Interoceptive Awareness and Decision Making

By Meagan Yarmey, PhD, MSW, RSW

You may be skilled at reading people, contexts, and systems. Many professionals are. What is less reliably developed is the ability to read the body, particularly under conditions of pressure, fatigue, or sustained responsibility.

In clinical work with high‑functioning adults, impaired interoceptive awareness often sits quietly beneath difficulties with decision making, emotional regulation, and burnout. People describe feeling mentally sharp yet internally “blunt”: disconnected from signals of tension, exhaustion, hunger, or overstimulation until those signals escalate into symptoms that can no longer be ignored.

This is not a failure of insight. It is a limitation of training.

Interoceptive Awareness and Decision Making

Interoceptive awareness refers to the capacity to perceive internal bodily signals, such as heartbeat, breath, muscle tension, visceral sensation, and physiological arousal. These signals continuously inform the brain about the state of the organism, shaping attention, emotion, and judgment (Craig, 2002; Khalsa et al., 2018).

Research shows that interoceptive awareness and decision making are closely linked. Individuals who are more attuned to internal cues demonstrate stronger emotional regulation, more adaptive stress responses, and greater behavioural flexibility under uncertainty (Critchley & Garfinkel, 2017). In other words, the body is not an obstacle to clear thinking; it is a critical source of information.

When that information is unavailable, or routinely overridden, decisions become cognitively sophisticated but physiologically misaligned.

The Pattern of Override

High performers are often rewarded early for ignoring bodily signals. Fatigue is framed as weakness. Tension is interpreted as motivation. Absence of hunger is treated as efficiency. Over time, this pattern becomes automatic.

From the outside, it looks like discipline. Internally, it reduces access to early-warning signals that would otherwise support pacing, emotional attunement, and discernment.

Interoceptive awareness and decision making suffer when internal information is dismissed as irrelevant or inconvenient. The nervous system does not stop sending signals; it simply increases their intensity. What began as subtle tension becomes chronic anxiety. What began as fatigue becomes insomnia or burnout.

The Neurobiology of the Signal

Interoceptive processing is associated with brain regions including the insular cortex and anterior cingulate cortex, which integrate bodily states with attention, motivation, and executive control (Craig, 2002). These systems operate continuously, whether or not their outputs reach conscious awareness.

When interoceptive input is chronically ignored, regulation becomes reactive rather than responsive. Individuals report feeling “on edge,” numb, or oscillating between hyperarousal and shutdown. Decision making under these conditions becomes effortful, rigid, and increasingly detached from values.

From a psychological standpoint, this is not a failure of will. It is a failure of signal integration.

Subtle Signs of Reduced Interoceptive Awareness

In psychotherapy, diminished interoceptive awareness often presents indirectly. People may struggle to answer simple questions about their internal state. They may be unsure whether they are hungry, tense, or emotionally activated. Decisions feel mentally taxing, and recovery from stress feels disproportionate to the trigger.

These are not deficits of intelligence. They are indicator lights.

Interoceptive awareness and decision making deteriorate together when bodily cues are no longer trusted as relevant data.

Reintegrating the Body in Psychological Work

Evidence‑based psychotherapy increasingly recognises that effective decision making depends not only on cognitive accuracy, but on physiological regulation. Cognitive Behavioural Therapy addresses the thought patterns that perpetuate overdrive (Beck, 2011). Acceptance and Commitment Therapy strengthens the capacity to remain engaged with values while discomfort is present (Hayes, Strosahl, & Wilson, 2011). Mindfulness‑based approaches support awareness of internal states without requiring immediate modification (Keng, Smoski, & Robins, 2011).

Across these approaches, the common thread is restoring access to information that has been filtered out, not because it is unimportant, but because it was once inconvenient.

Strengthening interoceptive awareness does not make people less effective. It makes decision making more economical, proportionate, and grounded.

Closing

Interoceptive awareness and decision making are not opposing processes. They are complementary systems. When internal signals are accessible, decisions require less force and fewer corrections. When they are not, even intelligent choices become unsustainably costly.

For many high‑functioning adults, reclaiming this capacity is not about learning something new, but about reversing a long‑standing pattern of disconnection that has been mistakenly reinforced as strength.

If you are interested in working with this differently, you are welcome to reach out.

References

Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). Guilford Press.

Craig, A. D. (2002). How do you feel? Interoception: The sense of the physiological condition of the body. Nature Reviews Neuroscience, 3(8), 655–666. https://doi.org/10.1038/nrn894

Critchley, H. D., & Garfinkel, S. N. (2017). Interoception and emotion. Current Opinion in Psychology, 17, 7–14. https://doi.org/10.1016/j.copsyc.2017.04.020

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

Keng, S.‑L., Smoski, M. J., & Robins, C. J. (2011). Effects of mindfulness on psychological health: A review of empirical studies. Clinical Psychology Review, 31(6), 1041–1056. https://doi.org/10.1016/j.cpr.2011.04.006

Khalsa, S. S., Adolphs, R., Cameron, O. G., Critchley, H. D., Davenport, P. W., Feinstein, J. S., … Paulus, M. P. (2018). Interoception and mental health: A roadmap. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 3(6), 501–513. https://doi.org/10.1016/j.bpsc.2017.12.004

© 2026 by Meagan Yarmey

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