E17. Norm Farb – Mindfulness, Interoception and Depression

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In this episode I speak with Norm Farb, Assistant Professor in the Department of Psychology at the University of Toronto, and Principal Investigator of the Regulatory and Affective Dynamics Lab. 

Dr. Farb studies the neuroscience of the self and emotion with a focus on how cognitive biases shape the emotional reactions that influence well-being, and how these biases and emotional reactions are affected by cognitive training practices such as mindfulness meditation.

He has led several influential studies on the mechanisms of mindfulness training and depression vulnerability, highlighting that resilience against depression stems more from the growth of mindfulness-related skills, such as interoceptive awareness, than the eradication of residual depressive symptoms. 

Show Notes

1:30 – How did Norm come to focus on the role of interoception in mindfulness, a practice so often described in cognitive terms  (such as quietening the mind). 

6:35 – On whether the interoceptive and default mode networks are anti-correlated

10:00 – Does mindfulness enhance your ability to perceive interoceptive signals from the body?

13:15 – How the experiential and narrative modes relate to depression 

24:50 – How do people relate to the signals from within their body in a way that supports their wellbeing?

32:00 – How does the interoceptive way of looking at mindfulness relate to the positive effects of mindfulness in healthy populations?

40:00 – Are there any cultural factors that might be shaping our balance between narrative and experiential modes?

46:00 – Is there research on interoception and intuition?

48:20 – What is coming up next for Norm?

53:10 – Advice for students

1:30 – How did Norm come to focus on the role of interoception in mindfulness, a practice so often described in cognitive terms  (such as quietening the mind). 

Norm started thinking that meditation would be a process of quieting the self, and expected to see reduced activity in the brain regions associated with self-referential thought (regions now identified as part of the default mode network). What he instead found, was greater activation in regions responsible for sensory processing. And so, following the data, he came to see that rather than quietening the self-related brain regions, meditation enhances the ability to access other modes of self-knowledge that aren’t about conceptual self-evaluation. This finding came to make good sense when Norm later started meditating himself, and realised that at least in the early stages, that meditation is a sensory awareness practice with the instructions centred on sensations and the body.

6:35 – On whether the interoceptive and default mode networks are anti-correlated

At least in young adults, there is an opponency between task-focused and default-mode networks. However, this may not be the case for everyone. More importantly, however, the interoceptive network is not a task-focused network in the conventional sense; it doesn’t use the same parts of the brain that we use to make judgements or manipulate information from the external world. 

10:00 – Does mindfulness enhance your ability to perceive interoceptive signals from the body?

No, mindfulness does not seem to make people ‘super sensors’, just as a concert pianist isn’t able to hear quieter sounds than other people. Instead, the concert pianist does more with, or gets more information, sounds. Similarly, mindfulness training seems support people become more in the habit of using information from the body.  In the brain, we see that mindfulness increases the integration of interoceptive signals into overall evaluative parts of the brain (e.g. the anterior insula), rather than enhancing activity directly in primary representers (i.e. posterior insula) of what’s happening in the body. And the connection between interoceptive and evaluative parts of the brain is strengthened.  

13:15 – How the experiential and narrative modes relate to depression 

While the first episode of depression usually relates to some adverse circumstances, people can fall into mental habits that make them vulnerable to future episodes of depression. Where this is true, recurrent depression can be seen as a product of an overly rigid negative set of interpretations that are applied to a variety of events in life. But in depression, people also tend to suppress new sensory processing once they become sad. The more people suppress signals from the body, the more likely they are to experience relapses into depression. 

So we see the opposite pattern activity from mindfulness: in depression there is a suppression of bodily signals and a dominance of conceptual-evaluative activity while in mindfulness there is greater integration of bodily signals relative to conceptual-evaluative judgements. From this perspective, mindfulness facilitates the opening to new (sensory) information that may serve to challenge the entrenched, negative mental patterns of depression. This opening to different information, contrasts with CBT where you challenge and restructure negative evaluations directly. 

24:50 – How do people relate to the signals from within their body in a way that supports their wellbeing?

While depression relapse may be associated with the suppression of interoceptive signals following a negative cue induction, just paying more attention to interoceptive signals isn’t always associated with better outcomes. For example, interoceptive signals may be interpreted in a catastrophising manner in panic disorders. So it is a matter of relating to interoceptive signals differently, rather than just boosting them.

To start relating to interoceptive signals differently, people shouldn’t start by trying to focus on their body in the most unpleasant, triggering or patterned situations. Instead they should start small, in safe, pleasant situations and get in the habit of relating to your body differently. Once you are in the habit of relating to your body in an open, curious way, you can slowly progress to more unpleasant, triggering or patterned situations. 

32:00 – How does the interoceptive way of looking at mindfulness relate to the positive effects of mindfulness in healthy populations?

Mindfulness can lead to a greater feeling of agency and presence, both of which are thought to be related to interoceptive signals. Strengthening of concentration is also likely to be a mechanism of beneficial effects. 

Additionally, mindfulness can help us see the patterns in our thinking, feeling, and behaviour which we all have, but often become blind to. Seeing these habits better gives us the chance to evaluate them, and decide to change it if it doesn’t serve us. 

40:00 – Are there any cultural factors that might be shaping our balance between narrative and experiential modes?

Our education system is all about moving into the conceptual and elaborative way of relating to experience. The complexity of identity in our modern cosmopolitan world also demands ready intricate narratives about who we are. 

46:00 – Is there research on interoception and intuition?

It’s not a big area of research, but there is at least one study on the topic by Barnaby Dunn and colleagues; Listening to your heart. How interoception shapes emotion experience and intuitive decision making.

