346. The science of interoception: How parents can help kids connect body signals to emotions with OT Kelly Mahler

Kelly (00:00):

Instead of focusing on emotion words, focus on your body signals, your body sensations. Think about the way different body parts are feeling. So I don’t know if you just peeled an orange, be like, oh, my hands feel so sticky right now. And then I like to bridge it to the action right away. Like, oh, I think I’m going to wash my hands or get the stickiness off. So all you’re doing there, you’re modeling out loud, you’re noticing how your body feels and it’s information that’s driving what you’re doing to take care of your body.

Dr. Sarah (00:33):

Most of us grew up learning about the five senses, sight, sound, taste, touch, and smell. But did you know there are actually eight senses? One of the most important for our kids’ ability to regulate their emotions and behaviors is something called interoception. Today I am so excited to dive into this topic with occupational therapist Kelly Mahler. Kelly has been practicing for over 20 years with a deep focus on interoception, which is the sense that helps us notice and interpret signals from inside our body, like a racing heart, a growling stomach, or butterflies before a big event. In our conversation we’ll explore what interoception is, why it’s so foundational for children’s ability to regulate, and how parents can use simple relational strategies to help kids tune into their bodies and emotions in a way that builds lifelong skills.

(01:29):

Hi, I’m Dr. Sarah Bren, a clinical psychologist and mom of two. In this podcast, I’ve taken all of my clinical experience, current research on brain science and child psychology, and the insights I’ve gained on my own parenting journey and distilled everything down into easy to understand and actionable parenting insights. So you can tune out the noise and tune into your own authentic parenting voice with confidence and calm. This is Securely Attached.

(02:01):

Back to school and sports season is here. And that’s why Name Bubbles, a mom founded brand is going to be a game changer for busy parents. Their durable, waterproof name labels for kids’ stuff, lunchboxes, water bottles, backpacks, clothing, more, are all dishwasher and laundry safe, which means once you stick them on, they stay put. They are perfect for daycare, schools, sports, and camp, keeping your kids’ belongings from going missing or ending up in the lost and found Name Bubbles are award-winning and trusted by parents nationwide. To check them out for yourself, visit namebubbles.com and use code NB15 for 15% off your first order.

(02:49):

Hi, welcome back to the show. We have Kelly Mahler here. I’m very excited to get into this conversation today because you specialize in interoception, you’re an occupational therapist, but you focus really on this specific sense and it’s one of those senses that a lot of parents haven’t really heard about, but it also has this really huge impact on kids’ ability to regulate and to connect. So before we dive into that, which is what I’m so excited about, I’d love for you maybe to start first by just telling the audience a little bit about yourself, the work you do and how you got into interoception.

Kelly (03:27):

Okay, sure. Well, thanks for having me on the show, Sarah. So I am an occupational therapist. Like you said, I’ve been practicing for 23 years. I’ve primarily worked with children in the school setting, but I have also been dabbling in the adult world, which has been really fun. And so this whole thing about Introception from the very first minute I was a baby OT 23 years ago, I’ve always been very interested in mental health and emotion regulation. And so that really drove my path that I started as an occupational therapist in the schools. I was getting the referrals for all the kids that were really dysregulated and no one could figure out what was going on with them. I honestly was trying my best, but I always felt like there was something missing. We were working on identify your emotion and use a coping skill and all of these traditional things.

(04:21):

And it wasn’t until 10 years into my career that I learned about this word called introception. And I hope it doesn’t scare your listeners away because it’s not super sexy the term, but I promise that you probably will. This will probably be very common sense to a lot of people that are listening once we talk about what it is, but it is the newest sense that scientists are studying. So we all have introception a sense within our bodies and its main job is to help us to notice our body sensations or we call them body signals. So if you’ve ever noticed maybe a throbbing head or sweaty skin or a racing heart or a growling stomach or a full bladder, there’s just so many internal body sensations that many of us experience and we experience those because of interoception. So these body signals are extremely important for so many things in life, including this emotion regulation that I was trying to work on with my students. But also it’s so incredibly important for things like toileting and eating habits. I mean, being able to notice when you’re hungry or full or when your bladder is full or you have a poop feeling in your butt or wherever it comes from. So all of these sensations really help us to do everything that we need to do to take care of our body.

(05:46):

So it’s such a big deal and once we explain it to parents, we’re like, oh my goodness, this makes so much sense. And what we’re finding is there are a lot of kids and adults that are very from these sensations for a variety of reasons. I mean, if we’re just going to be overgeneralizing for a second, we do live in a society that it is like go, go busy, busy, busy, busy screen, screen, screen, screen, screen. So our attention is constantly pulled outside of our bodies. We don’t live in a society that really helps us to slow down and notice how our body is feeling. And I think that is trending a little bit now with mindfulness and all of these body-based things. But even then when we slow down and notice we get signals like it’s weak to take a break. It’s weak to do what your body needs, no pain, no gain, push through work yourself, do you have a chronic health condition? It’s all of these messages that we are bombarded with. So I feel like this is just is opening a massive conversation and I’m so excited to talk more with you about.

