. (2007). Measuring dimensions of body connection: body awareness and bodily dissociation. Journal of Alternative and Complementary Medicine,13(9), 945–953. https://doi.org/10.1089/acm.2007.0537.
Quintana, D. S., Guastella, A. J., Outhred, T., Hickie, I. B., & Kemp, A. H. (2012). Heart rate variability is associated with emotion recognition: direct evidence for a relationship between the autonomic nervous system and social cognition. International Journal of Psychophysiology,86(2), 168–172. https://doi.org/10.1016/j.ijpsycho.2012.08.012.
Ring, C., & Brener, J. (1996). Influence of beliefs about heart rate and actual heart rate on heartbeat counting. Psychophysiology,33(5), 541–546.
Schachter, S., & Singer, J. (1962). Cognitive, social, and physiological determinants of emotional state. Psychological Review,69(5), 379.
Schandry, R. (1981). Heart beat perception and emotional experience. Psychophysiology,18(4), 483–488.
Schultchen, D., Zaudig, M., Krauseneck, T., Berberich, G., & Pollatos, O. (2019). Interoceptive deficits in patients with obsessive–compulsive disorder in the time course of cognitive-behavioral therapy. PLoS ONE,14(5), e0217237.
Schwerdtfeger, A. R., Heene, S., & Messner, E. M. (2019). Interoceptive awareness andperceived control moderate the relationship between cognitive reappraisal, self-esteem, and cardiac activity in daily life. International Journal of Psychophysiology,141, 84–92.
Sherrington, C. S. (1909). The integrative action of the nervous system: CUP Archive.
Störmer, S. W., Heiligtag, U., & Knoll, J. F. (1989). Heartbeat detection and knowledge of results: a new method and some theoretical thoughts. Journal of Psychophysiology.,3(4), 409–417.
Van der Does, A. J., Van Dyck, R., & Spinhoven, P. (1997). Accurate heartbeat perception in panic disorder: fact and artefact. Journal of Affective Disorders,43(2), 121–130.
Van Dyck, Z., Vögele, C., Blechert, J., Lutz, A. P., Schulz, A., & Herbert, B. M. (2016). The water load test as a measure of gastric interoception: development of a two-stage protocol and application to a healthy female population. PLoS ONE,11(9), e0163574.
Weiss, S., & Pollatos, O. (2014). Ocd and interoception. European Health Psychologist,16(S), 325.
Wiebking, C., Bauer, A., De Greck, M., Duncan, N. W., Tempelmann, C., & Northoff, G. (2010). Abnormal body perception and neural activity in the insula in depression: an fMRI study of the depressed “material me”. The World Journal of Biological Psychiatry,11(3), 538–549.
Wiens, S. (2005). Interoception in emotional experience. Current Opinion in Neurology,18(4), 442–447.
Williams, D. P., Cash, C., Rankin, C., Bernardi, A., Koenig, J., & Thayer, J. F. (2015). Resting heart rate variability predicts self-reported difficulties in emotion regulation: a focus on different facets of emotion regulation. Frontiers in Psychology,6, 261. https://doi.org/10.3389/fpsyg.2015.00261.
Yoris, A., Esteves, S., Couto, B., Melloni, M., Kichic, R., Cetkovich, M., et al. (2015). The roles of interoceptive sensitivity and metacognitive interoception in panic. Behavioral and Brain Functions,11, 14. https://doi.org/10.1186/s12993-015-0058-8.
Zamariola, G., Frost, N., Van Oost, A., Corneille, O., & Luminet, O. (2019a). Relationship between interoception and emotion regulation: new evidence from mixed methods. Journal of Affective Disorders,246, 480–485. https://doi.org/10.1016/j.jad.2018.12.101.
Zamariola, G., Luminet, O., Mierop, A., & Corneille, O. (2019b). Does it help to feel your body? Evidence is inconclusive that interoceptive accuracy and sensibility help cope with negative experiences. Cognition and Emotion,1, 12. https://doi.org/10.1080/02699931.2019.1591345.
Zucker, N. L., Merwin, R. M., Bulik, C. M., Moskovich, A., Wildes, J. E., & Groh, J. (2013). Subjective experience of sensation in anorexia nervosa. Behaviour Research and Therapy,51(6), 256–265. https://doi.org/10.1016/j.brat.2013.01.010.
Zucker, N., Mauro, C., Craske, M., Wagner, H. R., Datta, N., Hopkins, H., et al. (2017). Acceptance-based interoceptive exposure for young children with functional abdominal pain. Behaviour Research and Therapy,97, 200–212. https://doi.org/10.1016/j.brat.2017.07.009.
We would like to acknowledge the support of the undergraduate research assistants, Sophie Bell and Iris Yang, who helped to collect this data.
This study was not funded.
Conflict of interest
Authors Stephanie Schuette, Nancy Zucker and Moria Smoski declare that they have no conflicts of interest.
Research involving human participants
All procedures performed in this study involving human participants were in accordance with the ethical standards of the Duke University Campus Institutional Review Board (Protocol 2018-0291) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Schuette, S.A., Zucker, N.L. & Smoski, M.J. Do interoceptive accuracy and interoceptive sensibility predict emotion regulation?. Psychological Research (2020). https://doi.org/10.1007/s00426-020-01369-2