Interoception: The Hidden Thread Linking Trauma, Behavior, Pain, and the Possibility of Change
We all think we know what behavior is. It’s what we do, right? Our actions. Our patterns. Our habits. And we all believe we have a decent idea of what drives those behaviors—motives, emotions, beliefs. But I would argue that very few people actually understand what behavior *is* or why we behave the way we do.
Most people think they control their actions. But what if that’s not quite right? What if behavior isn’t about controlling action, but about controlling perception?
Behavior as Control of Perception
Think of a thermostat. We say it controls the temperature. But it doesn’t *do* temperature. It turns the heater or AC on or off, sure, but only to maintain a specific perception of heat.
Humans do the same. We act—we eat, scroll, argue, fidget, strive—to produce a specific perception. We want to *feel* a certain way. We open a bag of chips to gain the perception of satiety or flavor. We lash out at a partner to restore a perception of control. We stay at work late to maintain a perception of productivity or worth.
What we’re controlling, underneath it all, is our internal experience.
What Is Interoception?
That internal experience has a name: interoception. It is the brain's continuous, moment-by-moment sense of the body's internal state. Hunger, thirst, breath, heart rate, nausea, warmth, tightness, shame, calm, dread—these are interoceptive signals.
Interoception is distinct from proprioception (body position) and exteroception (external senses). It is our internal monitoring system—and it shapes everything. Our decisions, our self- concept, our emotions, our behavior.
Neuroanatomically, interoception travels through lamina I spinothalamic pathways and vagal afferents to the brainstem, thalamus, and insular cortex. The insula integrates and updates these signals, creating what neuroscientist A.D. Craig called "a representation of the sentient self in one moment of time."
And crucially, interoception is predictive. The brain doesn’t just receive signals; it anticipates them. It generates expectations for what should be felt and compares that to what is felt.
Discrepancies lead to new predictions—or, sometimes, persistent error.
Explore the neural mechanisms behind internal body awareness and discover how interoception influences emotion, decision-making, trauma, and social connection.
When Interoception Goes Awry
In trauma, this interoceptive system becomes distorted. Internal sensations may be overinterpreted as threats. A racing heart means panic. A gut clench means danger. Or, conversely, the system may go numb. Sensations fade. The body disappears.
Developmental trauma, in particular, may leave a person with persistent interoceptive discomfort—shame, tension, fear—that feels unresolvable. Unlike hunger, these sensations can't be fixed with a sandwich.
So we find ways to cope. We eat. We drink. We overachieve. We criticize others. We scroll. We control. Each of these behaviors helps us feel better. Or feel less.
This is the root of addiction. But it's also the root of many everyday behaviors.
The Superpower: Distress Tolerance
Here's the pivotal insight: people who can tolerate unpleasant internal states have more behavioral options. They can pause. They can choose. They can stay in a difficult conversation.
They can hear feedback. They can grieve.
People who cannot tolerate distress? They *have* to act. To fix, escape, soothe, or blame.
This capacity is called distress tolerance, and it is foundational. It's not just a psychological skill—it's an interoceptive skill. The ability to feel without fleeing.
Building Distress Tolerance
Fortunately, distress tolerance can be built. Practices that expose us to manageable discomfort help:
Sports and endurance: staying with fatigue and effort
Mindfulness and breathwork
Cold exposure and heat exposure
Therapy and relationship work
One mindfulness practice is Vipassana meditation, where practitioners sit for hours observing their internal sensations without reacting. Over time, this decouples sensation from impulse.
One can feel heat, ache, flutter, or fear without doing anything about it.
This rewires the interoceptive loop.
How Interoception Shows Up in Everyday Life
Distress tolerance isn’t just about staying calm in conflict. Interoception affects how we feel, how we act, and how we heal — often in ways we don’t realize. Let’s look at three places this shows up most clearly: pain, touch, and ethics.
1. Chronic Pain as Interoceptive Prediction
Pain is not just a signal from the body — it’s a prediction from the brain. In chronic pain, the nervous system keeps expecting threat or damage even when the tissues are healed.
This happens because the interoceptive system has learned to expect pain. The brain’s model of the body is stuck in a state of vigilance. What’s needed isn’t just mechanical treatment — it’s a new internal experience. A way to say: “This is safe. This is different.”
2. Manual Therapy as Interoceptive Modulation
That’s where manual therapy comes in. When offered with attuned, gentle presence, manual therapy provides novel interoceptive input. It doesn’t “release” tissue — it creates new signals that the insula can register and update.
Slow, calming touch activates C-tactile fibers, which travel straight to the brain’s interoceptive centers. When those sensations are consistent, safe, and not paired with pain or threat, they offer a new prediction: You’re okay.
In that way, manual therapy is less about fixing tissue and more about remapping perception. It helps people feel differently from the inside — which is where real change begins.
3. Interoception and Ethics
And surprisingly, interoception doesn’t just shape how we heal. It also shapes how we judge, argue, and relate.
Studies show that people with lower interoceptive awareness tend to make different moral decisions. That’s because many of our ethical intuitions are actually emotional sensations — disgust, anxiety, tension — that we interpret as moral certainty.
When someone disagrees with us, we don’t just have a thought. We have a feeling. And if we lack distress tolerance, we might lash out or withdraw — not because we’re thinking poorly, but because we’re reacting to discomfort in our bodies.
The more we can feel discomfort without reacting, the more nuanced and relational our ethical choices become.
Final Thoughts
Interoception links it all together:
Trauma makes it harder to feel okay
Addiction is an attempt to feel less bad
Pain is a stuck prediction about the body
Behavior is the control of internal perception
Conflict is often an attempt to escape discomfort
When we build interoceptive awareness and distress tolerance, we become freer.
Freer to act wisely. To relate gently. To listen. To hold pain without panic.
If there is a path forward—for ourselves, our clients, and our world—it starts inside.
It starts with what we feel.
And how we meet it.
Author
Dr. Mark Olson holds an M.A. in Education and a Ph.D. in Neuroscience from the University of Illinois, specializing in Cognitive and Behavioral Neuropsychology and Neuroanatomy. His research focused on memory, attention, eye movements, and aesthetic preferences. Dr. Olson is also a NARM® practitioner, aquatic therapist, and published author on chronic pain and trauma-informed care. He offers a variety of courses at Dr-Olson.com that provide neuroscientific insights into the human experience and relational skill training for professionals and curious laypersons.
