Interoception and Brain Disorders
May 10-17, 2025
Director: Sarah Garfinkel
University College London, UK
Co- Director: Sahib Khalsa
University of California Los Angeles, USA
Faculty:
Hugo Critchley, Brighton and Sussex Medical School, UK
Peter Strick, University of Pittsburgh, USA
Karin Roelofs, Radboud University Nijmegen, Netherlands
Sarah Garfinkel, University College, London, UK
Ivan De Araujo, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
Olaf Blanke, Ecole Polytechnique Federale de Lausanne, Switzerland
Sahib Khalsa, University of California Los Angeles, USA
The study of interoception—how the brain perceives and processes signals from within our bodies—is revolutionizing our understanding of nervous system disorders. Interoception sits at the intersection of neuroscience, psychology, and physiology, offering a holistic perspective on how the heart, lungs, stomach, and other organs influence cognitive and emotional processes. Interoception brings a profound shift to conventional paradigms that have historically isolated brain function from bodily processes.
This Advanced Course will immerse participants in the latest cutting-edge research on interoception, exploring how this “internal sense” operates across conscious and unconscious levels and how it reshapes our understanding of neurological and psychiatric conditions. Faculty will lead a deep dive into emerging neurobiological models of interoception from a cross-species mechanistic perspective while highlighting the role of interoception in shaping human cognition, emotion, memory, and decision-making. Throughout this course, we will break new ground in exploring interoception’s relevance in the etiology of complex brain disorders, including anxiety, depression, schizophrenia, eating disorders, functional neurological disorders, and depersonalization/derealization syndromes.
Attendees and faculty will engage in rich discussions about how interoceptive dysfunction may underlie the high comorbidity between mental and physical illnesses, offering novel therapeutic targets that leverage body-brain integration. Participants will 1) Explore and critique the most advanced contemporary models of interoception, examining neural, behavioral, and cognitive perspectives across species, 2) Gain insights into the dynamic interactions between peripheral bodily systems and central neural circuits, focusing on how they contribute to mood regulation, memory formation, and decision-making. 3) Discuss and debate interoception’s role in health and disease, emphasising emerging treatment approaches informed by mechanistic animal models of interoception. 4) Engage directly with each faculty expert for a full day of personalized, intense, and stimulating one-on-one or small-group mentoring. This transformative experience is designed for both emerging researchers and established investigators eager to enrich their understanding of interoception and its role in brain disorders. Dynamic, trans-disciplinary debates will challenge and expand your current frameworks and transform how we conceptualize brain and body integration, forging a new frontier in treating brain disorders.
Hugo Critchley
Interoception, and its impact on thoughts, feelings and behaviours from the perspective of autonomic medicine
Interoception represents the afferent limb of internal physiological regulation. Interoceptive signals, conveyed in part by viscerosensory afferent nerves, are coupled efferent neural control internal of bodily organs and functions. Autonomically-mediated changes in bodily physiology, including responses to motivational and emotional challenges, accompany and support adaptive behaviours. In predictive coding and active inference models, these responses and behaviours are geared at the prospective minimisation of interoceptive prediction errors. Autonomic disorders disrupt interoception. Autonomic failure (of central or peripheral) origin, different expressions of dysautonomia, and lesions to interoceptive spinal or cranial nerve pathways, provide a window into how interoceptive processing is organised and continues to psychological and behavioural processes.
During my session, I will; 1) describe the anatomical organisation of interoceptive and autonomic nerves and their interactions in the periphery and spine; 2) review clinical disorders of the autonomic nervous system and what these reveal about interoception; 3) cover surgical, pharmacological and neurostimulatory interventions impacting autonomic responses and interoceptive signalling. 4) discuss how compensatory responses, and the presence of representational redundancy in both interoceptive and autonomic processes, can influence the expression of clinical symptoms, with an emphasis on neuropsychiatric disorders.
