Interoception: The Inside Story—A Model for Psychosomatic Processes

Objective To comprehend psychosomatic processes, it will be necessary to understand the brain’s influences on bodily functions and also the body’s afferent sensory input to the central nervous system, including the effects of this input on behavior and cognitive functions, especially emotion. The objective of this Presidential Address is to review what is known circa the year 2000 of the processes and mechanisms of visceral sensory psychobiology, often called interoception. Methods Over 1000 publications that have appeared since the 19th century were reviewed to prepare this review, including a group that are specifically cited here. Results Factors and data were reviewed that were identified as germane to understanding interoception. These included definitional issues, historical roots, the neural basis, studies and results in the cardiovascular-respiratory and alimentary-gastrointestinal systems, studies of emotion, and studies in people with mental disorders. Drug and hormone effects, pain, proprioception, and phantom limb or organ factors, and the role of awareness were briefly described. Methodological issues, methods of study including functional imaging, and possible future directions for study were identified. Conclusions Understanding the physical basis of psychosomatic processes, including the so-called mind-body problem, will require a detailed understanding the psychobiology of interoception.

[1]  B. Weiss.  The cerebral cortex and the internal organs , 1958 .

[2]  E. Fischer.  Conditioned Reflexes , 1942, American journal of physical medicine.

[3]  S. Porges,et al.  Emotion: An Evolutionary By‐Product of the Neural Regulation of the Autonomic Nervous System a , 1997, Annals of the New York Academy of Sciences.

[4]  E. Mayer,et al.  Role of visceral afferent mechanisms in functional bowel disorders. , 1990, Gastroenterology.

[5]  E A Mayer,et al.  Regional cerebral activity in normal and pathological perception of visceral pain. , 1997, Gastroenterology.

[6]  J R Augustine,et al.  The insular lobe in primates including humans. , 1985, Neurological research.

[7]  J. Stern,et al.  Peripheral physiological variables and emotion: the James-Lange theory revisited. , 1970, Psychological bulletin.

[8]  F. Mauguière,et al.  [Positron emission tomography to study central pain integration]. , 2000, Revue neurologique.

[9]  P. Lang.  The varieties of emotional experience: a meditation on James-Lange theory. , 1994, Psychological review.

[10]  C. Darwin.  The Expression of the Emotions in Man and Animals , .

[11]  Herbert Spencer,et al.  The principles of psychology, Vol 1 (2nd ed.). , 1870 .

[12]  A Schnitzler,et al.  Different cortical organization of visceral and somatic sensation in humans , 1999, The European journal of neuroscience.

[13]  S Minoshima,et al.  Effects of Yohimbine on Cerebral Blood Flow, Symptoms, and Physiological Functions in Humans , 2000, Psychosomatic medicine.

[14]  Eraldo Paulesu,et al.  Silent Ischemia as a Central Problem: Regional Brain Activation Compared in Silent and Painful Myocardial Ischemia , 1996, Annals of Internal Medicine.

[15]  Dieter Vaitl,et al.  Interoception , 1996, Biological Psychology.

[16]  G. Talland.  Interoception and Behavior—An Experimental Study , 1968 .

[17]  N. Miller.  Learning of visceral and glandular responses. , 1969, Science.

[18]  J M Gorman,et al.  Neuroanatomical hypothesis of panic disorder, revised. , 2000, The American journal of psychiatry.

[19]  C. Frith,et al.  Central nervous pathways mediating angina pectoris , 1994, The Lancet.

[20]  J. H. Curtis,et al.  Learning Theory and Behavior , 1960 .

[21]  A. Damasio.  The Feeling of What Happens: Body and Emotion in the Making of Consciousness , 1999 .

[22]  A. Ehlers,et al.  Increased cardiac awareness in panic disorder. , 1992, Journal of abnormal psychology.

[23]  G. Razran,et al.  The observable unconscious and the inferable conscious in current Soviet psychophysiology: interoceptive conditioning, semantic conditioning, and the orienting reflex. , 1961, Psychological review.

