Feelings, Emotions, Interoception

Four words, four different things

A raw signal from inside the body: heartbeat, breath, muscle tension, temperature, the gut.

Example: “My chest is tight and my face is hot.”

Sensing and making sense of those inner signals (Khalsa et al., 2018).

Example: Noticing the tightness at all.

A whole-body response to a situation: physiology, an urge to act, and expression.

Example: Heat rising, jaw clenching, the urge to push back.

The conscious experience of an emotion, the part a person can notice and name (Damasio, 1999).

Example: “I’m angry.”

Interoception: the inner sense

Interoception is the sense of the body’s internal state (Craig, 2002). It is how a person knows they are hungry, tired, anxious, or calm. Difficulties with interoception appear across anxiety, depression, eating disorders, autism, trauma, and substance use (Khalsa et al., 2018).

Researchers distinguish three parts of it (Garfinkel et al., 2015):

Clinically, the point is that a client who says “I always know what my body is telling me” may not, and a client who says “I feel nothing” may be detecting more than they think.

Where emotions show up in the body

The same body can hold opposite emotions: the heaviness of loneliness, and laughter felt deep in the belly.

When people from several cultures colored in where they felt different emotions, each emotion produced its own consistent body map (Nummenmaa et al., 2014). Use these patterns to offer words, never to tell a client what they feel.

Joy, calm, and openness have body signatures too. Notice them as carefully as distress.

Building a feelings vocabulary

People who can name their emotions precisely, a skill called emotional granularity, tend to regulate them better and act less impulsively when distressed (Kashdan et al., 2015). “Bad” is hard to work with. “Disappointed,” “embarrassed,” or “lonely” each points somewhere different.

Intensity ladders

Each emotion comes in degrees. Teach clients to place themselves on a ladder, from mild at the top to intense at the bottom.

• A feelings wheel, with core emotions at the center and more specific words around the edge, is a useful visual for clients of any age (Willcox, 1982).
• For children, start with four or five feelings and a picture or color for each, then expand.
• Ask about mixed feelings. Two emotions at once, such as relief and guilt, are common and worth naming.

A sensation vocabulary

Many clients have words for emotions but none for sensations. Give them both.

Ask: Where is it? How big? Does it have a temperature, a color, a shape? Is it moving or still? Is it changing as we talk about it?

Building awareness in session

The first move is the same one taught in Orchard’s mindfulness training: notice what is happening before doing anything about it.

1. Notice“Something is happening in my body.”
2. LocateChest, throat, belly, face, hands?
3. DescribeUse the sensation words.
4. NameWhat emotion might this be? “I’m not sure yet” is fine.
5. RespondWhat does the body need right now?

Naming helps. Putting a feeling into words, called affect labeling, reduces activity in the amygdala, the brain’s alarm center, and lowers distress (Lieberman et al., 2007). “Name it to tame it” is an accurate summary for clients.

Practices

• Daily check-ins. Three times a day, the client pauses and runs the five steps, even when nothing seems to be happening. Practice in calm makes the skill available in distress.
• In-session pauses. When a client’s voice or posture shifts, pause: “What’s happening in your body right now?”
• Body scan. Move attention slowly from the feet to the head, describing what is there without trying to change it.
• Feelings thermometer. Rate intensity from 0 to 10 at the start and end of a skill, so the client sees change.
• Body maps for children. The child draws a body outline and colors where a feeling lives, then shows it on camera.

When this is hard: alexithymia and clinical cautions

Alexithymia is difficulty identifying and describing one’s own feelings, often with a focus on external events instead of inner experience. It is a trait, not a diagnosis, and it is common in autism, trauma, depression, and somatic complaints. The Toronto Alexithymia Scale is the standard measure (Bagby et al., 1994).

The Multidimensional Assessment of Interoceptive Awareness, Version 2, is a free self-report measure of how people attend to and relate to body signals (Mehling et al., 2018). Use either measure only with your supervisor’s direction.

Training and resources

Orchard pages

• Mindfulness & Self-Regulation: grounding, somatic tools, and strategies matched to client state
• Dialectical Behavior Therapy: emotion regulation skills, including check the facts and opposite action
• Anger Management: Body, Mind & Choice: client-facing training on the body side of anger
• Play: feelings work with young children
• Crisis Support Resources

Books for clinicians

• Mahler (2019), The Interoception Curriculum, especially for autistic clients and children
• Barrett (2017), How Emotions Are Made
• Ogden, Minton, & Pain (2006), Trauma and the Body

References