Dr. Sarah (06:50):

 Yeah. Oh my God, I love how passion you are about it. I share your passion for it. I think it’s a very, like you said, it sounds like something very technical, and then when you describe it, you’re like, oh, of course. There’s that thing. And you came up with a name to describe this sort of category of sensations that everyone knows. But to your point, we don’t have a lot of reinforcement in our world for staying connected to it. And then we also don’t have a ton of vocabulary that’s common for communicating it. A multi-step thing in interoception is just noticing the sensations in your body, but to use it for effective communication, getting your needs met, self-regulating, working through a challenging situation, that requires also an ability to describe what you are feeling either to yourself consciously, internally, so you’re translating the felt sense into a conscious kind of thought process about it, or a verbal process of saying, my stomach is grumbling. I’m hungry. Can I have a snack? Or my stomach just flipped over and I think I’m nervous about something and I don’t know if I want to do this thing. Can you help me figure out how to handle this? Right? Those are sophisticated multi-level things that we’re describing. Yet we often jump to the tell me how you’re feeling, use your words. And what we’re not understanding is in order to be able to use your words, that’s like step four five. We have to go to the the baseline. We have to build that foundational capacity to first notice. And it’s not really an emotion, it’s a sensation that we translate into an emotion based on the meaning we give it and then we can talk about it.

Kelly (08:51):

Yes. All of that. Yes, yes, yes, yes. We have been for decades, way too far ahead. And then we wonder why is this so hard for kids and adults? And it’s because we’ve been missing a lot of the foundational pieces, and I have even had conversations with such brilliant adults and they don’t even have the interoception vocabulary you’re talking about to be able to be modeling as a parent for their kids. So it’s this whole generational cycle. And so thankfully we’re here today to hopefully bring that to a lot of parents and that cycle.

Dr. Sarah (09:27):

I want to ask, I want to keep going, but I want to flip over to a different question I had that I think is important just because if people are listening to this and they’re like, okay, occupational therapy, so that’s when they pull my kid out of school and they work on their handwriting. I know that’s not, but I think there’s a lot of limited understanding of the scope of what occupational therapy is. And before we get into the ways that you use tools like building and interceptive awareness in your work, can you help parents understand what is occupational therapy? What are the use cases for it? Because a lot, it’s a really rich field and I don’t think people understand it quite well and then don’t know how to find the right kind of practitioner inside of it to help them with what they’re looking for.

Kelly (10:15):

Yeah, I mean, I cringe when you said about OTs being handwriting teachers in schools. And I have to say that that is our fault as a profession because we have so many OTPs, including myself, have practiced in that way. And like you said, our field is incredibly rich. We were founded as a mental health profession when I was in OT school. I never even talked in any of my classes about handwriting. So when I got out there in the schools and I’m like, what do you want me to teach a kid how to write the letter A over and over again, this is not what I signed up for. So OT, in its broadest sense is really, we call it occupational therapy because we’re talking about the occupations of daily life. So what is meaningful for each person to engage in every day? So whether that’s play or that’s maybe all of your self-care activities like showering and bathing and eating, it’s going to school, it’s being able to participate in the classroom in a regulated way so you can learn it’s everything that we do every day.

(11:18):

And so what an OT is trained to do, we have such a holistic training and trying to figure out when there is a barrier to participation, what is that barrier and how can we support so that a person can engage meaningfully? And so if you are a parent out there and you were seeking ot, and I’ve heard this from so many parents, and maybe it’s even a school situation where they’ve asked for occupational therapy evaluation and that OT comes in and they assess their kid’s handwriting and says, Nope, they don’t qualify, but yet your child is still really struggling to participate in the classroom because they’re dysregulated maybe, or there’s some other barrier That’s a flaw in our system. And I know so many amazing occupational therapists now out there that are really getting back to our roots and really doing things like introception and really getting back to this meaningful engagement in all of our daily occupations.

Dr. Sarah (12:08):

That’s so refreshing to hear because I work with a lot of kids and families and parents, and people will call us up and say, my 4-year-old, I’d like them to go to therapy. And oftentimes I say, look, we could just start with parenting support or maybe some child diadic therapy. But typically, I don’t, don’t think individual child psychotherapy is the first line for a 4-year-old or a younger child or even sometimes 6, 7, 8 year olds. I think if they can engage in certain aspects of play therapy and talk therapy, then yes. But some kids that’s not really, they need to be moving completely. And the way that an occupational therapy office is typically set up is it’s a fun zone jungle gym. It’s the best. And it’s such a great, more appropriate place in my opinion, to start with younger kids and older kids. I don’t want to preclude older kids from going to OT either. It just, once they have the capacity to do more verbal reflective stuff, they can participate in types of psychotherapy. But I think that it’s an underrated resource that we often send families to because yeah, maybe your field’s not good at explaining it in the mass way. And also the name occupational therapy is confusing. I think sometimes too.

Kelly (13:38):

It’s really what, my kid doesn’t have a job. I don’t know why. Occupational therapy, they have lots of jobs, they’re just not paid jobs yet, but jobs are just to live their life and play and engage in all of those daily activities.

Dr. Sarah (13:53):

So at some point, if you know of a good resource for parents to find occupational therapists that do this kind of work, that are this really integrative whole, really looking at the complexity of functioning, is there a place where people can go to find a good occupational therapist or resources or directories?

