The pathways of interoceptive awareness

A network of cortical brain regions, including the insula and anterior cingulate cortex (ACC), has been proposed as the critical and sole substrate for interoceptive awareness. Combining lesion and pharmacological approaches in humans, we found that the insula and ACC were not critical for awareness of heartbeat sensations. Instead, this awareness was mediated by both somatosensory afferents from the skin and a network that included the insula and ACC. Together, these pathways enable the core human experience of the cardiovascular state of the body.

• Publication year

  2009

• Venue

  Nature Neuroscience

• Publication date

  2009-09-01

• Fields of study

  Biology, Medicine, Psychology

• Identifiers
  DOI 10.1038/nn.2411PMID 19881506PMCID 2787640
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

• Bilateral limbic system destruction in man

  2010cited by this paper
• Interoceptive awareness declines with age.

  2009cited by this paper
• How do you feel — now? The anterior insula and human awareness

  2009cited by this paper
• Enter feelings: somatosensory responses following early stages of visual induction of emotion.

  2009cited by this paper
• Bolus isoproterenol infusions provide a reliable method for assessing interoceptive awareness.

  2009cited by this paper
• Handbook of Psychophysiology: Interoception

  2007cited by this paper
• Handbook of Psychophysiology: FOUNDATIONS OF PSYCHOPHYSIOLOGY

  2007cited by this paper
• Brain structures mediating cardiovascular arousal and interoceptive awareness.

  2007cited by this paper
• Neural systems supporting interoceptive awareness

  2004cited by this paper
• Central nervous system involvement in functional gastrointestinal disorders.

  2004cited by this paper
• Listening to your heart: interoceptive awareness as a gateway to feeling

  2004cited by this paper
• Regional Brain Activation Due to Pharmacologically Induced Adrenergic Interoceptive Stimulation in Humans

  2002cited by this paper
• How do you feel? Interoception: the sense of the physiological condition of the body

  2002cited by this paper
• Interoception: The Inside Story—A Model for Psychosomatic Processes

  2001cited by this paper
• The feeling of what happens

  1999cited by this paper
• Advances in psychophysiology: J.R. Jennings, P.K. Ackles & M.G.H. Coles (Eds) Vol.5 (1993).320 pp. £42.50 (hardback). ISBN 185302 191 1

  1994cited by this paper

• Brain Tissue Changes, Network Dysfunctions, and Cerebral Hemodynamic Deficits in Postural Orthostatic Tachycardia Syndrome.

  2026cites this paper
• Cardio-respiratory interactions in interoceptive perception: The role of heartbeat-modulated cortical oscillations

  2026cites this paper
• Traditional physical exercise and depression in older adults: the mediating role of interoceptive awareness and the moderating effect of perceived stress

  2026cites this paper
• Increased Cerebral Blood Flow in the Anterior Cingulate Cortex and Plasma Noradrenaline Level During Cardiac Pacemaker Stimulation.

  2026cites this paper
• Uncovering the embodied dimension of the wandering mind

  2026cites this paper
• "I'm Not Here, This Isn't Happening": Interoception and Its Role in Dissociation - A Systematic Review.

  2026cites this paper
• Operationalizing the Mind-Body Connection: Interoception via the Autonomic Nervous System.

  2026cites this paper
• When attention falters: brain, breathing, and behavioral signals of lapses in interoceptive attention

  2026cites this paper
• Human forebrain neural synchronization and entrainment to breathing during wakefulness, sleep, and external mechanical ventilation

  2025cites this paper
• Dynamic functional connectivity signatures of focused attention on the breath in adolescents.

  2025cites this paper
• Transforming personality traits (Gunas) through meditation: A randomized controlled trial

  2025cites this paper
• Psychological induction of interoceptive hunger cues and their effect on food desire.

  2025cites this paper
• The brain’s action-mode network

  2025cites this paper
• Heartbeat Resonance: Inducing Non-contact Heartbeat Sensations in the Chest

  2025cites this paper
• Microstructural Brain Correlates of Inter-individual Differences in Respiratory Interoception

  2025cites this paper
• Moving from isolation to integration: a Bayesian multisensory perspective of interoception and psychosis

  2025cites this paper
• Effects of transcranial electrical stimulation of the right prefrontal and left spindle cortex on the recognition of emotion expression

  2025cites this paper
• Synchronization of Cardiac and Musical Signals Improves Interoceptive, Cardiac, and Emotional Functioning.

