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Interoception: The Potential of Embodied Mindfulness

By writer and trauma recovery expert, Dave Emerson

At the Trauma Center in Brookline, Massachusetts, we have been using modified yoga as an adjunctive treatment for complex trauma since 2003. Complex trauma is a clinical phenomenon that describes what happens when people live in chronically abusive and/or neglectful environments which is particularly pernicious when that abuse and neglect is perpetrated by trusted caregivers.

Thanks to research from pioneers in the field and to brave women and men who have helped the rest of us understand we are now able to quantify many of the impacts of complex trauma, which indeed permeate the entire organism. For example, research has shown that all parts of the nervous system are impacted by chronic abuse and/or neglect from autonomic functions like digestion and sleep to more frontal lobe focused activities like information processing and planning for the future.

Now, not only do we know that survivors of complex trauma have difficulty feeling their body but we have indications of an underlying mechanism: under activity in the interoceptive pathways in the brain. Addressing this phenomenon has become a central part of our model of yoga at the Trauma Center.

One system in particular that has been shown to be deeply impacted by chronic abuse and/or neglect is the interoceptive system, which connects body experiences to mind. Prior to the emergence of technologies like functional magnetic resonance imaging, which allows scientists to get a reasonably clear picture of certain aspects of brain activity, clinicians treating people with complex trauma developed a universally recognized set of symptoms that included somatic impacts such as “difficulty localizing skin contact” and “difficulty being touched”.

In other words, clinicians and patients recognized the somatic impacts of complex trauma before there was any neuroscience to support them. Now that we have the neuroscience, we can see that the pathways in the brain that transfer body experiences like sensations in muscles (technically called, “visceral afferent information”) are severely underactive in traumatized people (see research by Bessel van der Kolk and Ruth Lanius for some good examples). Now, not only do we know that survivors of complex trauma have difficulty feeling their body but we have indications of an underlying mechanism: under activity in the interoceptive pathways in the brain. Addressing this phenomenon has become a central part of our model of yoga at the Trauma Center, which we call Trauma-Sensitive Yoga (TSY) (see my book Trauma-Sensitive Yoga in Therapy for more details on our model).

Now that we have a little background, we can consider some aspects of interoception from another perspective, that of mindfulness. When you practice interoceptive attunement you are consciously directing your attention toward something. In this way it is similar to many mindfulness practices that use an object like a candle flame or a sound or even a feeling as an opportunity to cultivate awareness (of course there are other mindfulness practices that don’t seek an object for awareness but just let objects come and go like thoughts and feelings and even sensations but in our case we are focused more on the energy of active attentional control and the conscious direction of attention toward an object).

In our model of TSY our object of attention (that to which we direct our attention) is body sensation. Each yoga form provides an opportunity to experience sensation in the body and to interact with it. At the Trauma Center our hypothesis is that, because of brain plasticity (research has clearly shown that our brains are not static things but that wiring can be strengthen and reconfigured and we can even increase the volume of grey and white matter through certain practices), if we practice interoception, we will strengthen our interoceptive pathways. In 2011-12 we took the first pictures of the brain under these conditions with a small pilot group and indications are indeed that we can strengthen interoceptive pathways (the brain picture is published in van der Kolk’s book, The Body Keeps the Score).

In 2009 we received the first grant ever given by the National Institute of Health to study yoga for trauma. We took this as an occasion to try our TSY model. Along with finding that a 10-week course of our TSY model resulted in a clinically significant decrease in trauma symptoms (see our paper “Yoga as an Adjunctive treatment for post traumatic stress disorder: A Randomized Controlled Trial” (2014)) we learned through in-depth interviews with participants that many were experiencing their bodies in new ways, for example, were more comfortable being touched by loved ones and were more able to use sensation in their bodies as information to help them navigate the world (see Jennifer West’s dissertation, “Moving to Heal” for transcripts of these interviews).

Our bodies are our mechanism for experiencing the world, for interacting with it. Consider what it is like to live in a body that you cannot feel or sense with any reliability. We believe that a great deal of the suffering of complex trauma is due to this disrupted, erratic connection to our body. By practicing interoception we may be able to offer our students a new way to relate to their body and thereby a new way to be in the world. Practicing interoception is as simple as contracting a muscle or muscles (lifting one leg for example) and noticing what you feel in that part of your body. What do you feel in your body when you do that?

For more info on trauma sensitive yoga, contact Dave Emerson through the Trauma Center at the Justice Resource Institute.

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