Kelly (14:14):

I can’t, well, there probably is none that are coming to my mind, but I always encourage parents to, if you’re looking for example, an outpatient therapy clinic, call ahead ask what exactly will they evaluate in your child? Evaluate how holistic they are. Do they look at all eight senses? Do they know about interoception? It is your right as a parent to ask questions and to be a savvy consumer. And I know that some areas of our country are more limited in their resources, and sometimes there is only one place to go, but you have the right, and parents sometimes that’s sometimes shocking to them. Like, oh, you have the right to shop around and find the best fit for your child.

Dr. Sarah (14:58):

Yeah, I love that. Okay, so I’m glad. And people can also probably contact you and you can probably help them find places in their local area. I don’t want to overwhelm you.

Kelly (15:07):

No, but we have a very helpful Facebook group. If I can just say it’s called Introception the 8h Sense, because interoception is our 8th sense, and you can go in there. We always have parents posting like, Hey, I’m looking for an OT in what area you live in. And usually we’ll have practitioners connecting with parents that way too.

Dr. Sarah (15:28):

Oh good. That’s good. We’ll link that in the show notes because that’s a useful resource. Okay, let’s get into interoception then. Maybe let’s start, we’ve talked about this on the podcast before, but not everyone’s listened to every episode. We’ll link some of them in the show notes, also touch on this stuff. But let’s talk about the eight senses. People are like, well, I know a five. What are you talking about?

Kelly (15:53):

Yeah. So most of us know about the five basic senses like smell, sight, sound, touch, and taste. And I refer to those as our outside senses or external senses. So they’re pulling in sensory information from the world outside of our body. So you have your eyeballs for the sense of sight pulling in all that you see around your body, or you have receptors for hearing in your ears, pulling in all that you hear around your body. But then we also have three inside senses. So these senses are pulling in information from the inside of our body. So we have the vestibular sense. So you have little receptors for the vestibular sense in your inner ear, and it’s our sense of movement. So every time you move those little receptors are like beep, beep, beep. You’re moving and sending information to your brain about what direction are you moving, how fast are you moving, and so forth.

(16:41):

So it’s very important for things like balance. It also has a big tie to a fancy word called our arousal level. So how energetic you feel. So if you think about if you have ever, I don’t know, gone on a roller coaster, that’s the extreme answer, extreme example that’s coming to my mind and all of that super intense fast movement for many people, their energy level changes after getting such intense movement. But the same is true if we’re just slow rocking in a rocking chair, and that really can affect our energy level too. So the vestibular sense is really helpful for that energy regulation. Then we have our proprioception sense, and that’s your sense of where your body parts are located in space. So you have receptors in all of your muscles, your joints giving information to your brain about where’s your body positioned. So when I’m climbing the stairs, I have fairly firm sense of proprioception.

(17:37):

I don’t have to watch my foot on every single step and watch and place it perfectly. It’s just automatically happening. I don’t have to watch my body. That proprioceptive system is sending that information to my brain about how my body is placing on the steps and moving. And then we have the eighth sense, which is intraception, and we already talked about that, but you have receptors in all of the tissues in your body, meaning all of your organs, your bones, your eyeballs. You have intraception receptors pretty much everywhere collecting information about the condition of all of those different body parts or what sensations are going on in all of those body parts.

Dr. Sarah (18:16):

So I was just curious, have you ever heard of conversations around the ninth sense of neuroception?

Kelly (18:23):

So I am familiar with Neuroception. To me that is part of interoception and most neuroscientists are they talk about interoception. Well, neuroception is a term coined by Dr. Steven Forges who’s brilliant with all of his theories and the polyvagal theory. But what he’s really talking about if you want to get to a neuroscience term is that’s an aspect of interoception.

Dr. Sarah (18:48):

Got it. So basically you think of interoception as an umbrella, and neuroception is a piece of it that lives under, that’s picking up the sensations of our fight or flight response, basically.

Kelly (18:57):

Yes. That’s basically right. Yeah. If you want to get super technical interoception scientists talk about how we have two branches of the sense, and it’s like the conscious branch and the unconscious branch. So there’s a lot of things happening in our body imbalances. Your pH levels might be off or your blood sugar or your ion concentration, and all of those introception receptors are monitoring all of that. And automatic changes are happening within your body, thankfully, that are not reaching our consciousness. Probably none of us woke up this morning and said, whew, golly, gee, my liver’s releasing a lot of enzymes this morning. We can’t feel all of those things, thank goodness, because it’ll be very overwhelming. But then we have what we’re here talking about today, and we have that conscious side of things where these sensations reach our level of consciousness like, Ooh, I have a funny feeling down below my belly button. I think I have to pee. Right? And that’s reaching our consciousness.

Dr. Sarah (19:46):

It breaks through.

Kelly (19:47):

It breaks through and and it spurs us into action and gets us doing things to purposely take care of our body.

