Physical Processing & Neuroscience

     "primates have a distinct cortical image of homeostatic afferent activity that reflects all aspects of the physiological condition of all tissues of the body. This interoceptive system, associated with autonomic motor control, is distinct from the exteroceptive system (cutaneous mechanoreception and proprioception) that guides somatic motor activity. The primary interoceptive representation in the dorsal posterior insula engenders distinct highly resolved feelings from the body that include pain, temperature, itch, sensual touch, muscular and visceral sensations, vasomotor activity, hunger, thirst, and 'air hunger'. In humans, a meta-representation of the primary interoceptive activity is engendered in the right anterior insula, which seems to provide the basis for the subjective image of the material self as a feeling (sentient) entity, that is, emotional awareness." 
     Craig AD. Interoception: the sense of the physiological condition of the body. Curr Opin Neurobiol 2003; 13(4): 500-5.

     Anxiety sensitivity (AS) ... is the fear of arousal-related sensations, arising from beliefs that the sensations may have harmful physical, social, or psychological consequences. AS is composed of 3 (or 4) dimensions: 
• fear of physical sensations, 
• fear of cognitive dyscontrol,
• fear of publicly observable anxiety reactions ±
• fear of respiratory sensations. 

     AS is a potential common vulnerability factor in PTSD & chronic pain.
     "Interoceptive exposure (IE) is among the most effective methods for decreasing AS. IE involves exposure to feared bodily sensations through harmless, brief exercises (e.g. repeatedly hyperventilating). Through repeated exposure to these sensations, patients learn that the sensations do not lead to catastrophic outcomes, and thus their AS abates." 
       Wald J et al. Posttraumatic stress disorder and chronic pain arising from motor vehicle accidents: efficacy of interoceptive exposure plus trauma-related exposure therapy. Cogn Behav Ther 2010; 39(2): 104-13.

     "Approaching the pain itself, wherever it is most prominent in the body, with bare attention, open-heartedness, and alert interest even for very brief moments, if that is all that we can muster in any moment, can be profoundly healing, restorative, and illuminating. And if practiced over days, weeks, and months, potentially it can make a difference in the quality of your life for years and years going forward. What we are talking about is really befriending your experience at the level of the body and at the level of the mind and heart, and seeing what unfolds.”                           Jon Kabat-Zinn 
       Gardner-Nix, J. “The mindfulness solution to pain. Step-by-step techniques for chronic pain management.” New Harbinger Publications Inc, Oakland CA, 2009.

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