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

Henry Evrard, Chinese Academy of Science, Shanghai, China 

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.

Henry Evrard

Functional and Comparative Neuroanatomy of Interoception

For decades, the brain has been examined in isolation. Yet, it is inherently part of a whole organism. Once dismissed as primitive and autonomic, ongoing sensory afferences encoding the body’s physiological state (interoception) are now known to play a key role in shaping emotion, cognition, and self-conscious subjective experience. A phylogenetically novel, primate-specific interoceptive afferent pathway links body and brain, offering a neurobiological foundation for the central representation of the ‘material me’—a cornerstone of the Emotional Embodiment theory of James and Lange, and Damasio’s Somatic Marker hypothesis. Mounting evidence shows that bodily states continuously influence brain states via distinct central nodes capable of switching functional networks in response to homeostatic demands. Using neuroanatomy as a gold standard, these lectures will trace the primate interoceptive pathway from the spinal cord and medulla to the cerebral cortex, with emphasis on the insular cortex. An overview of insular organization highlights overlaps in architecture, connectivity, and function, reinforcing the brain’s structured integration of interoceptive signals. We’ll also explore cell specificity, focusing on the morphologically distinct, spindle-shaped von Economo neuron, found primarily in the anterior insula and anterior cingulate—regions particularly vulnerable to neurodegenerative diseases marked by loss of self-conscious emotional awareness. While much of the evidence comes from non-human primate studies, a comparative analysis of the insula will bridge these findings to the human brain’s organization.

Karin Roelofs

Autonomic and central nervous system interactions during decision-making under threat: Relevance for anxiety disorders.

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.