Dr. Sarah (19:57):

So when you were saying that, that made me have this light bulb in my head, do you find that there are certain kids or adults, but people who have a heightened sensitivity to interceptive cues, which then we know that we know that some people are more sensitive to their interceptive signals. But if you are more sensitive, would that also likely mean that more of your interceptive signals are breaking through into consciousness, which could then be kind of an overwhelming internal experience of I get overloaded faster because I’m getting more signals, there’s more noise coming at my conscious awareness, which when I’m sitting in a classroom and I’m supposed to be focusing on this one thing that the teacher wants me to focus on, but I, I’m kind of getting blasted by all this noise from inside my body, this itch and this ugh, and the wriggling. And I feel like that could be really overwhelming. It could lead to irritability, it could lead to a lot of maybe hyper active fidgety, can’t sit still, can’t focus things we might see in an ADHD profile, but also things we might just see in agitation and frustration and emotion dysregulation.

Kelly (21:16):

Yeah, I mean, absolutely. I don’t think we know enough scientifically about what is happening in that experience, but there are so many people that have this intense inner experience like you’re describing. And I feel like when we talk about interoception differences, we talk about the muted side of things, which we can talk about in a second, but the intense inner experience gets a lot less focused on.

Dr. Sarah (21:38):

Yeah.

Kelly (21:38):

But it is extremely common. We hear from people all the time explaining their experiences, just like what you’re saying, where all of these sensations are just reaching their level of consciousness and it’s overwhelming. One of my clients explained her inner experience as one of those glitter timers that you shake and the glitter goes everywhere. And she’s like, I don’t even know what to pay attention to. What does this all mean? It’s just so overwhelming.

Dr. Sarah (22:05):

And I would imagine, okay, whether you are muted in your awareness of, well, I guess there’s two layers, there’s the actual activity and sensitivity of your receptors. So you could be have muted physiological arousal in those ways where the cues don’t pop up through consciousness at all or heightened. So the cues are popping up a lot. And then on the second level is your awareness or processing of it on a conscious level. So I know what to make sense of it. I could have lowered capacity to notice what’s happening and make sense of it. I could have, I think what we’re all trying to build towards in your work is a high greater capacity to notice and make sense of. So there’s the noticing and making sense of spectrum. And then below it is just how loud are your cues?

Kelly (23:09):

Yeah, absolutely. And I don’t know if this helps if we kind of merge the way that we structure our work and we have it broken down into notice body signals, connect body signals, regulate body signals. So the noticing piece comes from practicing noticing a variety of different body signals and different body parts, but then it’s like what you’re talking about, it’s not enough just to notice this tingly feeling in my stomach. You have to be able to connect it to the meaning for you. What does that feeling in your body mean for you? And then you also have to take it to that third level of regulating. Do you know what action your body uniquely needs in that moment? Because as hard as this was for me to learn as an occupational therapist, I was practicing in this way. I can’t just come in with a pre-prescribed list of coping strategies and it’s going to match every single person’s body.

(24:01):

A fidget in the classroom is not going to meet everyone. A calming corner in the classroom is not going to meet everyone’s body. So when we give people the knowledge about their body of the being able to notice and connect their body signals, then they are equipped to be able to find unique actions that meet their body’s needs. And so a lot of the research that’s coming out, and this is not consistent, so if we look at anxiety research, a lot of it is finding that that breakdown comes from the connecting piece. So they’re noticing a lot of body signals, but they don’t know what they mean. So that just drives the anxiety even more. It makes more sense. And then that anxiety is probably heightening the physiological response, which then is setting off even more body sensations. It’s probably like this vicious cycle, but I don’t want to leave out the people that also experience anxiety because they have a muted inner experience and they’re not noticing enough body signals, so their body is very unreliable and things just come out of the blue that they just had no idea were happening. So we have so much more to learn, but it’s really a fascinating area of science to watch.

Dr. Sarah (25:09):

But that is really interesting and it kind of illustrates the fact that the importance of interceptive skills across those three domains that you were talking about, notice connect and what was the third one? Regulate. Regulate, yeah. Because if any of those areas, even just in anxiety, it might be a different set of problems. The breakdown might be at different places, even just in two anxious kids. And then of course this is important for things beyond anxiety, right? It’s important for the regulating all emotions, but I see this a lot with rage and frustration and these kids that go from zero to a hundred in a second, a lot of the skill there is slowing down urge and action. And the way you do that is we have to help them first understand urge and action aren’t fused, and then by time help them actually practice staying in readiness before they go into doing and not in the hot moments, not when they are furious, but in play, right.

(26:29):

Like, I think you build these skills. We talk a lot about how in the moment there’s very little we can do to teach a kid something different, but after there’s some, but before the next big thing, that’s the richest time to teach skill building. And so when a kid’s going to their OT session or their therapy session or hanging out with you, playing at in the living room, whatever, those are times, those are before moments usually. So how do you leverage that? What are some of the strategies that you help your clients or parents for their own kids to build first awareness, noticing and then connecting and then regulating?

Kelly (27:28):

Yeah, so we have a lot of ideas. So I’m just going to try to be brief here. My favorite thing, if you’re just getting started with this work as a parent, is to start modeling, modeling your own inner experience, which I just want to say might sound simple, but it’s not for a lot of parents because this is new not only to your child, it’s probably new to you. And I was raised in a loving household, but my parents weren’t walking around talking about the way their body feels. So I didn’t have a lot of language, I didn’t have a lot of modeling. So when I started learning about this, it was really hard to get used to. So what I’m trying to say is be gentle on yourself. But what I’m talking about is really instead of focusing on emotion words, focus on your body signals, your body sensations, think about the way different body parts are feeling.

