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23. Interoception: Conscious and Unconscious processing

This episode we discuss the importance of the somatosensory system in forming our sense of self through our relationships and how it shapes neurodevelopment. We explore how individuals who have not experienced secure attachment early in life may struggle with somatosensory amplification and somatization later on. We chat about the role of touch in creating a sense of safety and connection, and how sensory integrative processing can impact overall wellness. If you’re curious about the need to balance and respect boundaries while providing positive somatosensory experiences for individuals with neurodiversity this episode is for you. Hopefully, like we did, you get a deeper appreciation of the power of touch in building empathy, shared experiences, and a sense of belonging.

Key Takeaways:

  • The somatosensory system plays a crucial role in our overall well-being and is connected to our attachment relationships.

  • Individuals who have not experienced secure attachment relationships early in life may have heightened somatosensory amplification and struggle with social anxiety and sensitivity.

  • Sensory integrative processing difficulties can have long-term implications for an individual's wellness and should be addressed early on.

  • OTs can support individuals in developing healthy somatosensory experiences through touch and other sensory interventions.

  • It is important to respect boundaries and understand the nuances of touch in different contexts, especially when working with vulnerable populations.


Cory: Before you get stuck into today's wonderful episode on interception. Uh, one to make sure that you all know Tracy's spirit model training is now widely available to those who are interested. If you are listening to this podcast and enjoy these kinds of discussions then I can, 1000% recommend the spirit model training that. Tracy and her team at DFX

have so diligently put together so that people all around the world who have been asking and asking for them to do training on this can access it. So if you want to deepen your practice and improve your ability just to think holistically about treatment and how to best come at these complex dynamic situations that we find ourselves in, in treatment. Then hit the link in the description and check it out because it will be so, so worthwhile.

The other small side note is that a little while ago, seed was asked by a local preschool to put together an online course on the basics of regulation.

How it unfolds typically in development how to integrate some of this new theory around polyvagal states and how we think about that as occupational therapists, along with some practical strategies to support it either at home or in an educational setting. So I wanted to let people know that that course is available.

And so if that's useful to one person listening on his podcast, then it will have been worth my time mentioning it. So if you have a parent or you're working with somebody that you just think might benefit from taking just a basic course on regulation, even just newer therapists. If you're interested, then reach out and get in touch and we can point you in the right direction, but our we'll hold you up no longer. Enjoy.

We are wondering today about interoceptive processing how it relates to, well, for me, how it relates to polyvagal theory, cuz we've kind of been talking about that in terms of making sense of our arousal and then also whether we're safe or not, and then linking that to the states in our nervous system.

And then also understanding the different processing. in those different states. Um, and we were curious about interoception in the mix of these things. Cause we talked about it a little bit in the, um, episode where we talked about somatosensory processing and it being , part of that processing. And we wanted to know a little bit about, or if we could flesh out, I guess, how interoception changes as we move through the different states. So if we're in a ventral vagal state, or we're in the social, uh, engagement system and we're regulated and interoceptive processing is still weak, like what kind of clinically should we be thinking about and what could we do around that? And then if we start to get stressed and we move into a sympathetic state, um, what I guess just inherently is disrupted in interoceptive processing in a more sympathetically activated state. And I know it's not as simple as just like pure sympathetic activation or pure, ventral vagal or any of that, but we'll, maybe we'll try to keep it as simple as possible just to talk about it, but maybe not.

Cause we like to go there, this conversation. then also maybe if we hit more of a dorsal vagal, um, shutdown, kind of immobilization states, what is potentially happening in the interoceptive processing in that space, and what we can look out for clinically. And then also maybe what we can do to adjust our treatment depending on where kids are at.

So what do you guys think?

Track 1: That's the next three episodes,

Tracy Stackhouse: of questions. Yeah. Next three episodes, right on Michelle. Oh, man. yeah, so I think it's really cool to think about each of these systems in such detail the thing that's interesting for me is that, you know, it pulls into my mind. Because I've just studied the brain a lot, and I think about it in a kind of, um, I don't think it's idiosyncratic the way that my brain works.

Um, I, ooh, kissing my brain. But, um, I think that it's a little bit of I've disciplined myself to think about the pathways, to think about the tracks, to think about the receptors, to think about the information goes and for the purpose of what. Right. That's always my

Track 1: Hmm.

Tracy Stackhouse: Um,

Cory: Hmm.

Tracy Stackhouse: you know, I think what happens so often in our thinking about these sensory integrative processes is that it, it's easy to. either be too general or too, too detailed. So in the podcast forum, because we don't have visuals, you know, we can kind of post a couple articles or whatever in the show notes, certainly. But because I'm picturing in my own mind's eye or I'm picturing the pathways, or I'm thinking about the insula. Um, and, you know, we don't often say in a normal conversation to each other, like, I'm thinking about the insula,

Cory: we should.

Track 1: Anterior poster.