  2025cites this paper
• Measuring Cardiac Interoceptive Accuracy in Infancy: Lessons From the Adult Literature

  2025cites this paper
• Manipulation of interoceptive signaling biases decision making in rhesus macaques

  2025cites this paper
• Interoceptive Neural Circuits Mediating the Progression from Somatic Diseases to Comorbid Depression.

  2025cites this paper
• An Optimal Beneficiary Profile to Ensure Focused Interventions for Older Adults

  2025cites this paper
• Women’s intuition as attunement: a biological and social perspective

  2025cites this paper
• How the body and brain process time.

  2025cites this paper
• Mitä sydän näkee? Katsaus interoseption merkitykseen ihmisen tiedonkäsittelylle ja hyvinvoinnille

  2025cites this paper
• Phase confusion: how inconsistent cardiac labeling obscures interoception research.

  2025cites this paper
• Effects of theta burst stimulation on the interoceptive brain network and cardiac interoception.

  2025cites this paper
• Clinical neurocardiology: defining the value of neuroscience‐based cardiovascular therapeutics – 2024 update

  2025cites this paper
• A feasibility study of a preventative, transdiagnostic intervention for mental health problems in adolescence: building resilience through socioemotional training (ReSET)

  2025cites this paper
• Nitric Oxide in the Hypnotizability-Related Interoception: A Scoping Review

  2025cites this paper
• Influence of binge drinking on the resting state functional connectivity of university Students: A follow-up study

  2025cites this paper
• Interoception vs. Exteroception: Cardiac interoception competes with tactile perception, yet also facilitates self-relevance encoding

  2025cites this paper
• Human self and Neurosurgery: Advances and insights from Geneva

  2025cites this paper
• Interoceptive inference and prediction in food-related disorders

  2024cites this paper
• Hemispheric divergence of interoceptive processing across psychiatric disorders

  2024cites this paper
• Disturbances of Interoception in Schizophrenia – Focus on Neuroimaging

  2024cites this paper
• Altered effective connectivity during threat anticipation in individuals with alcohol use disorder.

  2024cites this paper
• The heart can lie: a preliminary investigation of the role of interoception and theory of mind in deception

  2024cites this paper
• Interoception in pregnancy: Implications for peripartum depression

  2024cites this paper
• Measures and Models of Brain-Heart Interactions

  2024cites this paper
• Decoding acceptance and reappraisal strategies from resting state macro networks

  2024cites this paper
• The Body Mirroring Thought: The Relationship Between Thought Transitions and Fluctuations in Autonomic Nervous Activity Mediated by Interoception

  2024cites this paper
• Functional movement disorder is associated with abnormal interoceptive brain activity: a task-based functional MRI study

  2024cites this paper
• Brain Responses Difference between Sexes for Strong Desire to Void: A Functional Magnetic Resonance Imaging Study in Adults Based on Graph Theory

  2024cites this paper
• Dissociative Symptoms and Interoceptive Integration.

  2024cites this paper
• Heartbeat-evoked neural response abnormalities in generalized anxiety disorder during peripheral adrenergic stimulation

  2024cites this paper
• Emotion Processing in Peripheral Neuropathic Pain: An Observational Study

  2024cites this paper
• Insights into interoceptive and emotional processing: Lessons from studies on insular HD-tDCS.

  2024cites this paper
• Evolutionarily conserved neural responses to affective touch in monkeys transcend consciousness and change with age

  2024cites this paper
• A systems identification approach using Bayes factors to deconstruct the brain bases of emotion regulation

  2024cites this paper
• Insula-cortico-subcortical networks predict interoceptive awareness and stress resilience.

  2024cites this paper
• Dorsal motor vagal neurons can elicit bradycardia and reduce anxiety-like behavior

  2024cites this paper
• Blind individuals’ enhanced ability to sense their own heartbeat is related to the thickness of their occipital cortex

  2024cites this paper
• Interoception, Network Physiology and the Emergence of Bodily Self-Awareness.

  2024cites this paper
• Skeletal interoception in osteoarthritis

  2024cites this paper
• Enhancing Interoceptive Abilities and Emotional Processing: Effects of HD-tDCS.