(28:18):

So I don’t know if you just peeled an orange, be like, oh, my hands feel so sticky right now. And then I like to bridge it to the action right away. Oh, I think I’m going to wash my hands or get the stickiness off. So all you’re doing there, you’re modeling out loud, you’re noticing how your body feels and it’s kind of driving something that you’re doing that’s information that’s driving what you’re doing to take care of your body. Or the example I was giving you earlier, gosh, I have this really funny burning feeling, or not burning, but it’s pressure. I think modeling that you’re not sure and you’re working at out is really important too. It’s right below my belly button and I think this means I have to pee. I’m going to go check it out and see. So you’re modeling what you’re noticing your body, so you’re saying out loud the way my body’s feeling and what you’re going to do to go be curious about it and check it out.

(29:08):

So really going from, I kind of picture it in two columns, like notice your body signals out loud and then talk about the action piece of what you’re going to do to regulate it. So I don’t know if you’re noticing in that process, we’re not even saying anything about emotion words right now. We’re going right from body signals to the action piece. So noticing to regulating, but what this does is it’s showing your child, you have these internal processes that you’re paying attention to, so maybe they might start to pick up on that. You’re also getting interoception vocabulary out there, which I think is really important for kids and adults. So that modeling piece, just focusing on yourself first, and then once there’s a foundation there, then we start to pull in the child and be a little bit more curious about them. If you’re doing the orange example like, oh, ew, my hands feel so sticky after we peel that orange, I wonder if it’s same or different for you.

(30:08):

So we’re now flipping the curiosity to the child. We’re wondering how do your hands feel after you peel that orange? And we’re being really careful in this curiosity because what we’re finding in this work is that we all have such different inner experiences. So your hands might be feeling sticky or even it’s an uncomfortable feeling for you, but your child might be loving it. This is the best feeling in my body. We don’t know. So we want to try to avoid assuming their inner experience. We want to get that curiosity out there wondering about their body. Do your hands feel the same or different for you? Or how do they feel? Or I wonder what’s going on in your body. So just being curious and when you start that curiosity, your child might not be able to respond. They might not know, and that’s okay. I just think being curious is the first step. And then eventually over time many kids start to be able to tell us either with words or through actions like, Ugh, no, I don’t like that, or whatever it is. So the modeling and then bridging it to curiosity about your child’s body.

Dr. Sarah (31:20):

And you’re describing these day-to-day benign, neutral situations, do you find that there’s a place to start? Is it a bit of a staircase where it’s like we’re going to start about with these neutral things that are just part of everyday life and then maybe now we’re going to like, oh, you fell down your skin, your knee and you’re upset and maybe we could talk about how there’s a burning under your kneecap. You can feel that sensation of it’s stinging or it’s burning versus being hurt. Or now we might talking about it in like, oh, my kids just went back to school. I might be saying like, oh man, I’m feeling this nervous feeling this butterfly in my stomach kind of thing like the first day of something new. And sometimes when I don’t dunno what to expect, I get this kind of tingly feeling in my belly or So we’re trying to just also describe sensations of emotions that do feel maybe harder. They’re more abstract versus we all know what a sticky orange feels like. That’s really so concrete and tactile and being able to deepen this vocabulary into other areas that might be more seemingly more abstract, but trying to concretize them.

Kelly (32:34):

Yeah, absolutely. So you want to start with very neutral experiences at first, because if we start with the uncomfortable emotions, who is going to buy into this work? You know what I mean? If we’re only noticing those sensations when our body is feeling uncomfortable, and I’m not saying that sticky hands, it might be very uncomfortable, but into my mind it’s just a little bit more emotionally neutral and then slowly working your way. I still yet to this day, 12 years into this work, have never recommended ever doing this during a meltdown. Like a full blown…

Dr. Sarah (33:10):

Never. You don’t learn in meltdowns. Meltdowns are when we’re just, we’re keeping it safe.

Kelly (33:16):

That’s right. A meltdown is not a teachable moment. Someone sent me this.

Dr. Sarah (33:20):

For who people who are listening and can’t see the video, she’s literally holding up a sign that lives in her office that says, A meltdown is not a teachable moment. I need that sign. Did you make that or did you buy that?

Kelly (33:32):

Someone, one of my listeners or one of someone that took my course sent this to me. Oh my God, I love that. I know. So yes. But what we’re really finding, which is so interesting in this work is that even through playing and noticing more neutral body sensations, it’s spilling over into the difficult moments because kids are getting this practice noticing how their body feels, and that spills over into noticing maybe some of those more subtle sensations like, Hey, I’m just starting to get a little overwhelmed, or Hey, I’m just starting to need to pee a little bit, catching those early moments. And so we start with those neutral, and then sometimes we’ll work our way towards the next step. And this is not going to be true for every single person. I want to say I’m just giving some general guidelines, but we tend to work towards what we call homeostatic emotions. Again, I do not make these words up, these are interoception scientists, but what I mean by homeostatic emotions is exactly the example you gave Sarah with the pain. So falling and bumping their knee and kind of working in that space or noticing maybe body signals before a meal or after a meal or with toileting or maybe noticing when your body’s getting overheated or when you’re cold. These are all homeostatic emotions.

