When the Body Shapes the Mind: Interoception, Anxiety and the Psychology of Internal Signals

A racing heart or a change in breathing can become part of an emotional experience. Interoception research asks how internal signals are sensed and interpreted, why they sometimes become frightening, and what the evidence can actually establish.

Your heart speeds up during a brisk walk. Later, an unexpected pounding in your chest feels alarming. The circumstances differ, as may the underlying physiology. What a sensation means also depends on where you are, what you expect and what has happened before.

Interoception connects these questions about bodily functioning with questions about experience. It offers a way to investigate interactions between body and mind without assuming that every physical symptom has a psychological explanation.

What is interoception?

Interoception concerns the nervous system's sensing, processing and interpretation of information about the body's internal condition. It includes cardiovascular, respiratory and gastrointestinal signals, alongside processes associated with hunger, thirst, temperature and visceral discomfort. Much of this activity supports regulation without becoming conscious (Craig, 2002; Chen et al., 2021).

Feeling hungry is therefore one expression of interoception, rather than its complete definition. Likewise, awareness of a heartbeat is one channel through which researchers study a much broader set of processes.

Exteroception concerns information about the external environment, such as a sound. Proprioception concerns bodily position and movement. These distinctions help organise research, but their boundaries are debated. Temperature, pain and signals involving the skin illustrate why different frameworks draw the borders differently (Chen et al., 2021).

How the body communicates with the brain

Communication follows several routes. Signals from internal organs travel through pathways involving the vagus nerve and spinal cord; circulating chemical signals also contribute. Brainstem, hypothalamic and cortical systems participate in monitoring and regulating bodily conditions (Critchley & Harrison, 2013).

The insula receives particular attention in interoception research. An influential imaging experiment linked activity in the right anterior insular region with performance on a heartbeat-timing task (Critchley et al., 2004). This does not identify a single centre that creates all bodily feelings. Interoception involves distributed systems, and activity associated with a task does not establish one region's exclusive function.

Communication also runs towards the body. Changes in attention, behaviour and autonomic regulation can alter the physiological conditions being sensed. The relationship is an ongoing interaction rather than a message travelling in only one direction.

Why bodily sensations can influence emotion

Historical James-Lange accounts gave bodily changes a central role in emotion. James's original argument emphasised the experience of bodily responses in emotions with a distinct physical expression (James, 1884). That was a theoretical proposal, not an experimental demonstration explaining every emotion.

Contemporary work similarly examines how bodily information contributes to feeling, while allowing roles for context, learning, appraisal and action. A noticeable heartbeat might accompany excitement, exertion, illness or fear. Its presence alone cannot determine which description fits (Critchley & Harrison, 2013).

The walking example illustrates this interaction. Expected exertion can make increased cardiac activity understandable; an unexpected sensation may invite different interpretations. It does not follow that the physiological states or sensations are identical, or that interpretation can simply override a medical problem.

How psychologists measure internal bodily awareness

The phrase "body awareness" can conceal several questions. An influential framework distinguishes three dimensions (Garfinkel et al., 2015).

Interoceptive accuracy refers to performance on tasks intended to assess detection or discrimination of internal signals. Interoceptive sensibility concerns self-reported beliefs, attention or perceived sensitivity, depending on the questionnaire. Interoceptive awareness, in this framework, concerns metacognition: how well confidence corresponds to actual task performance.

These are useful distinctions, but terminology varies. A questionnaire called an awareness measure need not assess metacognitive calibration. Alternative classifications distinguish attention from accuracy and ask whether each is measured through performance or self-report (Murphy et al., 2019).

In heartbeat counting, participants report how many beats they perceive during an interval, and researchers compare this with a recording. Scores can also reflect estimated heart rate, prior beliefs and reporting strategies. Desmedt and colleagues demonstrated substantial contributions from processes beyond sensing heartbeats (Desmedt et al., 2018).

Heartbeat discrimination tasks instead ask participants to judge relationships between cardiac events and external signals, such as tones. They introduce different timing and decision demands. Ring and Brener found that counting and detection scores were unrelated in their comparison, despite consistency within each task (Ring & Brener, 2018). No single task provides an unquestionable measure of someone's general interoceptive ability.