Tracy Stackhouse: That's right. So it brings up all those questions, about where does interoception, what is it, where, how is it processed? And then it is connected to our state and we can think about state really in a rich and beautiful way through the polyvagal theory. So I love thinking about it there.

So that just gives us like a lot to talk about. And none of that is directly clinical. So of course, as I meander through some of these, more of the, what is the receptor doing, then let's be sure that you guys help me to land it back in clinical cases, because think this podcast is so beautiful that way, the way we dialogue about the clinical implications and kind of how does, how do we bring it to, to life for us as occupational therapists?

And, yeah. So anyway,

I just wanted to.

Cory: That sounds good.

Tracy Stackhouse: Okay.


Cory: Were you going to talk about the receptors in the inter receptor system today, trace?

Tracy Stackhouse: I

think we should touch base on it partly because it's an interesting thing when we, when we say state of the nervous system, so let's say that we're in a

ventral state, the receptors

function differently

they do when we're

Cory: in

a dysregulated

Tracy Stackhouse: state. And so we, we think

states sometimes as like happening in the autonomic or central nervous systems, but it affects the receptor. And so it's true that we have to think about the receptors. And if you think about your interoceptors, they're the, the deep somatosensory receptors that are your body. But they are, we have interceptors in our eyes and in our ears you know, throughout our oral facial structures, throughout our, pharynx and larynx and our esophagus, and our lungs and in our heart, and in our guts and in our, vascular system, in pressure throughout our connective tissue it's really, they're everywhere interceptors. So sometimes I think we should start there by just saying that for us as occupational therapists, when we hear interoception, we really need to make sure we're always broadening beyond, the visceral organs, which is what so many

people think of when they think about interceptors. And in that we're gonna tie together vestibular, proprioceptors, tactile receptors, all into this category of interoception.

We're crossing categories all the time and we

have to have the fluidity of thinking. It's not a rigid set of labels. And so does that feel comfortable to think about interoception that

Track 1: Mm

Cory: Yeah. In my mind I've kind of looped it into the somatosensory processing piece, but then also I'm always thinking about the vestibular piece and amongst that, because they, they all form that body concept. I mean, everything does, but like they're the real receptors of the body of ourselves, I guess.


I kind of try to think about them, parcel them out when I can, and put them back together as often as I can, as well.

Tracy Stackhouse: Yeah.

Track 1: I do too. And, and probably think about, tissues like I guess fascia is part of that as well. So I don't kind of just think about it in terms of organs. Can I complicate things this early? Uh, and wonder about emotions, like how, because my understanding is, your feelings and emotions and a sense of that in the body is part of interoception as well, and not just the tissue, um, within the

body is that

Cory: do you normally explain that to parents, Michelle,

Track 1: I talk about it as having two aspects. Again, this is, um, as in a way to communicate. No, but it's just, I just wanna say that I'm gonna do it really simple. But I just really say that it's the internal, expression in the body that is being noticed, in the brain, or may not be noticed in the brain.

And that includes, the tissues, the organs. So I usually break that down. You know, heart rate, blood pressure, thirst, bladder bowels is a really easy one to talk about. But, um, so it's those organs, but it's also, the feelings within the body. And I guess I tease that about because some of the kids we work with or people we work with, it can be easily noticed that they don't, perceive that they're hot. Like their temperature regulation mightn't be noticed by the child or bladder and bowel. So they might have some continents issues.

But I see that there's also this emotional dysregulation that's part of it. They're not noticing that they're getting a bit frustrated or nervous. And so that's kind of noticing the internal landscape for them and knowing what to do about it is just as complicated, and nuanced for the feelings as it is for the body system.

So, it's just really a story about saying what's happening on the inside Trace, am I right though? I didn't get the nod? Is feelings and emotions part of interoception?

Tracy Stackhouse: A hundred percent. Yeah. So when we, sometimes you'll hear, different OTs or often, folks who are thinking a lot about emotion regulation or affective regulation

Track 1: Mm.

Tracy Stackhouse: they'll start to get to the level of understanding that, affect is the evaluation or the coding of the experiences sort of pre-em emotion.

And that sensation and affect are dually coding for each other. And it's really actually

Track 1: through the

Tracy Stackhouse: interoceptive

Track 1: Hmm.

Tracy Stackhouse: Functions that carry that information to the, amygdala and then into the insula actually where that dual coating is actually happening. But it's interesting in that there, there is actual coating in the periphery too, that is both sensation and affective or, or more affective valence than just pure

Cory: affect

So mean like negative or positive in the periphery? I'm going to an extreme example, but like, if I touch something that's kind of sharp, then it's like right then and there negatively coded in the receptor right at my fingertip. I know that's really obvious example, but Is that what you're meaning?

Tracy Stackhouse: It's also like, the context for sensation matters so much. So is sharp. Mm-hmm. So sharp is a

threat, let's think about something like social touch. Okay. And then social touch on different parts of your body. So my daughter recently moved back to Colorado after living in New York City for 10 years. And so she kind of went from being a teenager because she moved there when she was, beginning university. And so she was in her late teens still when she moved there. Let's have a hiatus and talk about my introception of letting my daughter move

Cory: Oh, no.