48:20 – What is coming up next for Norm?

Norm has been developing a lot of behavioural tasks that can be run online that can test aspects of contemplative training (for example, tasks that can measure how stable someone’s attention is) and how these aspects are applied (for example, people’s emotion regulation tendencies).

53:10 – Advice for students

Early on, there should be a decision made around whether you want your role to be someone who pushes the frontier vs. consolidate and clarify things that have already started to be discovered. Norm has always been somewhat of a maverick choosing things that are interested to him, rather than making choices that are safer in terms of leading to jobs.

If you are interested in being someone that pushes the frontier, it can be helpful to think about applying the principles leading scientists are using in other fields to your field of interest. 

Norm also recommends people look into Open Science. Especially in the contemplative science field, the rigour demanded by Open Science is a useful way to distinguish yourself. 

E11. Rebecca Brewer – Interoception

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Today we speak with Dr. Rebecca Brewer, Senior Lecturer in Psychology at Royal Holloway, University of London. Rebecca studies social and emotional abilities across a range of clinical and typical populations, and how interoception (the perception of the internal states of one’s body) is related to these emotional and social abilities.

Interoception is a topic that I’ve been finding fascinating lately. Interoception is important to many processes fundamental to what makes us who we are, from homeostasis to subjective experience itself, from decision making to psychopathology.

In this conversation, we focus particularly on the relation of interoception to psychopathology, an area where Rebecca has done interesting work and proposed big ideas.

Show Notes

1:20 – What is interoception and why study it?

4:25 – On the relevance of interoception to psychopathology.

6:25 – On interoception abnormalities as the p-factor.

9:45 – Does the relationship of interoception abnormalities to psychopathology appear causal?

13:00 – On treatments targeting interoceptive ability.

21:45 – On what Rebecca hopes the next wave of interoception research

26:00 – On the importance of interpretation of interoceptive signals

28:30 – On whether interoception is an area of interest for positive psychology

30:30 – On the focus of upcoming research for Rebecca’s group

39:40 – What Rebecca wishes she new when she was a student.

1:20 – What is interoception and why study it?

Interoception is the perception of signal arising from within the body. Sometimes the definition is widened to include stimuli that share similar neural pathways, such as slow sensuous touch.

Rebecca’s early research focused on ASD and alexythymia (difficulty understanding your own emotions), which led her to interoception.

4:25 – On the relevance of interoception to psychopathology.

Many different clinical populations struggle to understand their own emotions. Additionally, it seems linked to other disorders unrelated to emotional recognition, such as eating disorders and substance use disorders.

6:25 – On interoception abnormalities as the p-factor.

The p-factor is idea that there is a single factor that might underlie susceptibility to psychopathology in general, analogous to the g-factor in intelligence. Rebecca did work with Geoff Bird and Jennifer Murphy suggesting that the p-factor might relate to interoception. They suggested this as interoceptive abnormalities have been seen across a very wide range of psychopathologies (including depression, anxiety, OCD, schizophrenia, eating disorders, substance use disorders).

9:45 – Does the relationship of interoception abnormalities to psychopathology appear causal?

It’s unclear at this point. In some cases interoception abnormalities can lead to psychopathology, but the relationship is likely bidirectional.

13:00 – On treatments targeting interoceptive ability.

There are different aspects to interoceptive ability. Hugo Critchley and Sarah Garfinkel proposed the following aspects:

  • Accuracy/sensitivity: your objective ability perceive a particular internal signal. eg. Accuracy in counting heartbeats.
  • Sensibility: how much do you report noticing and focusing on your internal states.
  • Metacognitive awareness: Your accuracy of your perception of your interoceptive accuracy/sensitivity.

There are treatments that train both sensibility (focusing more on internal signals) and accuracy. Sensibility can be targeted through mindfulness-based interventions. Accuracy can be targeted by providing external feedback at the same time a an internal signal, most commonly heartbeart.

It is not yet clear whether training heartbeat perception translates to improved perception of other interoceptive signals, and the other psychological processes that involve interoception, such as understanding emotions, empathy, processing risk and reward.

21:45 – On what Rebecca hopes the next wave of interoception research

On of the main things is to develop better tests of interoception. And, of course, larger studies looking at whether altering interoceptive ability changes cognitive functioning and psychopathological symptomatology.

26:00 – On the importance of interpretation of interoceptive signals

Alongside the objective accuracy one’s ability to perceive interoceptive signals, the interpretation of perceived signals is important. Interoceptive signals can be over-interpreted, as in the case of someone with anxiety who might think that they are having a heart attack when it is really just a slight increase in their heart rate, or under-interpreted, as in the case of those with alexythymia who tend to report heart attacks too late.

28:30 – On whether interoception is an area of interest for positive psychology

There have been some studies on non-clinical populations, looking at for example the relation between interoceptive ability and decision making. However, the majority of the work is clinically focused.

30:30 – On the focus of upcoming research for Rebecca’s group

One thing that Rebecca’s group will be looking at the link between interoception and social perception. For example, does your ability to perceive whether you are tired correlate with your ability to perceive if someone else is tired. This work could inform interpersonal interactions in medical and care-based professions, and any work where empathy is important.

39:40 – What Rebecca wishes she new when she was a student.

Rebecca wishes she new how much freedom and flexibility academia provides, both in terms of collaborators and research areas. Also, that not every piece of work needs to entail a groundbreaking idea. And that she had a better understanding of the publication process.

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Episode References

Other key researchers working on interoception include Sarah Garfinkle, Hugo Critchley, Anil Seth, Sahib Khalsa, Karen Quigley and Manos Tsikiris.