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Faidra Papanikolaou, February 23 2021

Interoception and stress

This short article aims to describe how awareness of our bodies influences our stress response and how a lack of body awareness may increase the risk of  “unconscious” stress, which can be the source of mental and physical health problems. At the end of the article, you can find a questionnaire to learn about your perceived stress levels and your body awareness.

Unconscious stress

Stress symptoms can sometimes seem to arise “out of the blue”, and can be persistent and prolonged, even during sleep (Brosschot et al., 2010, 2014, 2017). In modern societies, stressful situations can be numerous and the stressors are not always immediately apparent. Often people experience bodily symptoms of stress, but in the lack of any immediate stressor, the source of the stress is easily misattributed or or even ignored. This can further increase stress levels and could in severe cases result in medically unexplained symptoms, such as lower back pain, chronic fatigue, irritable bowel syndrome (Deary et al., 2007). The mechanism behind this could be a combination of worry and rumination that runs unconsciously, but also lack of awareness of our own body symptoms. 

The stress response

In previous blog posts, we already introduced the mechanisms of the stress response (Ozdemir, 2021a) and how it triggers a series of body symptoms, by activating our nervous system and releasing various hormones. When we are stressed, within seconds, adrenaline and noradrenaline activate the so-called “fight-or-flight” response, alerting the whole body (O’Connor et al., 2021). As a result, we may experience various physical symptoms, most commonly:

This, can also influence our immune system (Ozdemir, 2021b)

Worry & rumination: the unconscious stressors?

As long as it is switched on when it is necessary and off when no stressor is available, the stress response is adaptive and helps us go through everyday activities (O’Connor et al., 2021). However, if stress is prolonged, it becomes problematic. Scientists suggest that perseverative cognitions such as worry and rumination act as a mental representation of a stressor, which propagates stress and keeps the stress response active for longer periods (Brosschot et al., 2006). This explains why our stress levels remain high not only during but also before and after a stressful event. If not addressed, this could result in chronic stress with accumulative negative effects on health (Brosschot et al., 2006; Sapolsky, 2004).

The role of interoception

There is another mechanism, potentially underlying chronic stress and psychopathology. Neuroimaging studies revealed interesting links of depression and anxiety, with body awareness, or else interoception (Paulus & Stein, 2010). The concept of “interoception”, describes the ability to perceive internal sensations such as pain, heartbeat, respiration and temperature (Vaitl, 1996). However, those signals could become “noisy” (Paulus & Stein, 2010), which means that the individual can’t clearly distinguish if they stem from bodily functions, or from the stress response, and those noisy signals are more likely to be combined with catastrophizing beliefs that the person has a serious illness. 

This, naturally, increases the levels of stress even more, and the person enters a vicious cycle where their own body becomes a source of stress.

Thus, awareness of our own internal body processes and acknowledging when they signify high stress levels would give us insight into our “unconscious” stress. Then we would be able to detect the stressors in our lives and decide how to cope with them. 

Considering the impact of the pandemic on our well-being, coping with stress may be the first step to improve our mental health. 

In Sensae, we are currently working on technology to monitor the physiological signs of stress and help people acknowledge their internal body processes. Our mission is to aid people in finding suitable and healthy ways to increase body awareness as a means to improve resilience and cope with stress. When you know you are stressed there are several things you can try:

Thus, a person can choose their own favourite activity which helps them alleviate stress symptoms, and combine it with a healthy overall lifestyle. There are several options to deal with stress, but the first step is to acknowledge that it affects us. If you are interested in comparing how much you are stressed with how much you think you are stressed, you can fill out this 2-minute questionnaire:

To learn more about how we use technology to monitor and manage stress, and apply to participate in our closed beta programme,  by clicking here.


Brosschot, J. F., Gerin, W., & Thayer, J. F. (2006). The perseverative cognition hypothesis: A review of worry, prolonged stress-related physiological activation, and health. Journal of Psychosomatic Research, 12.

Brosschot, J. F., Geurts, S. a. E., Kruizinga, I., Radstaak, M., Verkuil, B., Quirin, M., & Kompier, M. a. J. (2014). Does Unconscious Stress Play a Role in Prolonged Cardiovascular Stress Recovery? Stress and Health, 30(3), 179–187. https://doi.org/10.1002/smi.2590

Brosschot, J. F., Verkuil, B., & Thayer, J. F. (2010). Conscious and unconscious perseverative cognition: Is a large part of prolonged physiological activity due to unconscious stress? Journal of Psychosomatic Research, 69(4), 407–416. https://doi.org/10.1016/j.jpsychores.2010.02.002

Brosschot, J. F., Verkuil, B., & Thayer, J. F. (2017). Exposed to events that never happen: Generalized unsafety, the default stress response, and prolonged autonomic activity. Neuroscience & Biobehavioral Reviews, 74, 287–296. https://doi.org/10.1016/j.neubiorev.2016.07.019

Callus, E., Bassola, B., Fiolo, V., Bertoldo, E. G., Pagliuca, S., & Lusignani, M. (2020). Stress Reduction Techniques for Health Care Providers Dealing With Severe Coronavirus Infections (SARS, MERS, and COVID-19): A Rapid Review. Frontiers in Psychology, 11. https://doi.org/10.3389/fpsyg.2020.589698

Deary, V., Chalder, T., & Sharpe, M. (2007). The cognitive behavioural model of medically unexplained symptoms: A theoretical and empirical review. Clinical Psychology Review, 27(7), 781–797. https://doi.org/10.1016/j.cpr.2007.07.002

O’Connor, D. B., Thayer, J. F., & Vedhara, K. (2021). Stress and Health: A Review of Psychobiological Processes. Annual Review of Psychology, 72(1), 663–688. https://doi.org/10.1146/annurev-psych-062520-122331

Ozdemir, Y. I. (2021a, January 14). What is stress and when does it become chronic? Sensae.Co. http://sensae.co/blog/what-is-stress-and-when-does-it-become-chronic

Ozdemir, Y. I. (2021b, January 21). How does stress affect our immune system? Sensae.Co. http://sensae.co/blog/how-does-stress-affect-our-immune-system

Paulus, M. P., & Stein, M. B. (2010). Interoception in anxiety and depression. Brain Structure and Function, 214(5), 451–463. https://doi.org/10.1007/s00429-010-0258-9

Perciavalle, V., Blandini, M., Fecarotta, P., Buscemi, A., Di Corrado, D., Bertolo, L., Fichera, F., & Coco, M. (2017). The role of deep breathing on stress. Neurological Sciences, 38, 451–458. https://doi.org/10.1007/s10072-016-2790-8

Sapolsky, R. M. (2004). Why Zebras Don’t Get Ulcers: The Acclaimed Guide to Stress, Stress-Related Diseases, and Coping (Third Edition). Henry Holt and Company.

Vaitl, D. (1996). Interoception. Biological Psychology, Volume 42(1–2), 1–27. https://doi.org/10.1016/0301-0511(95)05144-9.

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Faidra Papanikolaou

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