Tracy Stackhouse: to New York City when she was 18. That's a separate story. But you know, so she spent, formative early adult years and then is now, a full grown adulting person. Right. But it's, so the, this comes back to social touch in that, In our family, we are quite tactile with each other. We're super cuddly. We like to spend that kind of time together.

And one of the things she was laughing about was that, it's quite common for her to come in if I'm sitting in our family room and she sits on the couch next to me, she would sit down over there maybe because it's like an L-shaped couch. You can see my l if we're on the video, and so she might sit there so we can have an easy conversation, but at some point she's gonna migrate closer and closer because she's gonna want a shoulder rub or a, you know, like a tactile kind of connected moment. And then we were laughing about it because she's quite aware that she doesn't really like people to touch her neck unless it's in that context. And so we were talking about, we were actually talking about Introception the other day because she said, why is that?

Like, why is it that,

Track 1: Yeah.

Tracy Stackhouse: my neck is so off limits, unless it's in this context where then it's like I can't get enough. And so that's all based on this, evaluative system and the coding that's happening in the affective system, in the attachment, but in the connection and in the relationship system and how that sets a different scene and tone for, how the receptors actually are functioning.

And so what's interesting about that is that if you are. Not open to receive. The receptors themselves become more bristly. They're like, no, they're more rejecting

and more likely to receive the information in a defensive way, in a protective way. Not just over response, but defensive protection right. . Versus when we feel the warmth of

interoceptive experience and that that opens and creates a spaciousness in the receptors themselves to be open to being touched. And so there's this powerful thing happening there. Right? Isn't that

Cory: yeah, It's super cool.

I kind of talk about this as like it's not my example, but I, read about it in multiple places, but last place I saw it was, I think it was in Affective Neuroscience by Jaak Panksepp. And he was talking about context for processing of, of affect and that situation of the dark car park at night, the most clear, obvious example people can resonate with because we all feel a little more on edge when you're, uh, alone and you're walking to your car and it's dark and it's, you know, and you, your whole nervous system has shifted into a more protective, defensive state so that you can respond if you need to because the context of that environment


Track 1: Hmm.

Cory: and I, I think that's, yeah, it just makes so much sense. It helps integrate this information around sensory processing and state and this, this dynamic that we have, around it. But I'd never, I don't think I'd ever really wholly, fully included the receptors. So I think you're right. In my, in my thinking, I probably was thinking more about state, centrally,

 And not really like you'd see it in the body, but, but I've never really thought it even changes down to the level of the receptor, the way that it's going to just val, like that's not a word, but positively or negatively receive the input I guess. And it shifts that valence in a certain direction. and that makes a lot of sense to me.

Michelle Maunder: And it sets the tone, doesn't it, really? And it's interesting in your, well, both those examples that should your daughter, be touched on the neck or feel like she's been touched on the neck in the dark alleyway that, is very, very different to her being with you and, being really comfortable.

But, having some personal space and then looking at you in a way that's conducive to a, conversation and she's approaching you. Her body then is okay, I need some more, you know, proximity, touch, whatever. But she's even opened up to you in the family room.

That's a known space, but I guess she's coming back and there's some newness to that. But it's like, even then there's, I don't know with some. People, you come right in,

Cory: I love that, Michelle, the approach part of it as it comes back to that control, like, and we are talking about in treatment, one of the big things for safety is giving control back. Um, and I think obviously for your daughter, Tracy, her being in control of the approach around the input, and of course like your mom, like you're a whole different person in terms of

safety and all that you represent for her. But yeah, she in the approach, right? Like that changes the nervous system in itself

Track 1: drive it. There's a request for it then, so then she's like, you know, and obviously that's what she's reflecting. I was like, Hey, how come I want for you to touch my neck and I'm, I'm coming for you to touch my neck. But it doesn't work like that for other people in other times. So, so fascinating that she can even talk that through, and that we as OTs that talk about all the things that we do, and it's such a personal growth experience in our clinic.

You know, because you, we are observing each other to life really.

Tracy Stackhouse: Yeah, totally.

Track 1: It is just interesting where our little kids with, you know, or people with not the language and not the knowing. It's like, no wonder it's really awkward.

I think I told you about another little boy, but I saw him yesterday. He rounds at me like, he's gonna tackle me around the legs and gimme the gorgeous hug. Last time I explained that, he did it around my face, put his hands around my face, and just literally like, oh, yesterday he ran to me and pulled up short about, and I kind of Bob down, crouched down to be with him.

He stopped about a foot from me and we just literally just were like, oh, I'm so excited. But there was such a mobilized approach and energy that he doesn't need the tactile component of it to be expressing and probably receiving warmth or joy or approach. For me, it was just the running and the stopping.

Anyway, we're, we're digressing a little from interoception, but I dunno that it is cuz I think he knows. I don't need to touch you, Michelle, to get that, juice from seeing you. It's really hard not to, you know, it's so natural for me to have them come up and literally encircle my legs or whatever he doesn't.

