'Things You Didn't Know You Didn't Know' about mental health interventions
Interoception is how we feel and understand internal sensations like hunger, pain or heart rate. Associate Professor April Smith is developing a new tool that targets interoception as an avenue to improve mental health. Her online intervention, Reconnecting to Internal Sensations and Experiences (RISE), has already shown success in active-duty service members and clinical patients and is currently being tested in college students and veterinarians.
What is interoception? How does it relate to mental health?
Interoception is the ability to be aware of internal sensations in your body, so things like your heart rate, your respiration, whether you're hungry or full, if you're feeling pain, your ability to sense temperature and, critically, your ability to feel emotion sensations.
Research is showing a strong link between interoception and mental health. You can either be too in touch with internal sensations, or you could be too out of touch with internal sensations, and that could be problematic. If you're overly focused on your heart rate, you might start to think you notice heart palpitations, and then maybe you get really anxious, and then maybe that leads to a full-blown panic attack. Conversely, the inability to recognize when you’re hungry or full, or pain sensations, could facilitate things like restrictive eating, binge-eating or self-injurious behaviors and put someone at risk for those mental health conditions.
What is the RISE intervention?
The RISE intervention stands for Reconnecting to Internal Sensations and Experiences. For a number of years, we were seeing time after time that people who had engaged in suicidal behavior had worse interoception than people who hadn't. So, we started to think if interoception is a risk factor for suicidality, we might be able to improve it and thereby reduce suicide outcomes.
At the time, some studies started to come out showing you could actually improve people’s ability to attend to things like their heart rate or breathing through relatively simple procedures. And we thought, okay, let’s try to build out an intervention that is really aimed at improving interoception, interoceptive awareness, and see if that might in turn impact downstream suicidality.
With the goal in mind of getting people connected to their bodies, increasing the care of their bodies, we have a number of exercises and some psychoeducation we provide people about interoception and mental health. We also have them do some self-guided reading and interactive writing prompts. There are some audio clips they can listen to and even some at-home worksheets where they can practice the skills that they’re learning.
From the outset, it was really important to us to design an intervention that could exist online and be self-guided. For every mental health clinician, there are literally tens of thousands of people suffering. There's just no world in which we're able to get all those people connected to in-person clinicians. So, our lab really wanted to think about accessible interventions.
How does RISE work?
In the first part of the intervention, after they learn about interoception, we teach them about all the muscle groups in the body. We then work with them on body functionality, which asks them to think about how their bodies perform and function and what their bodies can do, rather than thinking about their bodies just in appearance-based terms. We’re all really good about thinking about how our bodies are “too” this or “too” that, but we have kind of gotten away from thinking about what our bodies can do for us: how they help us hug a loved one or send a work email or play the piano.
In our second session, we have them do a lot of work around emotion recognition and management of emotions that may be associated with ineffective behaviors. We provide education on a variety of emotions, from good ones to maybe less desirable ones, and really get participants to think about how they feel those emotions in their body, where they feel them, how they maybe distinguish between anxiety versus anger and then how they might shift from an angry state to a calmer state, and we give them skills to practice that.
In our third session, we move to some more body functionality work where we have people think about how they can use their body in terms of communication, but also how they can use their bodies to engage in self-care, healing, resting, digesting, things like that. Then, we end with a module on being more aware of hunger and fullness sensations. We have participants learn about intuitive eating principles as well as engage in a mindful eating exercise.
Who benefits from the RISE intervention?
Interoception and being in touch with our bodies is a great skill to teach to anyone. I've benefited from it. Unfortunately, in our society and culture right now, there are a lot of forces pushing us to disconnect from our bodies, whether that be because we're dieting to try to look a certain way, or we're trying to push down or manage our emotions, or we are on social media and sort of taking this observer stance of our body. All of that could worsen interoception and then drive or potentially facilitate people being able to hurt their bodies, whether that be through eating disorder behaviors or substance use behaviors or self-injurious behaviors.
I would just encourage people, to the extent that they can, to think about things that they can do to get back in touch with their bodies or take an attitude of more care or regard toward their bodies, because it really does seem like that can lead to better mental health outcomes.
About the expert:
April Smith is an associate professor of psychological sciences at the College of Liberal Arts at Auburn University. She directs the Research on Eating Disorders and Suicidality (REDS) Lab and co-directs the Auburn Eating Disorders Clinic. Smith has received more than $6.5 million in funding from the Department of Defense and National Institute of Mental Health to support her work improving mental health outcomes.