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• W4311452252 abstract "Disturbances of mind have in some times and places been seen as intrinsically connected to the body. The holistic approaches of ancient Chinese and Ayurvedic medicine focus on this interconnection and the need for balance, as did the Hippocratic medicine that spread from Ancient Greece through Arabic and Ottoman medicine back to the early modern Europeans, locating changes in mood and reason in an imbalance of bodily humours. The body feels far away from psychiatry and psychological therapies today, but the periphery is staging a comeback. It is gaining attention through very different types of explanation, from the levels of molecular neuroscience to subjective experience of embodiment. The different levels are not often connected within studies, but there might be benefits from attempting to bridge them. On a broad level, the synergy between physical and mental health is clear, as shown by the physical health disparities of people with mental illness, which are only partly mediated by lifestyle factors or discrepancies in physical health care. David Veale and colleagues argue that the importance of emotional safety has been overlooked in psychiatric care, and that emotional safety is in many ways also physical: using running to manage trauma and panic attacks, wanting to be held on the arm to be soothed, or wanting to use a punchbag to gain a sense of control. In their writing, the body is integral to emotions, through the neurobiology of feeling safe, not threatened, and on an experiential level of feeling in control. The link between physical exercise and mental health is becoming better established, but how this is mediated is not clear, with suggestions highlighting the social aspects of some physical activities or the mindful aspects of others. Within the brain, aerobic exercise increases expression of brain-derived neurotrophic factor, which led Richard Bryant and colleagues to question whether exercise immediately after exposure therapy sessions for post-traumatic stress disorder (PTSD) could enhance extinction learning. They found aerobic exercise did improve PTSD outcomes immediately after the treatment course, but only to the same degree as passive stretching after therapy sessions. Exercise led to significantly greater improvements at 6 months, and the innovation of adding exercise immediately after therapy is an interesting step towards involving the body in mental health treatments. To interpret the effects of both stretching and exercise, it could be useful to think through different levels. Psychiatry has long sought the physical correlates of experience, and although some people argue against the reductionism of putting the brain at the centre of mental health, neuroscientific work is challenging some categories of experience. Research is showing that brain and body are dynamically coupled, with signals from the periphery interacting centrally to influence how we think and feel. A new wave of mental health research is focusing on interoception—the processing of internal bodily stimuli by the nervous system—and suggesting that the neural functions of sensing, interpreting, and integrating signals from inside the body are key to emotional states and mental health. These signals include heart rate and breathing rate, as well as immune system activation. Interoception is posited as part of a range of mental health conditions, including depression, anxiety, and PTSD. Focusing on interoception might provide new understanding of the mechanisms by which some medications and psychological therapies work, and interoception is already being investigated for new treatment options, such as whether becoming more accurate in sensing one's heartbeat reduces anxiety. Emotional experience is a complex interplay between external and internal factors. Recent conceptualisations of interoception incorporate the attention given to interoceptive signals and the interpretation of them, synthesised in a multidimensional framework. There is disagreement about which bodily signals are strictly included in interoception, with some suggestions to expand brain–body understandings to the effects of changed muscle tension and slow affective touch on emotional states. It could be useful to broaden the scope even further to include various types of movement. Returning to aerobic exercise and stretching, this perspective could open the possibility of investigating paying attention to the experience of movement, how movements change what is sensed from the body, and what effects cognitive reappraisal of those physiological signals might have. Attending to physical experience holds promise for improving therapeutic responses to mental health disorders. It's time to bring the body back into the therapy room. Interoceptive pathways to understand and treat mental health conditionsAn increasing recognition that brain and body are dynamically coupled has enriched our scientific understanding of mental health conditions. Peripheral signals interact centrally to influence how we think and feel, generating our sense of the internal condition of the body, a process known as interoception. Disruptions to this interoceptive system may contribute to clinical conditions, including anxiety, depression, and psychosis. After reviewing the nature of interoceptive disturbances in mental health conditions, this review focuses on interoceptive pathways of existing and putative mental health treatments. Full-Text PDF Open Access" @default.
• W4311452252 created "2022-12-26" @default.
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• W4311452252 date "2023-01-01" @default.
• W4311452252 modified "2023-10-16" @default.
• W4311452252 title "Centring the periphery" @default.
• W4311452252 doi "https://doi.org/10.1016/s2215-0366(22)00408-4" @default.
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