Sahib Khalsa
Interoception and mental health: Bridging the gap
The internal organs emit signals that rhythmically propagate throughout the human body before reaching the nervous system. These interoceptive signals do not usually dominate consciousness unless the body’s physiology is perturbed or aversive physical or mental threats are perceived. The hierarchical and feedforward processing of such signals across the neuraxis facilitates the brain’s generation of accurate internal models of the body and world that allow an individual to 1) formulate (i.e., anticipate or predict) potential future outcomes and 2) take corrective actions focused on controlling or preventing aversive outcomes. Interoception is thus crucial for human health as it represents the afferent component of the brain-body feedback loop essential for linking internal sensation with body regulation, thereby minimizing erroneous feedback and maintaining homeostasis. Abnormal interoception plays a role in the expression of many psychiatric disorders, which implies that identifying and ameliorating interoceptive dysfunctions may aid in improving the diagnosis, prognosis, or treatment of those conditions. During this session, we will discuss links between interoception and mental health, from states of optimal health and well-being to states of illness recognized or diagnosed as psychiatric disorders, including depression, anxiety, eating disorders, addiction, and functional disorders. Using previous and ongoing studies, I will illustrate current knowledge gaps and delineate key methodologies that can address many open questions mechanistically. This will equip attendees with a framework for further learning and developing basic and clinical studies that advance interoceptive neuroscience and potentially improve human mental health.
Sarah Garfinkel
Interoception and Brain Disorders
Interoception occurs across conscious and unconscious levels, from the central sensing of basic afferent signals to their higher-order processing involving attention and appraisal. Historically, interoception has been assessed using behavioural tests of accuracy, self-report measures or through the characterisation of neural signals underlying interoceptive processing. However, these measures broadly neglect the nature of the afferent signals themselves, which can differ in different contexts and individuals, with implications for how they are sensed and processed.
Disturbances in interoceptive processing can be observed in different clinical and neurodevelopmental conditions; precise delineation of interoceptive dimensions, including the nature of the afferent signals themselves, can help elucidate the nature of these changes. Differences in interoceptive processing associated with transdiagnostic symptoms (e.g. dissociation) and in different clinical and neurodevelopment conditions (e.g. anxiety and autism) can be detailed across different interoceptive dimensions. The responsivity and adaptability of afferent signals may also underpin clinical differences in the processing of emotion and self.
Interoceptive dimensions pertaining to interoceptive precision, attention, appraisal, and the neural architecture underlying interoceptive accuracy can all be trained and modified. Interoceptive change can occur through techniques such as biofeedback, interoceptive accuracy training, behavioural activation, interoceptive appraisal, and peripherally acting drugs to target the interoceptive system directly. Interoceptive mechanisms, at different levels, have broad promise as accessible targets for therapeutic intervention.
Ivan de Araujo
Experimental Models of Body-Brain Communication
A growing body of knowledge is being generated on the pathways through which the body conveys signals to the central nervous system and, conversely, on how the brain modulates body functions. We will provide a moderately detailed description of the anatomy and function of body-brain systems in animal models. The mechanisms by which gastrointestinal cells communicate with emotion-related brain circuits are discussed. The topics include the influence of gut signals on reward processing and interoceptive mechanisms mediating the potent effects of contemporary weight loss drugs. A description of the anatomy of the vagal and spinal body-brain pathways will be provided, including approaches for experimentally manipulating these systems. In addition, novel pathways mediating brain influences on peripheral immunity are discussed, with an emphasis on how psychosocial stress weakens host defences against pathogens.
Olaf Blanke
Interoception and self-consciousness
Humans experience a ‘real me’ that ‘resides’ in ‘my’ body and is experienced as the subject (or ‘I’) of conscious experience and thought. This aspect of self-consciousness, namely the feeling that conscious experiences are bound to the self and are experiences of a unitary entity (‘I’), is often considered to be one of the most astonishing features of the human mind. I will present work that targets self-consciousness by investigating a minimal form of self-consciousness (i.e., bodily self-consciousness, BSC) that is based on the multisensory perception of tactile, proprioceptive, visual signals (exteroceptive BSC signals). For this workshop I will focus in particular on the role of interoceptive signals in BSC, such as cardiac and respiration-related signals, and their integration with exteroceptive signals, using methods from cognitive psychology, neuroscience/imaging, and medicine. Highlighting a series of studies investigating two fundamental aspects of BSC, referred to as self-location and self-identification with an individual’s body, I show that BSC is based on torso-centered bodily signals in a distributed cortical network, involving temporal, parietal and insular cortex. Several recent studies using heartbeat-evoked potentials in associated with experimental modulations of BSC will be presented. This torso-centered BSC system, by coupling exteroceptive and interoceptive signals, is fundamental for self-consciousness, leading to conscious mental states that are experienced as if by a unitary and embodied subject. I will conclude by highlighting recent work linking BSC to the motor system (especially the sense of agency) and recent work integrating BSC-modulations into contemplative practices to cultivate mindfulness and self-compassion.
