Interoception is the process by which you perceive your internal bodily signals, providing critical information about your emotional and physiological states. This can include changes in heart rate, breathing, and muscle tension that indicate increasing anxiety and agitation, as well as the mind's perception of pain and discomfort, for example, hunger, thirst, fatigue, and a need to go to sleep. Interoception has been referred to as the mind-body connection. There are two elements to interoception: interoceptive awareness, that is, whether our body sensations are in our conscious awareness, and interoceptive accuracy, how we interpret and integrate what we sense in our bodies.
Research has found that autistic adults often score lower across several areas of interoceptive awareness (Mul et al., 2018), yet some studies suggest a different pattern, showing higher sensitivity to internal sensations but lower accuracy in interpreting what those sensations mean (Palser et al., 2018). Many autistic people describe being especially aware of certain bodily signals, such as a gurgling stomach (Seth & Friston, 2016; Shah et al., 2016). These heightened or confusing sensations can make emotional regulation, social-emotional communication, and managing anxiety more difficult (Garfinkel et al., 2016).
We now have a screening instrument for interoception, the ISQ-8 (Suzman et al, 2021), which has the following eight items:
While the ISQ-8 offers a useful starting point for identifying interoceptive differences, research on its reliability and validity in autistic populations is still developing. The shorter ISQ-8 version was derived from the original 20-item ISQ and shows promising internal consistency and construct validity (Suzman et al., 2021). However, further studies are needed to confirm its accuracy and sensitivity across different autistic groups, including those with co-occurring intellectual or communication differences. Despite these limitations, the ISQ-8 can help clinicians and therapists begin meaningful conversations about body awareness and emotional understanding, areas that are often overlooked but essential for supporting emotional wellbeing.
Alexithymia is a sub-clinical condition characterised by having both difficulties with interoception for emotions and putting emotions into words. Alexithymia is commonly experienced by autistic people and can complicate their social and emotional experiences (Bonete et al., 2023). There are a number of reasons for this. Firstly, it is very difficult to regulate an emotion if you do not perceive it in your body or know what the emotion is. For example, if you can detect that your jaw muscles are tightening and your palms are becoming sweaty and you can label the emotion “anxiety”, you then have both the messenger and the signpost to tell you what to do next, as in, “I am noticing I am becoming anxious, I will take a step back and self-regulate before I continue. I can drop my shoulders/take a few deep breaths/imagine my favourite scene or person/ self-soothe.” If you do not get the message or see the signpost you are likely to continue with the task whilst experiencing increasing anxiety and the sorts of negative thoughts that tend to colour your world when you are anxious, for example, “I hate my job/school”, “ I am so bad at this”, “why are things always so difficult for me”, “that person hates me.”
In addition, as psychologists we are aware that in order to heal from trauma and past emotional pain that can underlie other mental health conditions, such as anxiety disorder sand depression, we need to feel and express our emotions. We need to feel to heal. If you are not able to sense your emotions in your body, or if, when you do, you are flooded with the intensity of the feeling and need to distract yourself or ‘zone out’ the healing that your body is capable of is blocked, and you stay stuck.
Interventions targeting interoception show promise in lowering anxiety levels, but also overall emotional regulation and expression in autistic individuals. These interventions include mindfulness, meditation, and Yoga. An example is a study conducted by our friend and colleague Dr Radhika Tanksale who incorporated Yoga into a conventional CBT programme with young autistic children. Results showed decreased anxiety levels but also increased self-regulation and emotional awareness (Tanksale et al, 2020).
The Interoception Curriculum was developed by Kelly Mahler (2019; 2023), an occupational therapist and has been found to increase emotion regulation in children (Mahler et al 2022). There is a good book on interoception for autistic children, Are You Feeling Cold Yuki? (Al-Ghani,2022).
Autistic people seeking help for mental health conditions would do well to ask their therapist to assess them for alexithymia specifically and interoception generally. The therapist can then incorporate increasing interoception and ability to recognise and express emotions into therapy.
Interoception and Autism - 15 January 2026
This webcast explores how developing interoceptive awareness supports emotion recognition, healing from trauma and grief, and connection to self and others.
We will share strategies to build interoceptive awareness through mindfulness, highlight common pitfalls for autistic people, and demonstrate how to adapt mindfulness and body-based practices for neurodivergent minds.
Al-Ghani K. (2022) Are You Feeling Cold, Yuki? London. Jessica Kingsley Publishers
Bonete, S., Molinero, C., & Ruisanchez, D. (2023). Emotional dysfunction and interoceptive challenges in adults with autism spectrum disorders. Behavioral Sciences, 13(4), 312. https://doi.org/10.3390/bs13040312
Garfinkel, S., Tiley, C., O'Keeffe, S., Harrison, N., Seth, A., & Critchley, H. (2016). Discrepancies between dimensions of interoception in autism: implications for emotion and anxiety. Biological Psychology, 114, 117-126. https://doi.org/10.1016/j.biopsycho.2015.12.003
Mahler, K. J. (2019). The interoception curriculum: A step-by-step framework for developing mindful self-regulation. Mahler Autism Services.
Mahler, K. (2023, May). The Interoception Curriculum: A Guide to Developing Mindful Regulation (IC). In Psychosomatic Medicine Vol. 85, No. 4, pp. A106-A107.
Mahler, K., Hample, K., Jones, C., Sensenig, J., Thomasco, P., & Hilton, C. (2022). Impact of an interoception-based program on emotion regulation in autistic children. Occupational Therapy International, 2022, 1-7. https://doi.org/10.1155/2022/9328967
Mul, C. L., Stagg, S. D., Herbelin, B., & Aspell, J. E. (2018). The feeling of me feeling for you: Interoception, alexithymia and empathy in autism. Journal of autism and developmental disorders, 48(9), 2953-2967.
Palser, E. R., Fotopoulou, A., Pellicano, E., & Kilner, J. M. (2018). The link between interoceptive processing and anxiety in children diagnosed with autism spectrum disorder: Extending adult findings into a developmental sample. Biological psychology, 136, 13-21.
Seth, A. and Friston, K. (2016). Active interoceptive inference and the emotional brain. Philosophical Transactions of the Royal Society B Biological Sciences, 371(1708), 20160007. https://doi.org/10.1098/rstb.2016.0007
Shah, P., Hall, R., Catmur, C., & Bird, G. (2016). Alexithymia, not autism, is associated with impaired interoception. Cortex, 81, 215-220. https://doi.org/10.1016/j.cortex.2016.03.021
Suzman, E., Williams, Z. J., Feldman, J. I., Failla, M., Cascio, C. J., Wallace, M. T., ... & Woynaroski, T. G. (2021). Psychometric validation and refinement of the Interoception Sensory Questionnaire (ISQ) in adolescents and adults on the autism spectrum. Molecular Autism, 12(1), 42.
Tanksale, R., Sofronoff, K., Sheffield, J., & Gilmour, J. (2021). Evaluating the effects of a yoga-based program integrated with third-wave cognitive behavioural therapy components on self-regulation in children on the autism spectrum: A pilot randomized controlled trial. Autism, 25(4), 995-1008.