  2024cites this paper
• Intranasal oxytocin improves interoceptive accuracy and heart-beat evoked potentials in a cardiac interoceptive task

  2024cites this paper
• Amphetamine use disorder is associated with striatum hypoactivation during anticipation of loss and reward

  2024cites this paper
• Attention to cardiac sensations enhances the heartbeat-evoked potential during exhalation

  2024cites this paper
• Interoceptive Signals Bias Decision Making in Rhesus Macaques

  2024cites this paper
• Sensing, feeling and regulating: investigating the association of focal brain damage with voluntary respiratory and motor control

  2024cites this paper
• Predicting attentional focus: Heartbeat-evoked responses and brain dynamics during interoceptive and exteroceptive processing

  2024cites this paper
• Resting-State fingerprints of Acceptance and Reappraisal. The role of Sensorimotor, Executive and Affective networks

  2024cites this paper
• Dorsal Motor Vagal Neurons Can Elicit Bradycardia and Reduce Anxiety-Like Behavior

  2023cites this paper
• Cardiac interoception in Anorexia Nervosa: A resting-state heartbeat-evoked potential study.

  2023cites this paper
• Mechanisms for survival: vagal control of goal-directed behavior.

  2023cites this paper
• Is that My Heartbeat? Measuring and Understanding Modality-Dependent Cardiac Interoception in Virtual Reality

  2023influential citation
• Within-Person Modulation of Neural Networks following Interoceptive Awareness Training through Mindful Awareness in Body-Oriented Therapy (MABT): A Pilot Study

  2023cites this paper
• Phasic Induction of Bioelectromagnetic Heart-Brain Coupling Through Emotional Stimuli

  2023cites this paper
• Disturbed interoception in body dysmorphic disorder: A framework for future research

  2023cites this paper
• Gastrointestinal Symptoms in Pediatric Patients with Anxiety Disorders and Their Relationship to Selective Serotonin Reuptake Inhibitor Treatment or Placebo

  2023cites this paper
• Interoception, heart failure and exosomal cargo as potential biomarkers

  2023cites this paper
• Perception of facial expressions involves emotion specific somatosensory cortex activations which are shaped by alexithymia.

  2023cites this paper
• Heartbeat-evoked neural response abnormalities in generalized anxiety disorder during peripheral adrenergic stimulation

  2023cites this paper
• Insula neuroanatomical networks predict interoceptive awareness

  2023cites this paper
• The impact of cardiac phases on multisensory integration.

  2023cites this paper
• Gastric vagal afferent signaling to the basolateral amygdala mediates anxiety-like behaviors in experimental colitis mice

  2023cites this paper
• Beyond Gender: Interoceptive Sensibility as a Key Predictor of Body Image Disturbances

  2023cites this paper
• A Primer on Interoception and its Importance in Psychiatry

  2023cites this paper
• Cough Sensitivity to Several External Triggers is Associated with Multiple Non-respiratory Symptoms

  2023cites this paper
• Local and Global Measures of Information Storage for the Assessment of Heartbeat-Evoked Cortical Responses

  2023cites this paper
• Minimal self-consciousness and the flying man argument

  2023cites this paper
• Impact of childhood trauma on the abnormal functional connectivity of brain regions in the fear network model of panic disorder.

  2023cites this paper
• Cardiogenic control of affective behavioural state

  2023cites this paper
• Civilian Moral Injury and Amygdala Functional Connectivity During Attention to Threat.

  2023cites this paper
• The impact of sociality and affective valence on brain activation: A meta-analysis

  2023cites this paper
• Cardiac and Gastric Interoceptive Awareness Have Distinct Neural Substrates

  2023cites this paper
• Neuroadaptive Technology and the Self: a Postphenomenological Perspective

  2023cites this paper
• Hemispheric divergence of interoceptive processing across psychiatric disorders

  2023cites this paper
• Deconstructing the brain bases of emotion regulation: A systems-identification approach using Bayes factors

  2023cites this paper
• Development and Validation of Japanese Versions of the Interoceptive Accuracy Scale and Interoceptive Attention Scale

  2023cites this paper
• Embodied empathy and abstract concepts' concreteness: Evidence from contemplative practices.

  2023cites this paper
• Reward-related activation of fronto-striatal regions scaled negatively with C-reactive protein

  2022cites this paper
• Intolerance of uncertainty and functional connectivity of the anterior insula during anticipation of unpredictable reward.

  2022cites this paper
• Rhesus monkeys have an interoceptive sense of their beating hearts

  2022cites this paper
• The relationship between brain neural correlates, self-objectification, and interoceptive sensibility.

  2022cites this paper
• A new framework for modeling the bidirectional interplay between brain oscillations and cardiac sympathovagal activity

  2022cites this paper
• Brain-heart interactions are optimized across the respiratory cycle via interoceptive attention

  2022cites this paper
• Reward-related neural dysfunction in youth with a history of suicidal ideation: The importance of temporal predictability.

  2022cites this paper
• Association between startle reactivity to uncertain threats and structural brain volume.

  2022cites this paper