Respiratory tasks can examine detection of added breathing resistance. Questionnaires such as the Multidimensional Assessment of Interoceptive Awareness assess several reported tendencies, including attention regulation and bodily trust (Mehling et al., 2012). Self-report describes experience and beliefs; it does not independently verify physiological detection.

Reliability and validity also answer different questions. A score may be consistent across repeated measurements while partly reflecting a reporting strategy. Conversely, an unstable measure can obscure relationships that researchers hope to examine. Researchers therefore need to specify the bodily signal, task demands and aspect of perception being measured before interpreting an association as evidence about interoception more generally (Murphy et al., 2019).

Interoception and anxiety: what is the relationship?

Noticing a sensation, detecting it accurately, experiencing strong physiological arousal and believing it is dangerous are different processes. Anxiety sensitivity refers to fear of anxiety-related sensations because of their anticipated consequences. Someone can monitor their heart frequently without identifying its activity particularly accurately.

A systematic review and meta-analysis of 55 studies found no overall evidence of an association between anxiety and cardiac interoceptive accuracy on counting and discrimination tasks (Adams et al., 2022). This challenges a simple claim that anxious people are necessarily better, or worse, at detecting their heartbeat. It does not settle questions about interpretation, breathing or every anxiety presentation.

A separate meta-analysis of 71 studies found associations between anxiety and particular self-reported processes, including negative evaluation of bodily signals and increased negative attention towards them (Clemente et al., 2024). Which aspect is measured matters. Attention, apprehension and task performance should not be combined into one score labelled sensitivity.

Why sensations can become frightening during panic

Clark's cognitive model proposes that catastrophic interpretations of bodily sensations can contribute to escalating panic (Clark, 1986). A perceived cardiac change may be interpreted as imminent collapse; the resulting fear can intensify arousal and monitoring. This is a model of a possible maintaining cycle, not proof that every panic attack begins with a consciously articulated thought.

Learning and behaviour also matter. Avoiding exertion or repeatedly checking for reassurance may bring relief while leaving feared predictions untested. The function depends on context: appropriate medical monitoring and safeguards should not be confused with unnecessary fear-maintaining responses. Our article on avoidance and anxiety examines that distinction.

Panic can feel physically overwhelming. Nevertheless, chest pain, breathlessness and dizziness have potential medical causes. New or concerning symptoms require appropriate medical assessment. The NHS chest-pain guidance explains when urgent help is needed, including calling 999 for chest pain accompanied by symptoms such as sweating or breathlessness. Psychological explanations should follow assessment, not replace it.

How expectations and context shape bodily perception

Predictive-processing theories propose that perception integrates incoming information with expectations about its likely causes. A prediction error is a mismatch between expected and incoming information; uncertainty concerns how much confidence to place in those sources. These accounts suggest ways that learning and attention could shape bodily experience (Barrett & Simmons, 2015).

They do not mean the brain invents every symptom. Bodily changes constrain perception, and theoretical models require tests that distinguish them from competing explanations. Our discussion of placebo and nocebo effects explores related questions about expectations without treating symptoms as imaginary.

In a breathing experiment combining resistance manipulations, computational modelling and imaging, Harrison and colleagues found insular activity related to predictions and prediction errors. Associations with anxiety extended across perceptual and higher-level measures (Harrison et al., 2021). Such findings support investigating specific predictions; they do not establish a complete computational explanation of anxiety.

Stress, internal signals and emotional understanding

Stress can change cardiovascular activity, breathing and attention. Those changes may affect both the information available to perceive and the meaning attached to it. Sympathetic activation can support adaptive action; it is not inherently harmful, and physiological arousal is not identical to subjective distress. Evidence about stress and interoception varies with the stressor, timing and assessment method (Schulz & Vögele, 2015).

Emotional awareness raises another question: can someone identify and describe what they feel? Alexithymia refers to difficulties in these areas, alongside features such as externally oriented thinking. A 2024 review of 32 cross-sectional studies found that its relationships with self-reported interoception depended on the construct and questionnaire examined (Van Bael et al., 2024).