So because I do love touch, it's hard. I have to think about it to not touch him and really kind of follow his lead to be like, where you going? You know, where, how far are your hands gonna come up to my little face but not touch me? Um, yeah. And just tune to that really.

Tracy Stackhouse: Yeah,

So, you know, our biases, our internal motivations around what feels right to us, is informed by our interoceptive processing across all the different interceptors, whether they're visceral, or tactile, proprioceptive, external receptors or vestibular, kind of the vibration receptors, the ones that pick up on the, on the jush of what's going on around us.

All of those things tell us and reinforce to us our and proclivities. But as we kind of tune into them, even for little ones, they'll tune into that and use it as a go signal, yes, go ahead and hug me. Or a stop signal. maybe not so much. And right away, even in very little children, we pick up on these cues from each other around the social boundaries, social space, what feels comfortable, what doesn't feel comfortable.

And it's all based in this neuroceptive function of comfort. And safety versus the opposite of that, which feels threatening or uncomfortable, disruptive, um, or something I need to protect myself from. So that valence based function that neuroception is picking up is really driven by, interceptors in very many ways.

Of course, it's through all of the sensory systems, but they're gonna be processed through this low route and then eventually into the insula. Uh, and so that, that's where we pick up that queuing. Um, and it

Track 1: Hmm.

Tracy Stackhouse: uh, inform us, you know, for me, I'm kind of a hugger, but I'm gonna pick up on cues pretty fast if somebody's not a hugger. And I might interact with folks who are not huggers and you either learn that about them or, and that, and there's no qualitative judgment about. Is the hugger or the non-hugger

the, you know, way to be. It's like what works for

Cory: you.


Tracy Stackhouse: there is a collegue

of mine here in Denver who started a new podcast recently actually, that's kind of about this.

It's, it's not about interoception,

the social experience and all of our neurodiversity.

Track 1: Hmm.

Tracy Stackhouse: I love the name of their podcast. It's called, um, you Don't Wanna Hug, right? Because Yeah. Cuz her starting space is No, thank you very much. And you know, my starting space is sort of Thank you very much. So both are awesome

Track 1: yeah, bring it in

Tracy Stackhouse: uh, I think that's sort of sweet

thought it would be worth mentioning

Cory: I'd have to check it out.

Track 1: this is where that the social piece and the cognitive piece and that tuning in because if you are really, um, focused internally, because you might be tactile, defensive that you really have a strong sensation of fluctuations in temperature or, you know, bowel, you may be so focused internally that you don't even tune into.

You are not a hugger. And so I come on in because I am, and my focus is on my internal story or the opposite, you know, that I'm, so, focused on the story externally that I don't notice what's happening for myself internally, and I get really tired and thirsty and, you know, whatever.

But I can see how things can go wrong really quickly if you are not able to shift, um, the attentional system from internal to external, um, scapes or whatever your environments, really fast. And then know that, um, either pick it up, very quickly from neuroception, but also from, you know, your social knowing of other people's perspective, like there's so much social, skill or capacity required to make those nuances, because if you just do a little sidestep Trace to avoid a cuddle coming in, somebody has to notice that and go, oh, that, that, that angling back might mean. She's like, well, step back is like that. That's the definitely no hug. Um, versus, uh, my need for a hug is so great that I'm not even going, I'm not tuning into what your needs are.

I'm, I'm just fulfilling my own at the moment. Yeah, so if there's any kind of, neuro diversity around our, interoception functions and or social and or executive functioning, I can see how it just can go wrong.

Cory: My brain goes many directions, but what you were talking about Michelle, made me think, about the relationship that we have with a caregiver early on that can help us tune in the experience, and code that experience for us. And that without that we might be a little, wayward in our ability to, to make sense of those internal signals and, you know, not just interoception, but the whole body like, and people helping us code that experience. Um, but before someone helps me label and understand and make sense a bit more cognitively of the interoceptive processing. Tracy, I was wondering earlier we were talking about, um, emotions or feelings and these words get confusing, but I'm, I'm curious about the pickup of that in the body. I guess it depends on the receptor. So first of all, I'm kind of wondering. do we actually know what the receptors look like? Interoceptive processing because that, I don't know, I'm weird. I, it helps me to know actually what the receptor physically looks like sometimes. I know that's really detailed, but the reason I like to know that is because I wanna know how it gets activated. And then that helps me understand what the process is. So I just do, we know that well enough of like, what's the receptor, how does it pick up? And what is actually the, is it a physical change? is it a chemical change? Like how can we talk about that? Or am I leading US wayward here?

Tracy Stackhouse: well, I wanna try to answer it I think it's such a good thing to try to grapple with. So receptors, most interoceptive receptors are somatosensory receptors, but they change depending on the state. So that's the thing that can get a little bit complicated to try to trace out and track out. And that feels a little bit, um, tricky to do here. But if you,

if we like, let's just stick with any particular receptor. Let's say that we're thinking about the stretch receptors in our viscera or around our heart or lungs, um, in our ears or in our mouths or in our throats. So the tension, the relative tension, that's a stretch receptor.

