Kelly Mahler, OTD, OTR/L, earned a Doctorate in Occupational Therapy from Misericordia University, Dallas, PA. She has been an occupational therapist for 20 years, serving school-aged children and adults. Kelly is the winner of multiple awards, including the 2020 American Occupational Therapy Association Emerging and Innovative Practice Award & a Mom’s Choice Gold Medal. She is an adjunct faculty member at Elizabethtown College, Elizabethtown, PA, as well as at Misericordia University, Dallas, PA. Kelly is a co-principal investigator in several research projects pertaining to topics such as interoception, self-regulation, trauma & autism. Kelly is an international speaker and frequently presents on topics related to the 11 interoception books and resources she has authored.
If you are interested in interviewing Kelly regarding her interoception research and client experiences, visit kelly-mahler.com/kellys-research.
Interviewee: Kelly Mahler, OTD, OTR/L
1. Can you tell us more about the concept of interoception and how it relates to behavior and self-regulation?
Interoception is a sense that allows us to experience sensations from the inside of our bodies. For example, interoception might help you to notice how your stomach feels: is it empty or full? Is it fluttery, gassy, or maybe nauseous? Or interoception might help you to notice other bodily sensations like a racing heart, burning lungs, full bladder, tense muscles, heavy eyes, sweaty skin, sore throat, pounding head, or dry mouth.
These interoceptive sensations provide us with vital information about our current emotional experience and/or what our body needs in the moment for comfort, regulation or health. For example, if we notice that our stomach feels empty, that might be a clue that you feel hungry and that your body needs food. Or perhaps you notice your eyes feel heavy, and your muscles feel sluggish, and that might be a clue you feel tired, and your body needs sleep. Or perhaps you notice that your muscles feel tense, your skin feels hot, and your hands feel clenched, and that might be a clue you are feeling frustrated and need a jog or quiet break.
We are wired to behaviorally act on the way our body feels. If our inner experience is clear, we have lots of clues helping us to know what we need to successfully self-regulate or manage our “behavior.” However, for many people, their interoceptive experience can be unreliable or confusing, which can result in difficulty self-regulating a variety of emotions or bodily needs.
Take the case of someone with a muted interoceptive experience; they might miss certain body signals providing them with clues to what their body needs. For example, they miss clues letting them know they are getting overwhelmed and then are surprised by a meltdown, shut down, panic attack, or other strong stress response. Or they might miss the body signals letting them know when they are growing hungry and end up “hangry” where they have passed the point of manageable hunger, and it becomes an emotional emergent situation (must eat now!!!!).
For other people they might have an intense interoceptive experience where they might notice many different body signals at once and are not sure which are important or what the inner chaos all means for them. Or perhaps there is one or two body signals that are so intense that it is difficult to notice anything else. Similar to those with a muted interoception experience, they are not receiving reliable information letting them know when they are growing overwhelmed, or hungry or a variety of other emotions.
Interoception is one of the hottest topics in neuroscience, however it is just making its way into mainstream knowledge. Notably, unreliable interoception is widely present across the general population but is also found to be prevalent in people that have specific diagnoses like autism, ADHD, depression, anxiety, and developmental trauma/PTSD. Because interoception is an “inside” process, when someone has an unreliable interoceptive experience, it is often misunderstood or mislabeled with terms such as oppositional, attention-seeking, defiant, challenging, lazy, reactive. Although these terms are reflective of what might be seen on the surface, they’re often extremely inaccurate and represent a disregard for underlying factors such as interoception.
2. How did you come up with the idea for The Big Book of Interoception Games?
The goal of all our interoception resources is to help each person connect and learn about their own unique inner experience in an engaging way, and The Big Book of Interoception Games is no different. It is a compilation of 53 games geared directly towards helping people of all ages to notice, understand and regulate their interoceptive body signals while playing.
The concept of “playful learning” summarizes what I am all about as an Occupational Therapist and as a mom. I was raised in a household where my parents and my grandparents were all super playful people, and we bonded through shared games and activities. Then I went to school to become an OT, and our whole profession is based on using meaningful forms of activity, including play, to help our clients reach their own goals. So, this concept of playful learning is deeply ingrained in me; to have fun and to provide meaningful learning opportunities for my clients.
The Big Book of Interoception Games seeks to help people play their way to an enhanced inner understanding.
3. How can the games be used by educators and therapists to support learners with “challenging behaviors”?
Neuroscience clearly indicates that interoception is connected to our ability to self-regulate. Thus, when someone has an unreliable interoceptive experience, it can result in difficulty regulating their own emotions, bodily needs, “behaviors.” This breakdown can appear as so-called “challenging behaviors” which is often a term that reflects a belief that a person is doing what they’re doing on purpose—to purposefully misbehave or to purposefully be oppositional, defiant, manipulative, etc.
If we want to successfully support “challenging behaviors,” we need to understand them through a more scientifically valid way. Interoception provides an important lens in helping to understand a person’s true experience. It can provide an excellent path to developing self-regulation and thus improve the underlying cause of so-called “challenging behavior.” In other words, if we want to support behavior, we need to support interoception growth.
The Big Book of Interoception Games provides educators, therapists and parents/caregivers with many ideas to support this interoception growth via structured and direct opportunities that often benefit many people.
4. Are there any instances of how the activities in the book have helped a specific learner or client?
The activities in this book have been incredibly helpful for a wide variety of people. Take for example, the 7- year old who grew in her ability to notice and understand the sensations indicating when she needed to urinate, resulting in her achieving independent toileting.
Or the 16-year-old that experienced frequent explosiveness at school, thus had been taught many, many different coping strategies, only to memorize them but not be able to use them “in the moment.” His school claimed that he was refusing to use the tools they provided him, but he wasn’t refusing; he was missing the interoception clues that let him know when he was growing overwhelmed and needed a coping strategy. Through the activities in the book, he discovered a buzzing feeling on the back of his tongue and over time realized that this sensation was a powerful clue that he is starting to feel overwhelmed. The activities gave him the inner understanding of “when I notice the buzzing feeling on my tongue, it means I am getting overwhelmed, and it is a great time to use a preferred coping strategy.”
Or the 43-year-old mom who, when playing the games with her child, had an emotional epiphany that a sensation she noticed for most of her life, a periodic feeling of electrical zaps on her skin, was not a skin issue which her medical providers could never figure out, but rather was a clue that she was experiencing auditory overload from too much environmental noise. This valuable insight led her to being able to regulate her needs in a more effective way.
5. How do you hope the book will inspire professionals and families to think differently about behavior and self-regulation?
I want to inspire people to think differently, dig deeper and discover the root cause of the behaviors we may observe. It is my hope that this book will inspire professionals and families with practical and playful ideas for that needed inner discovery. To give them the tools to dig deeper. To ask the right questions. To honor and validate each person’s unique inner experience. To help them implement an interoception-based approach for supporting self-regulation and so-called “challenging behavior.”
I believe interoception is a missing piece in many of the supports we provide, and I hope professionals and families can use this book to spark playful interoception growth in their clients or own children. Who knows, maybe the activities will even inspire that inner wonder in themselves!