Reported confusion or distrust of bodily signals is therefore different from poor performance on a heartbeat task. Difficulty naming an emotion does not establish impaired bodily detection. Nor can cross-sectional associations determine whether interoceptive experiences influence emotional difficulties, result from them, or share other influences.

What this means for assessment and formulation

Clinical assessment can explore which sensations occur, their circumstances, interpretations, consequences and effects on daily life. Physical health, medication, relationships, environmental pressures and previous experiences belong in that enquiry. The aim is a shared understanding that can be revised, as discussed in our article on psychological formulation beyond diagnosis.

One useful distinction is between the intensity of a sensation and the difficulty it creates. An assessment might examine whether distress centres on discomfort itself, uncertainty about its cause, a feared consequence or restrictions in daily activities. These possibilities should be explored collaboratively rather than inferred from how often someone mentions their body. Relevant medical information and the person's own account remain essential.

Interoceptive research also extends to eating-related experiences, chronic pain and other conditions involving bodily symptoms (Chen et al., 2021). These are areas of investigation, not evidence that one interoceptive deficit causes all such difficulties. Neither a questionnaire nor a laboratory task provides a diagnostic marker for an individual reader.

Can treatment change the experience of sensations?

Interoceptive exposure is used within cognitive behavioural therapy for panic-related fear. Following assessment and collaborative planning, treatment helps people encounter feared sensations and test anticipated consequences. The intended changes concern fear, interpretation and avoidance, rather than a requirement to become better at counting heartbeats.

A component network meta-analysis covering 72 trials associated interoceptive exposure with better outcomes within CBT packages for panic disorder (Pompoli et al., 2018). Component estimates depend on modelling assumptions and the available treatment comparisons. They do not prove that exposure works equally well for everyone or identify its sole mechanism. Inhibitory-learning accounts emphasise learning alternatives to feared outcomes, alongside other proposed change processes (Craske et al., 2014). NICE guidance supports CBT for panic disorder.

Other approaches remain less established. A randomised trial involving 121 autistic adults reported lower trait anxiety after interoceptive training than after an active comparison intervention. Only half supplied three-month follow-up data, and one cardiac-anxiety adverse event was recorded (Quadt et al., 2021). This is promising evidence for that intervention and population, with substantial uncertainty; it does not justify universal body-awareness training.

Why more body awareness is not always better

Mindfulness can involve attending differently to sensations, but benefit should not be assumed to arise from improved sensory accuracy. A 2025 meta-analysis found a small positive association between mindfulness and objective body-awareness measures, alongside substantial heterogeneity, publication-bias concerns and generally weak study quality (Schwartz et al., 2025).

Breathing-focused or body-focused practices can also be uncomfortable. A systematic review documented adverse experiences associated with meditation, although its broad evidence base cannot establish the risk of any particular body-awareness exercise (Farias et al., 2020). Suitability, consent and clinical judgement matter. Increased attention may be helpful in one context and distressing in another; its amount alone is a poor treatment goal.

What the research still cannot establish

Interoception is unlikely to be adequately represented by one universal score. A 2026 study of 241 participants found cardiac and respiratory performance dimensions largely uncorrelated, while subjective confidence showed some shared variation (Banellis et al., 2026). Its particular tasks and sample do not settle how every bodily system relates.

More broadly, inconsistent definitions, task reliability, reporting beliefs and differences between physiological systems complicate comparisons. Medication, fitness, current arousal and health can influence what is measured. Short laboratory tasks may generalise poorly to everyday symptoms, while brain-imaging associations do not establish necessary or sufficient causes.

Longitudinal and experimental research is needed to clarify direction of influence and treatment mechanisms. Group averages cannot determine whether one person's perception is accurate or explain their diagnosis. The useful contribution of interoception research is more precise questions about how bodily conditions, expectations, attention and circumstances interact. Understanding those relationships requires taking physical sensations seriously while keeping explanations open to evidence.

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Clinical guidance

National Health Service. (n.d.). Chest pain. Retrieved October 22, 2026, from https://www.nhs.uk/symptoms/chest-pain/

National Institute for Health and Care Excellence. (n.d.). Generalised anxiety disorder and panic disorder in adults: Management (CG113): Recommendations. Retrieved October 22, 2026, from https://www.nice.org.uk/guidance/cg113/chapter/recommendations