Those are proprioceptors and they are

Cory: Mm-hmm.

Tracy Stackhouse: If you are in a state of like, blissful excitement and you are ready to have a dialogue with a friend, so that would be describing us right now. Um, we have a certain degree of tension that is being produced through the vagal circuitry, through the interceptors, to bring our voices into a bit more connected, melodic quality because we are feeling warm and engaged with each other, and we're really working to be connected across space and time, and to share this moment that we love doing together.

So the stretch receptors are constraining, so the sensory processing tends to

Detached audio: direct

Tracy Stackhouse: and constrain. And enhance processing through that process. Right. So the receptors themselves are changed based on the state. And the number of receptors and the quality of receptors are also changed based on that state. So if instead, you know, I was in, a dorsal shutdown kind of state, the quality of my ability to even access my voice might be shut down. So I might become selectively mute and I might not even be able to mobilize the sensory motor function of my vocal system because I'm in so much shutdown. And that's a change in the receptors themselves.

So they, they change constantly. The initial change, the valence based change is actually electrical and that's the first thing that changes in the sequential processing. Then it becomes chemical and it becomes complicated chemical soup. Right? Um, so that

is a story of up and down regulation, inhibition, disinhibition, you know, facilitation all of those things are happening within the chemical system. But it initially is based on this neuroceptive signaling, uh, that sensory affective quality that tells us, is this a good

thing? Do I want more of it? Do I want less of it? And those are all interoceptive signals that come from the receptors.

Cory: can I see if I can wrap my head around it? So we, if at the moment just in this conversation, we're in more of a ventral vagal space, we feel more open and more connected so we can have this fun conversation and in that space, um, and maybe it's chicken or egg, but at the moment we'll start with we're in that space and in that comes the signaling from like, whenever I smile, I get the receptors in my face and I have more access to that function.

I guess I get more signal that and I guess they feedback, I'm in this state and now I'm doing these things and the appropriate receptors are telling me that this is a joyful experience and I'm getting the continued sustained interaction between the information in my body and then the state and that I'm checking in with that all the time.

I guess that they're at a match, I'm assuming. So if a signal came in and I was in a didn't feel good or I was like, I'm unsure, or I'm thinking really hard or whatever, maybe I have less access to my open engagement. It kind of gets shuts off a little bit. And then the body kind of does the same thing in terms of the appropriate receptors change in the way that I'm using them and then in the way that I can access them,

even just for functions around talking.

Okay. And I guess, yeah, it can drive the other direction, I guess, can't it? Like they can drive each other in this pile. This. Direction of the receptor can drive the shift in the state, and the state can drive the shift in the receptor. And it's again, chicken or egg. Um, but I guess we have to look at the dynamic, don't we?

Tracy Stackhouse: we're in a trusting, safe relationship with each other and we don't, um, tend to give each other very many signals of uncertainty, then we can stay in a pretty continuous flow with each other. We've all experienced. Lots and lots and lots of social interactions, pretty much on a daily basis, where the safety isn't a thousand percent established and the trust and connection isn't a thousand percent solid. And you say something to somebody and you get that little pause where you're literally having a mismatch. We're like, Hmm, did that land that person? And we even may say

uh, out loud. Uh, once we're aware

 We certainly, our nervous system is, is asking that question right away before we ever say it. So this kind of gets into the deeper part of interoceptive processing and the posterior and anterior parts of the insula. And how those kind of connect back to the, the deeper circuitry that's lower than the insula and the circuitry that surrounds the insula that, uh, allows for social and higher level executive and cognitive and language skills to kind of help us with the storying of what's happening in the anterior parts of the insulin. So the higher parts of the insula we think about as interoceptive awareness. So we have an awareness, but the lower centers, there isn't a conscious awareness of it. It's the part where get the signal where something doesn't feel comfortable or where something feels like it's shifting. So when neuroception signals to us that there's a slight constraining or shifting off of pure safety, we start to have this little bit of a different experience.

And a lot of that is gonna get processed, you know, pretty broadly through the brainstem in autonomic functions, in the limbic system, but certainly in the posterior parts of the insula. And what happens is

Track 1: there's mismatch


Tracy Stackhouse: then between what's expected and what's happening. And it's the mismatch that actually signals us, oh, I'm having an emotion.

I'm having uncertainty. I'm having a trigger of, wonder. I'm having a trigger of pause of I was in full approach, but maybe now I need to pause. And I'm sort of of, oops. You know? So as soon as we have that happen, that sort of shifts us into this more awareness based process. And that is a much more cognitively mediated process than the lower parts, which are not at all based in awareness. Um, is that, is that

Track 1: Yeah, that's super

Cory: Yeah. So you have an initial neuroception around safety or not, so that valence of like, is this positive or is it negative? And it's coming in through all of the sensory receptors they're, depending on the state, receiving that in certain ways. if you, that information comes in and goes up into, the brain is taken up into the brain, goes through the brainstem, obviously the amygdala, some of the, like you talk about low route processing, so the lower, lower components in the brain there, that sends it up in through to the insular, which is sort of more central in my, it's kind of low but central.