Dr. Sarah (34:53):

Which to translate correcting if I’m getting this correctly, when we talk about homeostatic emotions, we’re talking about the not emotional emotions. It’s not affective emotions, but emotions that are related to keeping ourself at baseline, right? If I’m hungry, I’ve moved away from baseline. If I’m painfully full, I’ve moved away from baseline of homeostasis. If my knee is burning, I just scraped it on the asphalt. When I fell off my bike, I’ve moved away from homeostasis. So this sort of baseline regulated nervous system, regulated body, that’s a homeostatic emotion sometimes, and we don’t need to get into this so technical, but we often conflate the words affect and emotion, but they’re actually different, right? Affective emotions are a type of emotion and homeostatic emotion is a type of emotion.

Kelly (35:54):

Yeah.

Dr. Sarah (35:54):

I think that hopefully makes it more plain, but I think your examples of it gave really helped.

Kelly (35:59):

Okay, good. And thank you for translating that for me. And I think maybe the reason why homeostatic emotions tend to be a little bit easier of a starting point than getting to those affect of emotions like frustration and anxiety and embarrassment. And this is my best guess, and maybe you’ll have some insight into this too. The homeostatic emotions tend to be a little bit more neutral in, I don’t know, that maybe their levels of shame and guilt. If I may say that.

Dr. Sarah (36:26):

Yeah, shame, or even arousal. We do get, when you think about arousal levels, when you move out of homeostasis, you’re going to ideally be aroused to some degree to go cue you in to regulate back down. If you’ve ever had to pee really, really bad and you’re like driving in a car and you can’t are awake, you are as awake as you could possibly be. You are very aroused. But when you are enraged, the threat is so shame, but also threat. I would think.

Kelly (37:06):

Yes, that’s what it is. Maybe the threat and shame combined.

Dr. Sarah (37:10):

Yeah, I think threat and shame, it’s connected to a much more, I don’t know, affective emotions are, they’re just a higher level than homeostatic emotions. They don’t carry as much. There’s not as much at stake in our relationships, and we’re hardwired to attend to that, whether we know it or not, whether we’re aware of it or not probably has an evolutionary basis there.

Kelly (37:44):

Yes, absolutely. Yeah. So I think we just need to be careful in how we’re really pulling kids into their bodies and noticing it. We want them to be comfortable, we want them to feel safe. We want them to buy into this. So that’s kind of why we gently ease them into their bodies.

Dr. Sarah (38:00):

Well, it’s like learning any new skill. You don’t start in the advanced level. If you’re going to try to start training for a marathon, you’re not running 30 miles to start. We have to start at the beginning. We have to build these muscles and in doing it through play and doing it through neutral times and doing it through connected moments, modeling it first, then doing playful things that feel fun, they’re getting the reps in.

Kelly (38:29):

I love that you just said they’re getting their reps in. That’s exactly what it’s about. It’s about giving so many reps of noticing different body parts so that when the moment calls on it and your access to that thinking brain goes away. When we get to those high level threat shame, emotion affective emotions, it’s almost like a habit. It’s almost like we are used to this. We’re used to relying on our body signals for important information.

Dr. Sarah (38:56):

Yeah, we’ve been talking about how being playful can be such a powerful way to help kids build skills, and that’s exactly why I created a free resource. I think you’re going to love. It’s a guide filled with playful connection based games for kids of all ages that are designed to support your child’s developing brain and nervous system. These activities are simple, fun, and most importantly, backed by science. So they actually work helping your child build the emotional wiring they need to calm their body and grow their resilience over time. You can grab the link to download the free guide right in the episode description or head to drsarahbren.com/games to get it sent straight to your inbox. That’s drsarahbren.com/games. Okay, now let’s get back to the episode. 

So let’s go to play for a second because I think play is one of the best ways to build these skills. Are there some games or activities or things that you do with your clients or that you teach families to do that? I mean, obviously we’ve been saying you have to do an individualized approach.

Kelly (40:12):

Yeah.

Dr. Sarah (40:12):

You have to figure out what your kids’ preferences are, what their strengths are, what they’re not as good at, and you’re going to have to tailor it. But what are big hits? What are good things that people can have in their back pocket for a chill moment where I’m going to do some reps now let’s get some practice in.

Kelly (40:28):

Yeah. Well, one of our favorite and most popular strategies, something called focus area experiments, it’s from the interoception curriculum, but you don’t need the curriculum to do these. So what they are, so as the name implies focus area, so we pick one body part, I usually like to, we didn’t mention this either. I like to start with outside body parts first, noticing your hands or your feet or how your nose feels or how your ears feel because they tend to be a little bit more concrete because kids can see the body parts while they’re also working on how do they feel. And then we slowly move into noticing our inside body parts. How does my heart feel or how do my lungs feel? How does my stomach or my bladder feel? And I know that if you’re someone that you’re really working on potty learning with your child, it’s really kind of a draw to go right to the bladder.

