Interoception: The ‘Sixth Sense’ That Could Transform Mental-Health Care

By the time Maggie May, an Arkansas woman in her 30s (name changed), entered a psychiatric clinic in 2024, she had long struggled with atypical anorexia nervosa—severe food restriction and distorted body image. Conventional psychotherapy and nutritional counseling had not helped. She enrolled in a trial that combined talk therapy with sensory deprivation to strengthen awareness of internal bodily signals, a capacity known as interoception.

What Is Interoception?

Interoception refers to the brain’s ability to sense and interpret internal bodily signals: heartbeats, breathing, gut rhythms, temperature, and other visceral cues. People differ in how accurately they perceive these signals, how confident they are about those perceptions, and how well their confidence matches actual performance. Growing evidence suggests that interoceptive processing is intimately linked to emotion, decision-making and mental health.

From Theory to Experiments

The idea that bodily sensations shape emotion dates back to the 19th-century James–Lange theory, which proposed that emotions follow physiological reactions. Modern experiments built on that idea: in the 1980s researchers provoked panic-like responses with carbon-dioxide inhalation or drugs that increase heart rate. In the early 1990s Anke Ehlers reported that people with panic disorder could perceive heartbeats more readily than controls—suggesting heightened internal attention could worsen symptoms.

Key Mechanisms: Prediction and Ambiguity

Neuroscientists increasingly view the brain as a prediction machine that uses prior knowledge to interpret incoming signals. Because internal signals are often ambiguous, the brain’s expectations strongly shape how we experience them. Misguided predictions—mistaking normal heart variability for dangerous racing, or interpreting hunger as disgust—may contribute to anxiety, eating disorders and other conditions.

Measuring Interoception: Accuracy, Sensibility, Awareness

In 2015 Sarah Garfinkel and colleagues proposed a useful framework that separates three interoceptive dimensions: interoceptive accuracy (objective task performance), interoceptive sensibility (subjective self-assessment), and interoceptive awareness (calibration between belief and ability). This helps explain seemingly mixed findings: people may be accurate but unaware, confident but wrong, or neither.

New Measurement Tools and Neural Markers

Early heartbeat-counting tasks were vulnerable to bias and belief. Newer tools aim for precision: Micah Allen developed a heart-rate-discrimination task asking participants whether tones are faster or slower than their pulse; similar devices probe breath perception by varying airflow resistance. Brain measures such as the heartbeat-evoked potential and activity in the insula help link objective performance with neural processing.

Clinical Trials Targeting Interoception

Researchers are translating basic science into treatments. One example is flotation-REST (reduced environmental stimulation therapy), which places participants in a soundproof, dark salt-water tank to blunt external input and amplify internal sensations. Sahib Khalsa and colleagues repurposed flotation-REST for anorexia nervosa and found reduced body dissatisfaction six months after treatment in a randomized trial of hospitalized patients. The approach is also being trialed for anxiety, depression and substance-use disorders.

Other interventions include heartbeat-detection training, breath-synced wearable feedback, and mindfulness combined with bodily feedback. At Emory University, Negar Fani tested a wearable that vibrates in time with inhalation; trauma-exposed participants reported improved confidence in their bodily signals and a practical grounding tool they could recall after sessions. In autism-focused work, Critchley, Garfinkel and colleagues reported that targeted interoceptive training reduced anxiety for at least three months in a randomized study.

Where Interoception May Matter Most

Interoceptive differences have been linked to a broad range of psychiatric conditions. Some disorders—panic and anxiety—appear associated with heightened internal attention; others—borderline personality disorder, schizophrenia—may involve blunted internal awareness. Structural and functional differences in the insula are frequently reported across studies, though results vary by task and bodily system.

Development, Trauma and Plasticity

Interoceptive abilities likely develop early: infants as young as three months show sensitivity to heartbeat-synchronized cues. Caregiver responses to hunger, distress and pain may help calibrate a child’s later interoception. Early-life adversity and chronic interpersonal trauma can produce dissociation from the body and may reshape interoception, in some cases increasing risk for self-harm or suicidal behavior.

Open Questions and Future Directions

Major challenges remain: interoceptive skills do not necessarily transfer across heart, breath and gut systems, so researchers must identify which bodily domains and which interoceptive dimensions matter for each disorder. Better measurement, targeted trials that manipulate interoception, and multimodal biomarkers (behavioral, neural, immune) will be central to progress. Researchers are also exploring links between the immune system and brain states, since chronic inflammation may alter mood over longer time scales.

Implications

Understanding interoception could yield novel treatments that target body–brain signaling, potentially benefiting both mental and physical health. Trials show early promise, but careful, domain-specific work is needed to translate lab findings into reliable clinical tools.

If You Need Help
If you or someone you know is struggling or having thoughts of suicide, help is available. In the U.S. call or text the 988 Suicide & Crisis Lifeline at 988, or use the Lifeline Chat at chat.988lifeline.org. If you are outside the U.S., contact local emergency services or your country’s crisis hotline.