“Gifted” Practitioners and Interoception
FEATURE
Robert 'Ric’ Wiegand
DC
There has always been a small percent of “gifted” practitioners who have developed exceptional perception skills and been able to perceive subtle physiological changes that most other practitioners don’t perceive.
Until recently, neuroscience wasn’t able to explain why only a limited number of practitioners have been able to develop these exceptional abilities. Common sense suggests a small group of practitioners may simply work harder at developing their skill sets than others, or that some practitioners are bom with an extra-sensitive nervous system, so they are innately aware of subtler changes than other practitioners are. However, recent findings have shed new light on other factors that play a critical role in developing these skills. These findings make it possible for a large percent of practitioners to develop exceptional perception abilities.
One of the most valuable skills a practitioner can develop is a heightened awareness of extremely subtle yet significant changes in a patient’s physiology.
Palpation illustrates the potential of incorporating these new findings into clinical assessment procedures. To start, it’s useful to keep in mind that your nervous system produces a variety of conscious and nonconscious responses to stimuli it detects during palpation. For example, when you palpate a patient, you have the option of paying attention to 1) tactile sensory responses (e.g., fine-touch sensations) and 2) allostatic/adaptive responses that your nervous system produces.
Fine-touch sensations provide information about an external stimulus your nervous system has detected (“exteroceptive” sensations). Allostatic/adaptive responses include autonomic, arousal, affective-emotional, and motivational responses/sensations. These internal physiological responses provide insight into the biological significance of stimuli your nervous system detects during palpation. Conscious awareness of these “interoceptive” responses/ sensations is “interoception.”1-2
Most conventional methods of palpation train practitioners to pay attention to the fine-touch sensations their nervous system produces. This feedback provides useful clinical insights about select changes in a patient’s physiology, e.g., changes in tension, motion, and/ or structural relationships. Practitioners often invest considerable time and effort to refine their awareness of these (exteroceptive) sensations.
By contrast, conventional palpation methods generally pay little or no attention to the interoceptive responses/sensations that are produced during palpation. Unsurprisingly, only a small percent of exceptional practitioners go on to develop an appropriate awareness of these responses/sensations. That’s unfortunate because, whether or not you are aware of it, your autonomic nervous system is constantly responding to information you are detecting about a patient during palpation. The interoceptive feedback your nervous system produces can provide unique clinical insights that finetouch sensations are unable to provide.
Paying attention to interoceptive feedback during palpation may appeal' to be a novel tactic, but, in fact, there is a long history of objectively monitoring adaptive/interoceptive responses to gain greater insights about external stimuli the nervous system detects (psychophysiology ).3 The fact is that your nervous system produces adaptive/interoceptive responses to more of the stimuli it detects during palpation than it does for finetouch sensations.4
The big problem with utilizing interoceptive feedback in a clinical setting is that only a small percent of interoceptive responses can be experienced subjectively. A persistent challenge has been to identify a core set of clinically relevant interoceptive responses/sensations that most practitioners can consciously experience. In the past, technology was not advanced enough for neuroscience to provide a solution for this problem. Consequently, practitioners who wanted to develop interoception skills had to try to figure out which interoceptive responses/ sensations to pay attention to on their own, and most met with limited success.
That has changed recently. Contemporary neuroscience has successfully defined a core set of clinically useful interoceptive responses/sensations, of which most practitioners can reliably develop access.
Evidence suggests that practitioners cannot optimize their perception abilities solely by developing awareness of conventional (five-sense) sensory responses. This approach overlooks some significant factor(s). Many practitioners have developed high-level, fine-touch awareness skills, but they don’t demonstrate “gifted” perception/palpation abilities. Conversely, some gifted practitioners only develop mediocre fine-touch awareness skills, and yet they still demonstrate extraordinary palpation/perception abilities. Moreover, when “normal” practitioners learn how to heighten their awareness of key interoceptive responses/sensations, they generally start to demonstrate extraordinary perception abilities.5
In effect, the ability to incorporate select interoceptive feedback, along with conventional sensory feedback, appears to be a key factor that distinguishes “gifted” perception from “normal” perception. Practitioners who utilize information from both exteroceptive and interoceptive feedback sources inherently have a more comprehensive pool of data on which to base their clinical decisions. They can know things about a patient’s physiology and intervene in ways that they can’t know or do without developing interoception.
A closing observation: in the past, developing clinically useful interoception skills was often a difficult and time-consuming task. In truth, much of the difficulty occurred in the discovery phase, i.e., while a practitioner was struggling to figure out which interoceptive responses/sensations are clinically significant and attempting to develop strategies to heighten awareness of these select responses/sensations.
Once you know how to go about it, developing clinical interoception skills is not inherently difficult (it is an innate propensity). Contemporary neuroscience makes this requisite knowledge available. Most practitioners who leam this information are able to develop valuable clinical interoception skills in a short amount of time.
Robert ‘Ric ” Wiegand, DC, lives in Eugene, Oregon. He is a cofounder of the Access Workshop, which presents a neuroscientific approach for rapidly developing clinical interoception skills. For more information, visit www. A ccess Workshop, com.
References:
1. Interoception. homeostatic emotions and sympathovagal balance, Irina A. Strigol,2 and Arthur D. (Bud) Craig3
2. Frontiers in Psychology: On the Origin of Interoception, Erik Ceunen. Johan W.S. Vlayen. and Ilse Van Diest
3. Neural Correlates of Subjective Awareness and Unconscious Processing: An ERP Study, Dominique Lamy, Moti Salti, and Yair Bar-Haim
4. Fine-touch sensations are initiated solely by input that is detected by (large-fiber) mechanoreceptors. Interoceptive responses/sensations can be initiated by input that is detected by mechanoreceptors. nociceptors, and thermoreceptors.
5. Author's personal observation from more than three decades of teaching clinical interoception skills.