(41:15):

But I really encourage you to start with some outside body parts first. And so you pick your focus area. So let’s just say we’re going to do hands and then we use some experiments, and what we talk about is we try to playfully evoke a stronger sensation in that body part. So in the hands, for example. And so maybe we’ll hold an ice cube or we’ll shake our hands really fast in a silly way or squeeze some slime or make some slime together. And so those activities are most likely, we can’t guarantee because everyone’s body is different, but they’re probably evoking of stronger sensation within that hand that helps capture attention. It helps make it super concrete. And now let’s be curious about your hands. How do your hands feel while you’re holding the ice cube or how do your hands feel while we’re making slime together?

(42:04):

And it gives the reps, like you were talking about, the reps of noticing how the hands feel. And again, I can’t stress enough, try not to label what you think your child’s hands are experiencing what they’re noticing in their hands, but really get curious about what their unique experience is. Because I’ve been trained in a lot of programs and we’ve been trained to label either label emotions like, oh, you look frustrated right now, or even that’s spilling over a little bit into this interoception work. Just I think by accident because of those emotion labeling programs like, oh, I bet your hands are feeling slimy right now, or I bet your hands are feeling cold right now. And so we want to try to avoid labeling because that’s us assuming what they’re experiencing and what we’re hearing from so many people is that when we label an emotion or a sensation that we are at high risk of being wrong.

(42:56):

And so think about this from your child’s perspective. If you’re constantly having your emotions or your body signals mislabeled by another person, lovingly mislabeled, I have to say for the right reasons. I have to say, I’ve done so much of this, but if you are constantly having your inner experience mislabeled, it becomes so confusing to you. All these other people are saying, I look frustrated, or all these other people say that my hands must feel cold right now, but that’s not my inner experience. What we hear from so many kids as they get older is they start to doubt themselves. They start to not trust their bodies because all these other people are saying it, so they must be the one that’s wrong. So they never developed this authentic attachment to their bodies. It’s always other people’s narrative. So it’s really, really important. Even if your child can’t respond when you’re holding ice cubes and you’re like, I wonder how your hands feel right now, really.

(43:52):

I know. Then the instinct is like, I don’t want my kid to struggle. I’m going to tell them what I think is going on, but really try to be curious there. So you could say you bring in modeling again and be like, oh, my hands feel drippy and numb right now while I’m holding this ice cube, and I wonder if it’s same or different for you. So you’re saying it could be the same, but it also could be different, or you could give them a couple options like, oh, I wonder if your hands feel wet or wonder if they feel cold or if they feel numb, or maybe something else altogether. So give them that option of something else that you’re not labeling and saying I your body. You’re giving some curiosity there.

Dr. Sarah (44:35):

Yeah, I love that. One other thing I’m thinking about is like, okay, you and I were on a podcast, we are doing nothing but talking, right? And when you’re doing this exercise with your kid, you might be very compelled to do a lot of talking because you’ve heard all of these examples of things to say. So you’re trying them all out. I would say just please give yourself permission to know that if you say it one time and you play for 15 minutes and you said one reflective thing about your interceptive experience and get curious one time about their interceptive experience check, you’ve completed the exercise. The reps come from being in it. And I think one of the challenges, I see this a lot with parents even outside of these interceptive exercises, because I love when people do this, but is I’m just, when we’re labeling feelings, when we’re talking to our kid, we’re helping try to co-regulate with them and get them through a tough moment. I see parents, they can’t stop talking. And the ironic thing is we’re trying to help a kid build interceptive awareness. They really need to be in their felt sense, they need to be in their body, and when we talk to them, they go to their mind and that pulls ’em out of the felt sense. So it’s tricky. Like actually we want to help a little bit with the labeling and the connecting and the regulating piece.

(46:14):

But over index, it’s okay to over index on the noticing part. Give them that info, oh my God, my hands, they’re freezing right now that feel this stinging sensation underneath where the ice cube is. And my other fingers are like, they want to kind of let go a little bit like, oh, this feels so weird. What are you feeling? And just see what they say as though you’re having a normal conversation with not like, oh, now we’re going to practice noticing. It’s like, Ooh, be super authentic. What do you notice? Ask your kid what they notice and then go back to playing so that now you’ve planted a seed, you’ve made that kind of conscious link for them so that they could take their felt sense, connect it to their hands in that moment, do some sort of cognitive processing, whether they could say it to you or not. They might not have the language yet, but you’re helping them make the link and then let them play now because you’ve kind of connected the fields. Don’t interrupt that connection with more talking. Let them be in the field. Let them be in that connected space for a while. We don’t have to lead this very much at all. We can just, you just want to click the things together and then get out of their way.

Kelly (47:39):

Yeah, absolutely. I always talk about how it’s almost like a coaching model. You’re not going to be on the field with them, right? You’re just going to, I like how you said, plant the seed. You’re just going to plant the seed and put them out there in the field, which is their body hopefully, and that they’re taking time to really connect in that safe space with you.

Dr. Sarah (47:58):

Yeah, because the other thing, your job is less to do the narrating and the explaining and more to be sort of this presence because when they are in that connected relational container with you.