What do you, would you say.

Tracy Stackhouse: a and it really does go. From, you know, more frontally oriented parts of it that are anterior, but the posterior parts of the insula are really technically in the lower limbic system. They're subconscious and they're really interacting more with, autonomic and brain stem functions.

Cory: right. So that it hits that spot and if it hits that spot, and we are in a certain, well, you said use approach, so like if we're in a place where things are feeling like, let's just imagine we're a hundred percent safe. Maybe that never happens, but like, imagine you're in a hundred percent of safety and then suddenly you get a interoceptive signal that, mm, maybe you do need to not be an approach right now.

You need to change that initially, just subconsciously hits those. those parts in the brain and then the, a mismatch to what, like what would we call that if it's the signal is now changed and now we need to shift out of approach? It's a mismatch in the insular, but how,

Tracy Stackhouse: so part of it is that, if our awareness is I'm safe and this feels good to me, we have that pre perceptual. So most of Neuroception is not really, it's below the level of perception, but then it tips into perception because the processing is continual and it's temporal and it's, you know, it's happening a live feed all the time.

And so what is not perception becomes perception and it becomes

Track 1: awareness


Tracy Stackhouse: So when you first have a sense of safety, then you know you are safe. So awareness

comes is, um, you know, we get that intuitive almost feeling it's this kind of, you know, rapid.

Oh, there's something that doesn't feel right anymore.


is really critical because it, and it, it's a mismatch partly in the insular. So the insular is like the awareness part of the anterior insular processing is telling us this is what's happening to you. And then when it shifts, it's like something shifted. And because this is all based on valence and we have an expectancy kind of paradigm, if we're in safety it shifts out, the shift is away from safety. So the mismatches,

safe, but now I'm not.


Cory: sorry. You go.

Tracy Stackhouse: no, go

Cory: I was gonna say, so it pulls that, that preception not our subconscious processing. This change in signal pulls in the awareness processing to then go, Hey, something changed. Maybe we need to change behavior. Like now we pull in cognitive awareness of the experience and then, and it might be really quickly and rapid.

Like obviously usually it's probably pretty rapid that we do that. But there is a, a blending of the two, I guess. So

I'm just

Track 1: Hmm.

Cory: like what do you

think, Michelle?

Track 1: Well, uh, I'm just thinking of, keep using us as an example, Cory. So you and I, if we, which we do sometimes not quite get each other, but because, we are bathed in safety mostly, but if I say something a bit sharper or blunt or whatever, and there's just a, oh, what does she mean by that?

I'm still mostly bathed in safety. My, you know, when it, when it moves up to perception of, it's a curiosity of what did you mean by that? Or, you know, did I get that right or, but it's dampened that

 down, so I won't go so mobilize, but, I've picked up, there's a, ooh, there was a curiosity, there was a bump. And then I do that from a, social exec functioning, pull in, Hey, what happened there? I noticed that. And they were like, ah, you know, blah, blah, blah, blah.

And, and then we keep going kind of thing. So that's how I'm perceiving it. But if you are not in such a consistently safe environment, that, that miscuing might more rapidly escalate to a whoa, uh, something happened. And if it's a big queue or you are not invested in the person, I might just walk away.

You know what I mean? If it's in the street and it's like, oh, it's like, actually I'm not exploring that, that was a mismatch. And yeah, no worries mate. See you later. You know, it's just like, bye, I'm out of there and you don't, check out. Did I get that right?

Anyway, I was just trying to give a social example of, how that cascade might happen and that if you are in safety, you might dampen that down. But if you are in a context which isn't so queuing a safety back in the alley, you are just gotta take the nuance of, oh, there's a mismatch and you might be outta there and have a much, stronger or less inhibited reaction to a mismatch.

Absolutely. And maybe that is the context is like you were right to leg it out of that alley. But I wonder if that's what's happening in the clinic. That there's a, a little something goes, or a big something, a perception of a, something goes wrong and we see the kiddo, have a bigger reaction to it and, and pull away.

 And then we have to try and uncover what bit happened there? Was it loud sound in my voice? Was it the social stuff? Was it not winning? And you, bailed, that it's not purely interoception, but maybe it's, a sensation of I've gotta do a we, and it's coming really fast and I don't feel it till it's, um, really ready and I've got a full bladder and I just gotta go and I can't stay here in this, in interaction anymore.

Cory: Michelle I just said respond to that beautiful comment . but yeah. can we talk a little bit about now then the states like, cuz Michelle's talking here about moving into a flight or a, like that mobilization, I'm thinking about then the sympathetic nervous system pulling in and then resourcing us to deal with a potential threat.