[24]  S. Fisher.  Organ Awareness and Organ Activation , 1967, Psychosomatic medicine.

[25]  Vladimir Hachinski,et al.  Human forebrain activation by visceral stimuli , 1999, The Journal of comparative neurology.

[26]  Wilfrid Jänig,et al.  Visceral nociceptors: a new world order? , 1992, Trends in Neurosciences.

[27]  J. R. Augustine.  Circuitry and functional aspects of the insular lobe in primates including humans , 1996, Brain Research Reviews.

[28]  D. Perani,et al.  Chronic pain: a PET study of the central effects of percutaneous high cervical cordotomy , 1991, Pain.

[29]  Sean A. Spence,et al.  Descartes' Error: Emotion, Reason and the Human Brain , 1995 .

[30]  J. Cacioppo,et al.  Principles of psychophysiology : physical, social, and inferential elements , 1990 .

[31]  O. Cameron.  Adrenergic dysfunction and psychobiology , 1994 .

[32]  D. Cechetto,et al.  Central representation of visceral function. , 1987, Federation proceedings.

[33]  Mats Fredrikson,et al.  Neuroimmune relations in patients with fibromyalgia: a positron emission tomography study , 2000, Neuroscience Letters.

[34]  M. Washburn,et al.  Bodily Changes in Pain, Hunger, Fear, and Rage. , 1917 .

[35]  Cechetto Df,et al.  Central representation of visceral function. , 1987 .

[36]  M. Mesulam,et al.  The Insula of Reil in Man and Monkey , 1985 .

[37]  E. Katkin,et al.  Blood, sweat, and tears: individual differences in autonomic self-perception. , 1985, Psychophysiology.

[38]  J. Scadding.  Visceral Sensation. (Progress in Brain Research Vol 67) , 1987 .

[39]  O. Cameron,et al.  Venous plasma epinephrine levels and the symptoms of stress. , 1990, Psychosomatic medicine.

[40]  P. P. Newman.  Visceral afferent functions of the nervous system. , 1974, Monographs of the Physiological Society.

[41]  James W. Pennebaker,et al.  The psychology of physical symptoms , 1982 .

[42]  L. Freire-Maia,et al.  The autonomic nervous system is not a purely efferent system. , 1990, Medical hypotheses.

[43]  B. Vogt,et al.  Contributions of anterior cingulate cortex to behaviour. , 1995, Brain : a journal of neurology.

[44]  W. Jänig.  Neurobiology of visceral afferent neurons: neuroanatomy, functions, organ regulations and sensations , 1996, Biological Psychology.

[45]  G W Hohmann,et al.  Some effects of spinal cord lesions on experienced emotional feelings. , 1966, Psychophysiology.

[46]  P. Montoya,et al.  On the relation between cardiodynamics and heartbeat perception. , 1993, Psychophysiology.

[47]  F. Cerveró,et al.  Visceral pain: mechanisms of peripheral and central sensitization. , 1995, Annals of medicine.

[48]  D. Spalding.  The Principles of Psychology , 1873, Nature.

[49]  G. Ádám,et al.  Operant discrimination of an interoceptive stimulus in rhesus monkeys. , 1965, Journal of the experimental analysis of behavior.

[50]  J. Pennebaker,et al.  Visceral perception versus visceral detection: Disentangling methods and assumptions , 1984, Biofeedback and self-regulation.

[51]  L. Gannon.  The role of interoception in learned visceral control , 1977, Biofeedback and self-regulation.

[52]  O. Cameron.  Visceral Sensory Neuroscience: Interoception , 2001 .

[53]  R. Rescorla,et al.  Two-process learning theory: Relationships between Pavlovian conditioning and instrumental learning. , 1967, Psychological review.

[54]  R. T. Kelleher,et al.  Epinephrine, Norepinephrine, and Acetylcholine as Conditioned Stimuli for Avoidance Behavior , 1960, Science.