(48:17):

They can actually engage so much more freely with their felt sense because we actually can’t go into the felt sense if we aren’t feeling kind of super safe and connected. Going back to that polyvagal reference. We need to be in our parasympathetic, our ventral vagal, our safety connection space to do any of this learning, but also to be aware to go into the body if we feel even a little bit uncomfortable relationally, you’re going to get frustrated with me or you’re going to stop paying attention to me for a little bit. You might go into, you’re multitasking. Just you being present and focused on the play with them actually acts as a co-regulating body so that they can stay in the felt sense. So you’re doing a lot by just zipping it and just being with them.

Kelly (49:20):

Yes. That’s really hard for myself and a lot of people to know that sometimes when you’re doing nothing, you’re doing everything, but you’re really not doing nothing, are you?

Dr. Sarah (49:30):

No.

Kelly (49:31):

No.

Dr. Sarah (49:31):

It’s true. I get this a lot because I do a lot of supervising of therapists and training therapists, and especially working with kids and play therapy, and a lot of times early therapists are like, I feel like I’m not doing anything, and I feel like the parents are going to be like, why are you just playing Jenga with my kid all day? And I feel like I need to show them all the worksheets that we did or show them the proof that we did this thing. And I’m like, I know it’s really hard to fight. And as parents, we kind of feel the same. No one’s going to be evaluating us, but although we think that everyone is all the time, but we do feel like we have to be teaching or parenting or it’s like you’re doing so much by being the container.

Kelly (50:19):

So well said.

Dr. Sarah (50:20):

And yeah, this is so interesting. I’ve really hope that this is empowering for parents. Realize these, they sound complicated, these terms, but they’re so intuitively simple and they’re just part of the human experience. And we’re not teaching a kid really anything new. We’re just teaching them to connect to something that is always existed in their body since the day that they were literally incepted because they’re aware they have interceptive sensory experiences in utero. This is from day one. They are able to experience this, so we’re not teaching them something that new. We’re just teaching them how to stay in the noticing to make meaning of it connect and to eventually build the skill of using that connection to regulate. And so for a lot of kids, it’s actually relatively intuitive to go from connect to regulate. It can be difficult for a lot of kids too. I don’t want to imply that this can, if you just step back, it will click for them. But I think we also really have to trust our kids that given the right building blocks and the right environment and the right support, this is very doable.

Kelly (51:41):

Absolutely. It’s been an interesting adventure. And I’m proven, my hunches are proven wrong a lot because interoception is so new. And a lot of our research projects, they’ve been short intervention windows because they’re done with occupational therapy students and they want to be done with their research before they graduate. So anyways, it gives us this eight week window and all we’re doing is practicing the noticing. So all of those experiments that we were just talking about, but yet we’re having statistically significant gains in emotion regulation. So we’re not even getting to the connecting or the regulating piece. I’m not saying that that’s not needed, especially for certain children and adults, but I think it’s really fascinating to think about that. Just the noticing that we’ve been talking about so much is having this automatic spillover into kids being able to identify what emotion they’re experiencing and how do I regulate this meaningfully to me.

Dr. Sarah (52:36):

And that actually maps onto other mindfulness neuropsychological research as well. They do brain scans of people who do practice mindfulness, and it changes the structure of the brain. It does build more, I forget if it’s white matter or gray matter, but the important parts in the prefrontal cortex and in neuro neural connectivity. And those are the things that allow for the byproduct of emotion regulation and meaning making. So the noticing is probably a big, big, big part of why the connecting and the regulating becomes available. So I would over index on noticing.

Kelly (53:19):

Agreed.

Dr. Sarah (53:20):

That makes so much sense. Thank you so much for coming on. If people listening want to get in touch with you or learn more about your work, where can we send them?

Kelly (53:32):

Probably my website or www.kellymahler.com. And you’ll see if you go on my website, I’m very passionate about lots of free resources. So we have free printables, we have free blog posts, free videos, and you can learn more about the Interoception Curriculum there that I referenced. I think that’s probably the best place to start.

Dr. Sarah (53:55):

Amazing. Tell me really quickly about the Interoception Curriculum and is it a course that people can, how do people do it?

Kelly (54:03):

Well, we do have courses, but the Interoception Curriculum is actually a physical book. It’s like 25 lessons and it’s chunked into three sections. So there’s 15 lessons on noticing body signals, and then there’s four lessons on connecting body signals to the emotion. And then the last part of it is the action piece of exploring all different kinds of feel good actions to find what matches your unique body felt experience. So it’s something that I designed mostly for professionals to use, but there’s so many parents that are using it because they are, they’re seeing the value of it, and they’re really having a hard time finding professionals that are doing this work yet. So you can check that out on my website.

Dr. Sarah (54:47):

That sounds like an amazing resource. I’ve got to check that out too. Thank you so much. It was really, really lovely talking with you.

Kelly (54:55):

Same. Thank you.

Dr. Sarah (54:56):

If you enjoyed listening to this conversation, I want to hear from you, share your thoughts and your feedback with me by scrolling down to the ratings and review section on your Apple Podcasts app or whatever app you’re listening on. And let me know what you think of this episode or the show in general. Your support means the absolute world to me, and just a simple tap of five stars can make a real impact in how the show gets reached by parents everywhere. So thank you so much for listening and don’t be a stranger.