 But I wonder then how that with interoceptive processing. Probably, I mean, I guess on both fronts, on the awareness, on our ability to. Perceptually be aware of our interoceptive processing. And then also on the not awareness, cuz I assume it impacts both, that subconscious processing of interoception probably all gets altered.

But then also the conscious awareness, what we will pay attention to in a mobilized state is gonna be different as well. So, um, yeah. Can we talk about that a little bit?

Tracy Stackhouse: Yeah. All of this is so interesting because it does make us move in our thinking and not silo our thinking too "oh, it's an interoceptive problem so I'm gonna treat it interoceptively".

Or it's, a social engagement issue or it's, um, you know, whatever happens to be because these things are interacting with each other across this neural circuitry.

So the polyvagal system is one part of that. And then interoceptive processing itself is a part of that. And then our social and problem solving, you know, all of these things, right? They're interactive, that's why we a tool

Track 1: like the


Tracy Stackhouse: honestly, is to sort it so we can try to identify clinically where are the strengths and where's really robust resource available for this kiddo or whoever this family, us, ourselves, maybe. Or like, what are we gonna be targeting a bit in interventions? So our state, if we're in a ventral state, like we're here together in a ventral state, we feel safe and we feel connected, and we can operate from that. If we get a mismatch in our social interaction, which happens,

Cory: yeah.

Tracy Stackhouse: it's happened in this

even a few times, right?

Where miss time or what, and part of that's just the technology, but it's human interaction is funny that way. So when that happens the mismatch to us, it is a interoceptive cue before we're aware of it. It's a interoceptive queue, but we're not tipping out of safety. And so the neuroceptive function, you know, it organizes a approach avoidance, and it really organizes activation and deactivation based on what is the valence doing itself. And so if we're in safety and we're in engagement, we're gonna pretty much stay in that steady state until the interaction or cues. Change. It could be that the cues from our body change.

So if we're in a really, robust, deep conversation, we can't sustain it forever. And we inevitably, we run out of energy, we run out of air, we can't sustain the oooiness for a long, long time. And so we inevitably get an interoceptive cue that we need to shift something. And that shift when we stay in ventral is, available to us. We can make lots of choices. The thing about the state dependency is that as soon as you're not in ventral, um, and you could be in a blended state, so you could be partially in ventral, but you could start to have a mobilization into sympathetic activation for whatever queue would shoot you there. And then you have a little bit less spacious choice available to you

in what's on the horizon for you. And as that becomes narrow and, and more constrained and more pushed by the state, the interoceptive cues follow. And so,

regulation begets, regulation dysregulation, begets dysregulation.

It's the kindling process

is happening.


Track 1: this is what happened, Cory, we had a business meeting yesterday, um, which we were very invested in, and I needed to go to the toilet by the end of it. So the meeting finished and um, Cory zoomed me so we could finish our component of the conversation. And she's like, how are you going? I was like, it's all really awesome but I need to go to the toilet

And then it was like, okay, blah, blah, blah, blah, blah. And, and anyway, at the end I cared less . I was like, yeah, yep, no worries. I've gotta go to the toilet. I'm gonna wet my pants. See you later. Like literally

I went from this is got a hundred percent and I was probably in a blended state. I'd been thinking about it a lot and very excited.

So it was Ventral and sympathetic. I am less able to tune in, I can hyper focus and so I think I'll tune into my body less. I'd had back to back sessions as well, I gotta say. So I hadn't noticed, oh, you, you got your bladder 30% full, Michelle, maybe you should, you know, whatever, 50%. So I had this exciting, exciting, had no cues probably in the meeting.

And then at the end of the meeting when it was like, ah, that went really well. It was like, Ooh, you've really gotta go to the toilet. And so I knew Cory would be ring. So it was like, Hey, how you going? Yeah,

Cory: I should have let you go, but then again, that's my not queuing and being like, I just wanna talk about this Oh, fun times.

Track 1: I just did too. So eventually I was like, okay, safety, safety. Cory. Cory, juicy content. This is awesome. Suppress the need to go to the toilet. Hang in there, hang in there. Chill. Interoception was like, you your pants if you don't leave.

Is that about that attentional system? Trace? I think about that attention and ability to shift in and out and, certainly in that focus state that you know, that has that sympathetic activation to hold your focus, we're less able, I guess, to tune into to keep us in that state and we we're driven to stay in that state, to have that meeting or this podcast, we tune out a little.

Like, under my conscious awareness, am I really monitoring my internal landscape as much as I am if I'm just gonna go back in, in the house after the podcast kind of thing? So is, is that what's happening? Do I. Suppress my not suppress, do I not shift my attention internally, externally, as frequently and automatically when I'm really invested in something.

So, so can the attentional system drive, issues with, interoception?

Tracy Stackhouse: Oh, absolutely it can. Yeah. So if you, if you have a harder time, you know, using that attention or shifting, it definitely can make it harder. It's a cognitive resource to pay attention to it, but you don't need to pay

to it until the valence shifts so you don't need to pay attention to your bladder control. Once you have bladder control. Until your bladder

to get full. And it's the stretch receptors and the full feeling that start to shift the signal to say, wait, pay attention to me cuz something's happening here that's meaningful. So the meaning of the sensation becomes heightened. When it becomes heightened. Until then you aren't inhibiting it, it just isn't salient enough that it,

Track 1: Hmm.


