The demands of seeing multiple clients or exposure to the distressing personal histories of clients, particularly those with significant stressors or health challenges, can lead to feeling overwhelmed and put massage therapists at risk for burnout.
Interoceptive awareness, or awareness of inner body sensations, can facilitate the massage therapist’s ability to manage and reduce feelings of overwhelm, and support self-care.
Interoception is the perception of all sensations from inside the body and includes the physical sensations related to internal organ function such as heartbeat, respiration, satiety, and the autonomic nervous system symptoms related to emotions.
Much of these perceptions remain unconscious; what becomes conscious enters awareness, which involves higher mental processes such as emotions, memories, attitudes, beliefs and behavior.
Neurobiologist Bud Craig, PhD, author of the book How Do You Feel? An Interoceptive Moment with Your Neurobiological Self, and other researchers involved in neuroscience, have outlined how, and in which areas of the brain, interoception is processed and how it relates to emotion, stress and regulation.
The Internal Life
What the research on interoception highlights is that our bodies can give us information that is critical for staying healthy. This involves cues that tell us we’re out of balance and need to adjust in order to better cope with stress.
For example, being more aware of internal sensory experiences makes it easier to notice if you are uncomfortable, tired or stressed.
Some common internal cues include shallow breathing when stressed, queasiness or butterflies in the stomach when anxious, wandering attention when fatigued, and elevated heartbeat when nervous or angry.
By paying attention to thoughts, feelings, sensations—the internal life—a massage therapist will be more aware of internal cues and thus more able to engage in self-care in order to maintain balance and important mind-body-spirit connections.
Self-care is the self-initiated behavior people can choose to promote health and well-being. The profession of massage therapy demands a great deal both physically and emotionally, and thus the ability to manage stressors through self-care, to stay healthy and to prevent burnout is critical so that clinical work is not negatively affected.
Personal stressors related to interpersonal relationships or life circumstances are highly relevant to well-being.
Likewise, stressors related to professional work with clients may include, for example, taking home your client’s worries or ruminating on their stories (in psychotherapeutic terms, this is called countertransference), and physical fatigue from over-efforting or from seeing too many clients in one day.
Symptoms of burnout include general fatigue, sense of disengagement from clients, professional loneliness, a loss of meaning and purpose, and cynicism.
Research by A.E. Beddoe and colleagues in the Journal of Nursing Education demonstrated a strong relationship between increased mindfulness and reduced stress among health professionals who received mindfulness training; and, another study by C.S. Mackenzie and colleagues in the Journal of Applied Nursing Research indicated that mindfulness significantly reduced burnout and increased life satisfaction.
Interoceptive awareness is very helpful for providing information on sensory cues that can underlie symptoms of stress.
Engaging in interoceptive awareness involves the ability to engage in present-moment awareness of bodily experience with an attitude of non-judgement—and is thus a mindfulness skill.
The practice of attending to interoceptive awareness involves turning attention internally to access awareness of bodily sensations. Once accessed, one can learn to develop the capacity to sustain awareness to facilitate deeper awareness, and processing of sensations to promote self-understanding and regulation.
Taking the time to attend to sensory awareness is thus one way that interoception can translate into facilitating self-awareness and self-care.
Massage therapists might already be acquainted with the idea of mindful presence; for example, the practice of taking a few minutes to center yourself before working on a client.
To practice interoceptive awareness, it can be helpful to engage in a body scan to notice how your body feels internally and then deepen your attention to an area, such as where you notice a tight muscle, or to your respiratory diaphragm if you notice shallow breathing.
Doing so will help you develop your ability to access and engage in interoceptive awareness, and will likely provide you with increased information about your internal state and, in the moment, help to center you if you are feeling stressed.
Other activities that can set the stage for engaging in interoceptive awareness are meditation, tai-chi, yoga and quiet walks in nature. While a simple process, interoceptive awareness can take some practice and patience and is not often explicitly taught.
That being said, there are myriad resources aimed at learning mindfulness skills, and some involve attention to interoceptive awareness.
One such resource are the podcasts available for free through Dharma Ocean, some of which are focused on learning fundamental somatic meditation practices: dharmaocean.org.
Dimensions of Awareness
Interoceptive awareness can be understood as a construct of multiple dimensions.
Below are the dimensions of interoceptive awareness that are believed to be integral to the development of interoceptive awareness from a theoretical and educational perspective, according to Wolf Mehling and myself in our chapter titled, “Body Awareness and Pain” in Integrative Pain Management: Massage, Movement, and Mindfulness Based Approaches.
- Noticing body sensations includes those sensations that are viewed as negative, positive or neutral.
- Emotional reaction and attentional response to these sensations includes: suppressing, ignoring or avoiding perceptions of sensations such as by distracting oneself; worrying that something is wrong; and present-moment awareness with non-judgmental awareness of sensations, such as a mindful presence.
- Capacity to regulate attention pertains to various ways of controlling one’s attention as an active regulatory process. These include the ability to sustain awareness; actively direct attention to various parts of the body; narrow or widen the focus of attention; and allow sensations without trying to change them.
- Mind-body integration is viewed as the goal of mind-body therapies and includes emotional awareness, or the awareness that certain physical sensations are the sensory aspect of emotions; self-regulation of emotions, sensations and behavior; and the ability to feel a sense of an embodied self, representing a sense of the interconnectedness of mental, emotional and physical processes as opposed to a disembodied sense of alienation and of being disconnected from one’s body.
- Trusting body sensations reflects beliefs about the importance of sensations and the extent to which one views awareness of bodily sensations as helpful for decision-making or health.
A Source of Insight
A mindful focus with nonjudgmental present-moment awareness can diminish ignoring, avoiding and distraction from negative or stressful physical sensations or emotional feelings.
Differentiating variations in internal sensory experience can help you gain insight into how these variations correlate to activity and movement, and allow for fine-tuning of personal activities and modification of any fear-avoidance beliefs and behavior.
One can learn that emotion and regulation skills can change the intensity or bother of physical and emotional discomfort. Any sense of overwhelm can then improve.
Listening to the body using interoceptive awareness skills will ultimately help with learning to trust that the body can be a source of insight.
If present-moment awareness and direct, immediate felt experience can be learned, then you can learn to choose between avoiding or thinking about stress or discomfort versus sensing it so that you can engage in positive activities to resolve, accept and positively influence your experience.
About the Author:
Cynthia Price, PhD, LMT, is a Research Associate Professor at the University of Washington in Seattle. She studies Mindful Awareness in Body-oriented Therapy (MABT), an approach she developed to facilitate body/interoceptive awareness and related skills for self-care and emotion regulation. She also directs the Center for Mindful Body, which teaches health professionals how to instruct in interoceptive awareness. She also wrote “Interoceptive Awareness Helps Your Clients Help Themselves.”