Implementation of an interoceptive curriculum in general education classrooms
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Interoception, commonly known as the eighth sense, differs from the other senses because it refers to sensing the internal state of our body rather than the external world. This communication allows for homeostasis within the body, coordinating the regulation of vital processes in the body such as blood pressure and breathing (Quadt et al., 2018). Opdensteinen and colleagues (2021) define interoception as "the processing and perception of internal bodily changes through sensing, integrating, and interpreting physiological signals arising from inside the body across all body systems (p. 1). Signals are sent to our brain from internal organs telling us if we are hungry, thirsty, need to use the restroom, have stomach pain, etc. Researchers discuss awareness and accuracy as important components to understand interoception. Interoceptive awareness is the processing of these inner sensations, so they become conscious of these signals (Price and Hooven, 2018). Interoceptive accuracy is the correspondence between the occurring signals and how the body perceives them (Opdensteninen et al., 2021). It is crucial for children to develop these skills to help function in everyday life. The perception of body signals is based on prediction from prior experience and these signals must be important enough on the 'interoceptive hierarchy' to get a response (Quadt et al., 2018). The signals are unconsciously placed on a hierarchy, telling your body which ones to react to. When the interoceptive body sensations are salient, the information is sent to the brain and the body then makes adjustments to maintain homeostasis (Schmitt and Schoen, 2022). As we go throughout our day, the brain takes in a lot of information about our surroundings, storing much of this information in an unconscious part of the brain. While much of this information remains unconscious, the processing of the sensations brings the information to a conscious awareness (Price and Hooven, 2018). Those who have poor interoceptive skills possess information about their sensations, but they are in an unconscious part of the mind. Once we become more connected with our internal guide, we can begin to make more sound decisions and manage our emotions more skillfully (Paul, 2021). We must know what our body is telling us in order to react. The sensations come from all over our body including our muscles, organs, and bones. From here, the signals are then sent to the insula, a structure within the brain that processes sensory, motor, and autonomic feedback signals from the body. When using brain scanning technology, the size and activity level of the insula are visible and vary among individuals. This activity in the insula is correlated with one’s awareness of their own interoceptive sensations (Paul, 2021). Interoceptive awareness is influenced by genetic factors as well as the environment. If we are consistently told to suppress these internal signals as we are growing up (e.g., you are not hungry) or told how we are to respond (e.g., you must wear a sweater), we are teaching our body to ignore or not to respond. By suppressing the signals, we are teaching our body that we do not need to react to these signals which leads to poor interoceptive awareness. Stress can also influence our interoceptive process by affecting the intensity, perception, and interpretation of the internal sensations (Price and Hooven, 2018). Interoception has been related to health and disease because the internal organs are sending signals to the brain and the brain either does not process them (awareness) or does not respond in an appropriate way (accuracy), which can lead to sickness and disease (Quadt et al., 2018). Paul Lewicki, a cognitive scientist, conducted an experiment in which participants watched a cross-shaped target on a computer screen, where it would appear, disappear, and reappear in a new spot. After several hours of watching this shape, the participants became more accurate at predicting where it was going to reappear, but when asked about the pattern they were unable to put it into words. Higher accuracy was due to the information being stored in an unconscious part of the mind. According to Paul (2021), Lewicki called this "nonconscious information acquisition" (p. 25). As we are going through our everyday lives, the brain is constantly relating situations to past encounters and bringing upon relevant information when needed (Paul, 2021). How do we know that our brain has something relevant enough that it wants to share? Interoception; the muscles become tense, we get a shiver, some sort of signal given by our body (Paul, 2021). This idea has also been tested out through gambling in which participants played a card game on the computer and physiological changes were measured through electrodes on the body. After playing the game for a while, the electrodes picked up that the physiological changes increased when participants thought about choosing a bad card (Paul, 2021). Our brain sends signals, even from information that is unconscious, based on previous experiences. Individuals who can tune in to these signals have documented reactions. Once the body has an awareness of the body signals, how well they are perceived is interoceptive accuracy (Cali et al., 2015). Without an accurate perception, we cannot respond appropriately. Pollatos and colleagues found that children aged 6-11 years old with higher, compared to lower, interoceptive accuracy showed better decision-making performance regarding forgoing short-term benefit for long-term profit (2023). Part of positive emotion regulation is knowing how to respond to our emotions. When children aren’t able to accurately depict the signals, they may be unsure of how to respond leading to negative behaviors. According to Suzuki and Yamamoto (2023), individuals with higher interoceptive accuracy can "assess positive emotions in a more nuanced manner" (pg. 8). The literature thus far has found that interoceptive awareness and accuracy are related to emotion regulation (Zamariola et al., 2019; Opdensteninen et al., 2021; Quadt et al.,2018; Price and Hooven, 2018). Those who are more in tune with the signals feel their emotions more intensely and manage them more proficiently (Paul, 2021). The differences in the intensity of the emotion felt may be related to the conscious versus unconscious processing of the interoceptive signals (Quadt et al., 2018). When we experience different emotions, there are often bodily changes as well. For example, when we feel angry, we may feel our temperature rising and our heart beating fast. When we feel nervous, we may have an upset stomach