Tracy Stackhouse: the valence hasn't called your attention to it. But attention is a tricky function that is, really a big, huge topic that maybe we can entertain in a future episode in a bit more detail. But I, I think about it like, in the anterior insula. Okay. As soon as you really have a deep thirst, and the valence tips like this isn't just you're ignoring your body. No. You really are deeply thirsty and you really need it, then the interoceptive awareness will become a stronger signal and whatever the rest of your frontal cortex is doing in the attentional system, it's like, Hey buddy, knock it off.

Pay attention over here finally. And so once the anterior insula gets fussy like that, it will draw your attention from the other things your attention system is so very all the time, and so the insula is, it sort of becomes nudgy and we want it to do so. That's its job actually.

Track 1: So that's the individual differences, Tracy, cuz I see that some kiddo's, valence is perhaps set differently. I had a really articulate, um, little girl I was working with and she was able to, draw out on a scale that her first, knowing or perception that she had to go to the toilet is she perceived herself at, um, her bladder was about eight or nine.

Like full on a scale of 10. And that if she was in the playground and had a long way to go, she would have to go immediately, but she couldn't run because that put pressure on her anyway. It was so fascinating that there was no valence tipping for her or, you know, the, anterior, insular wasn't, um, getting nudgy, getting antsy and demanding that attention earlier.

And that's why continence issue was such a issue for her when she got the signal and she was like, oh, I'm off. I've gotta go do that. And she knew to do that. It just came late for her. Um, yeah. So can we shift that Trace? Can we shift valence at that receptor

Tracy Stackhouse: Yeah, so it also brings up, um, the really important, dual processing of discrimination as well.

So the, if you really have an urgency, that's a valence tip and that's gonna drive it. But before the urgency, becomes critical. So the urgent signal should be closer to like a four or five, and

Track 1: then that should be

Yeah. Yeah.

Tracy Stackhouse: enough. For you to have discriminative awareness of those interceptors. And awareness can come not just from the valence tip, but just from, there's a qualitative difference here that I'm tuning into. And so for a lot of kiddos, that takes a long developmental course. Even in some kids, especially boys, are a little slower with this, and it takes a little longer to develop that awareness, for urgency, for urination, for instance. So there's kind of a lot of different themes we're talking about here. But for

Track 1: Yeah. Yeah. Yeah.

Tracy Stackhouse: you know, you can improve both. You can improve your reactivity to the valence. So we have a lot of kids that we see for toileting needs where they're averse to toileting because they hate the feeling. And so that's more of a modulation, valence based kind of intervention that you're doing versus the kiddo that you're trying to build the awareness when it's not urgent, the pre urgent, valence driven, but the earlier sensory discrimination driven.


Track 1: Mm.

Tracy Stackhouse: know, Kelly Mahler is an OT who she and her colleagues in in Pennsylvania have done all of this incredible work around researching this and developing some interventions and, you know, but they're very interoceptive awareness based interventions. So you work on building actual awareness of tactile discrimination, of knowing whether something is soft or hard or wet or dry or cold or hot or, um, squishy

Track 1: Hmm,

Tracy Stackhouse: uh, pushable or whatever.

You do all of this sort of sensory discrimination building, across the tactile system across all of our systems, and including across our

internal sensory motor ability to squeeze our tummies or take a deep breath or blow hard all these different functions that they're really intercept based, but they're also in our awareness. So that's an set of interventions. But a lot of our kids, the issue is pre that. It's more in the posterior insula and it's in the lower functions. So I think we have to be discerning about, you know, if, if you are working with this little girl you're talking about, only around the valence and urgency, then we're gonna miss the part around her sensory discrimination. If we only work on the sensory discrimination, she may always feel some level of negative valence for going to the toilet cuz she associates it with urgency. She may associate it with, I never make it on time. And then, it brings up all of these sense of self issues. It can be a lot of interoceptive cues can be deep shame triggers for any of us, even for very little children. And we have to be really aware of that. So it brings up a lot of issues for our treatment for sure.

Cory: Oh, that's probably where we should go in our next episode because, um, I'm amazed we have chewed through time today and I did not even realize

Track 1: There you go. Perception of time. Obviously, we didn't get any interoceptive cues to say, Hey, pull up you guys.

Cory: maybe I just ignored them. So invested. Um, no, that's been such a useful conversation. I don't know if I've ever heard this discussed prior to this conversation, I'm hoping other people will have some fun thoughts about it as well. Um, and maybe, yeah, we can think about what we dive into in the next episode. Jumping off of this one,

Tracy Stackhouse: Yeah, we'll look forward from listeners around this topic or any of the topics, and,

Cory: Mm

Tracy Stackhouse: look forward to going in the treatment direction around this in a little bit more detail. Yeah, great.



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