Interoception Assessment: Dilemmas and Practical Solutions

Let’s talk about a frequently asked question that we hear: How do you assess Interoception? That is a great question, and one that is widely debated right now in the interoception field. Researchers are really working hard to figure this out. There’s not a general agreement or consensus right now. What we do know is that we have some existing methods of measuring interoceptive awareness. All of them have pros, all of them have cons.

These tools can fit into 3 main categories.

1. Objective Measures: these are measures that aim to make a quantifiable measure of our inner experience. For example, the heartbeat detection test is a widely used test by    researchers where they hook a participant up to a heartbeat monitor, and they ask the participant to count their heartbeats within a certain duration of time, whether it’s 30 seconds or 60 seconds. Then the researchers compare how accurate that person was at counting their heartbeats compared to what the researchers measured on the heartbeat monitor. The closer the number of beats counted is to what researchers measured, the higher the level of interoceptive awareness.

Pros: Objective measure that can provide raw score or data.

Cons: There is more to interoception then just your heartbeat (so can we generalize your ability to count your heart to how aware you are of muscle tension or bladder fullness?); Interoception does not typically involve having someone tell you what sensation to attend to (can you figure out what sensation is important to pay attention to in real life?); Interoceptive Awareness involves the ability to notice and connect body signals which the latter is not captured by objective measures.

2. Subjective or Self-Report Measures: As the name implies, these are measures such as questionnaires or interviews that seek to gain information from the person themself and that person is asked to report on their inner experience.

Pros: A benefit of this type of measure is that it seeks to gain information from the person that knows best about their own personal inner experience. Whenever possible, when we’re seeking that same information from my clients. we of course, want them to be sharing as much as they can possibly share about their own inner experience. And so, these self-reports can be really helpful.

Cons: The main drawback is that these subjective measures are really not quantifiable. They can’t really give you a solid number that’s measurable, but they do give really great qualitative information.

3. Caregiver Report or Observation: We use these measures for my clients that might not be at a point in time where they can reflect and tell us about their inner experience. So, we’re doing our best guesses at trying to understand some of the outward things that we see them doing and thinking about that through an Interoception lens. For example, if my client’s having toileting accidents, seeing that through an Interoception lens and considering could those toileting accidents be partly due to an underlying Interoception piece? Could my client be not noticing those body signals or misunderstanding those body signals telling them when they need to go pee or poop?. Really looking at all of the observations that we see and thinking about them through an Interoception lens to try to get one step closer to understanding the deep whys behind what it is that we see in our

Pros: Encourages caregivers/observers to consider interoception as one of the underlying factors that could be creating a barrier to participation.

Cons: Can we accurately capture the inner experience of someone other than ourselves? That remains to be better understood.

Interoception Assessment Challenges: We All Have Unique Inner Experiences

While there are a lot of issue with the assessment of Interoception, the biggest one in my mind is that really there is no one ‘good level’ of Interoception. There’s no right interoception and wrong interoception. There’s no typical interoception and atypical interoception.

We all have unique inner experiences. What your body feels like when you’re hungry is different than what my body feels like when I’m hungry. What your body feels like when you’re anxious is different than what my body feels like when I’m anxious. And so, interoception becomes a really hard thing to quantify and say, “If you take this test and you score this score, it means you have average interoception.” It really becomes difficult to do that because that’s not the way that our inner experience works. There’s no right or wrong.

I think that is why really it becomes tricky when we’re thinking about assessment of interoception. That qualitative look into the inner experiences can be really helpful, but how do we best do that? Pondering some of what we might be observing in our clients and considering that there could be an interoception thing at play, that can be extremely, extremely valuable too. But again, how do we best do that?

One thing is for sure, we are learning new information about interoception daily. My ability to assess interoception experiences of my clients has certainly improved over the last 10 years, but I’m also very excited to see how we improve and get better of the next 10 years to come.

We’re going to continue talking a lot more about interoception assessment, including some of the specific strategies that I currently use with my clients and how we are assessing their inner experience. We’re assessing their inner experience not to declare if they are on level, or if they’re accurate, or if they’re “typical”. We’re assessing to try to better understand their experience so that we can support them in ways that are more meaningful to them.

If you want to learn more about interoception assessment, I hope you will have a look at the On-Demand Course all about this topic!