or sweaty palms. These can vary from person to person. Rather than our brain determining which emotion we are feeling then creating the bodily changes, the body produces sensations, then initiates an action, then the mind puts together an emotion. Therefore, the greater our sense of these signals, the greater we experience the emotion. Becoming more aware of our internal sensations can help handle emotion (Paul, 2021). Physiological changes, such as sweating or a fast heart rate, that result from the brain’s perception of the signals have been noted to be crucial to understanding and recognizing emotions (Zamariola et al., 2019). Interoception impacts one’s functional participation (Schmitt and Schoen, 2022). When children have challenges with emotion regulation, it interferes with their ability to participate in school. Children who show impairments in self-regulation were rated as less emotionally and behaviorally engaged in the school setting (Jahromi et al., 2013). Graziano and colleagues (2007) found that emotion regulation reported in 325 5-year-old children predicted the child’s academic success and productivity in the classroom. The same study found that children who had increased emotion regulation were less likely to have behavior problems (Graziano et al., 2007). Behavior is not controlled by emotion or emotion regulation, but sensory input plays a role in how an individual feels and processes that feeling, leading to their behaviors (Schmitt and Schoen, 2022). Kwon and colleagues (2016) found the following: (1) "emotions affect how effectively individuals allocate and utilize cognitive resources and skills, including attention, memory, and problem solving", (2) "emotions affect attitude and behaviors toward academic tasks... and effective emotion regulation activates and sustains motivation and engagement, whereas negative emotions and poor emotion regulation lead to avoidance of academic tasks", and (3) "emotions and regulatory processes might affect achievement through their impact on social behaviors" (p. 84). Emotion regulation leads to benefits in health, social connections, and life tasks (Price and Hooven, 2018). Therefore, increasing a child’s interoceptive awareness can lead to better emotional regulation, engagement and increase learning ability at school. We rely on our eighth sense to bring awareness to what our body is telling us. When the interoceptive signals are reliable, they establish a sense of safety, and we can participate in meaningful occupations (Schmitt and Schoen, 2022). Without directing our attention to the signals our body is giving us, we wouldn’t be able to go to the bathroom when we need to or know we need something to eat when our body is hungry. If one has poor interoceptive awareness, the bladder must be very full before realizing they need to use the restroom, or the stomach must be super full before realizing they are full. According to Schmitt and Schoen (2022), if the interoceptive process is "interpreted inaccurately or inconsistently, one’s sense of safety, health and wellness are threatened" (p. 3). Without these basic needs met, children are unable to allocate all of their mental, physical, and emotional resources to their education. Studies report that an interoceptive curriculum, 30-60 minutes per week, can improve emotional regulation for students with autism spectrum disorder (ASD) (Mahler et al., 2022; Hample et al.,2020). However, we don’t yet know whether the general population of children might also benefit from an interoceptive curriculum (Mahler et al., 2022; Hample et al., 2020). Therefore, an IC implemented in a general education classroom is needed. The population is one major gap in the current research; research thus far has found that an interoceptive curriculum can improve emotion regulation for children diagnosed with autism spectrum disorder but hasn’t studied using an IC in children without an ASD diagnosis in the school setting. (Mahler et al., 2022; Hample et al.,2020). Children without an ASD diagnosis, that have deficits in emotion regulation may have negative behaviors due to not understanding what their body is telling them (Mahler et al., 2022). Implementing an IC to children can be beneficial in increasing their performance and engagement in school (Schmitt and Schoen, 2022; Price and Hooven, 2018). All children may benefit from increasing their interoceptive accuracy, allowing them to have a better understanding of their body signals and what they mean. There is not sufficient research regarding an IC for children who do not have an ASD diagnosis. Therefore, an IC implemented in a general education classroom at a tier I level is needed. Current studies vary in the time an IC intervention is delivered, ranging from 8-25 weeks, and between 30-60 minutes per week (Mahler et al., 2022; Hample et al.,2020). A study that implemented an 8-week intervention phase focusing on improving the ability to notice body sensations found that participants’ ability to notice the signals increased but so did their ability to make meaning of the signals (Hample et al., 2020). There is no current research that spends more time per week on an IC, while in a shorter time frame (weeks). Spending more time on IC during a week in a classroom may allow for more improvements in interoceptive awareness and therefore engagement in school. An IC can be embedded into a classroom’s routine to help improve the student’s emotion regulation, possibly lessening maladaptive behaviors and increasing participation. Educators may not have the time available in a day to spend 30 or more minutes on an extra activity. If broken up into 10-minute periods each day, this method may fit more easily into a classroom routine. Shortened, these activities can be completed during transitions or as a redirection. Current research has focused on what interoception is, how it works in the body, and common populations that frequently have poor interoception skills. Research has shown that poor awareness and understanding of the internal body sensations affect areas of individuals lives. Current research has also shown the correlation of interoception and emotion regulation, linking the important role interoception plays in everyday life. There is limited research on ways to improve one’s interoception accuracy and awareness, especially in children without an ASD diagnosis. In the current project, activities were implemented in a general education classroom, with children aged 3-8 years, to improve their interoception skills. Embedding an interceptive curriculum into a classroom’s routine can promote emotion regulation and negative behaviors, leading to an increased readiness to learn and participate.
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