Peter Strick
The Brain Contribution to the Brain-Body Connection
The Brain-Body connection has two essential components. One provides signals to the central nervous system to create the sense of interoception. The other enables the central nervous system to regulate the autonomic, cardiovascular, respiratory, gastrointestinal, and immune systems. Standard diagrams of the brain-body connection generally illustrate that every internal organ is a source of information for the central nervous system and a target of parasympathetic and/or sympathetic control.
The diagrams illustrating the Brain-Body connection generally display the brain as a “black box” with opaque elements and internal operations. Views about the operations performed by the black box have evolved considerably. Formerly, autonomic control was considered rather automatic, like a thermostat. You set it and forget it. When the temperature rises above, or drops below certain boundary settings, your heater or air conditioner automatically responds to restore the correct temperature. However, nuanced autonomic control does not fit this classic model. Instead, it fits a newer model, termed allostatic regulation, which is characterized by a changing set point that depends on context and adapts to anticipate rather than react to changing conditions. For example, with allostatic regulation, the set point will vary dynamically for different behavioral states (e.g., sleep, wakefulness, exercise) and physiological challenges. Allostasis depends on an internal model–a memory for specific conditions–that develops through experience and updates based on error-driven feedback.
Allostasis includes the important element of prediction to implement anticipatory shifts in values. For example, the intention to stand from a sitting position must be accompanied by an anticipatory increase in blood pressure. Without this predictive regulation, the consequences are disastrous—for example, orthostatic hypotension and fainting. Autonomic changes can also begin long before the events we perceive as stressful. Clearly, allostatic regulation cannot be accomplished using simple spinal cord reflexes and negative feedback error correction. Instead, it requires a brain-body connection that engages higher central neural structures to implement features like memory, internal models, and prediction. During these lectures, we will discuss the involvement of multiple areas of the cerebral cortex and the cerebellum in the allostatic control of adrenal medullary and stomach function. In addition, we will examine the insights gained from using transneuronal transport of neurotropic viruses to reveal the large-scale neural networks that form the basis of the brain-body connection.
Karin Roelofs
Autonomic and central nervous system interactions during decision-making are under threat in health and anxiety.
Behavioural scientists often assume that automatic defensive threat reactions, while essential in explaining animal behavior, only have limited value when it comes to understanding human behavior. There is, however, increasing evidence that acute defensive reactions, such as freezing and associated parasympathetic dominance, have an impact on subsequent approach-avoidance decisions under acute threat in humans. Understanding the mechanisms that drive such decisions is particularly relevant for patients with anxiety disorders, whose persistent avoidance is key to the maintenance of their anxiety.
The parasympathetic state of freezing is associated with distinct bodily and cognitive responses that are geared towards concealment of overt responses, optimizing sensory processing, and action preparation. Of particular importance for the onset and control of this preparatory state are the neurotransmitters noradrenaline and acetylcholine, which modulate neural information processing but also regulate the activity of the sympathetic and parasympathetic branches of the autonomic nervous system. Parasympathetic dominance under threat is characterized by low heart rate (HR) and high heart rate variability (HRV). It has been linked to optimal performance in acute threat situations but also to increased stress resilience in the long run. However, patients with anxiety disorders are characterized by sympathetic hyperarousal and often show a failure to reach parasympathetic dominance under acute threat, impacting their threat coping.
In this session, we will discuss 1) how we can assess the interactions between these autonomic systems and the central nervous system during freezing in humans; 2) the impact of freezing and autonomic balance on the neural control of approach-avoidance decision-making; 3) the impact of autonomic balance on perceptual sensitivity (interoceptive vs. exteroceptive processes); 4) the role of parasympathetic dominance under threat in stress resilience and the problem of sympathetic hyperarousal in anxiety disorders; and 5) new virtual reality-based biofeedback interventions that help upregulate HRV during decision making under acute threat.