Interoception and Body Scanning in Chronic Pain and Emotion Regulation

A Narrative–Analytical Review of the Evidence and Safety Considerations

Compiled by: Sahar Yazdani

Yoga & Meditation Teacher

 

Abstract

Background: Interoception refers to the process of receiving and interpreting internal bodily signals and plays an important role in pain, emotion, and emotion regulation. Yoga therapy and mindfulness-based interventions—including body scanning—may be associated with changes in bodily attention and attitudes toward bodily experiences. However, the conceptual boundaries among interoception, body awareness, and body scanning are sometimes ambiguous in the research literature, and evidence regarding the precise role of these constructs in reducing chronic pain and improving emotion regulation remains inconclusive.

Objective: This article uses a narrative–analytical review approach to examine evidence concerning the relationship among interoception, body scanning, yoga therapy, chronic pain, and emotion regulation, and to analyze methodological and conceptual limitations in this field.

Methods: This article is a narrative review rather than a systematic review. Sources were selected through targeted searches of PubMed and Google Scholar and specialized yoga therapy resources (including the International Journal of Yoga Therapy and related documents), without claiming comprehensive coverage of the literature. The focus was on systematic reviews, meta-analyses, intervention studies, and conceptual articles published through September 2026.

Findings: The review of the evidence indicates that mind–body interventions and yoga therapy have been associated with improvements in some self-reported dimensions of interoceptive awareness and reductions in pain intensity and pain interference. A 2025 pilot study of a 6-week interoception-based yoga intervention for chronic pain reported that the intervention was associated with increased interoceptive sensitivity and accuracy and reduced pain; however, its single-group design and limited sample size (26 enrolled, 24 starters, 19 completers) limit conclusions regarding definitive efficacy or causal relationships. A 2024 meta-analysis of mind–body interventions reported improvements in self-reported interoceptive awareness and reductions in pain, but the specific contribution of body scanning was unclear. Direct evidence regarding body scanning in yoga therapy is limited and is largely extrapolated from MBSR studies.[pmc.ncbi.nlm.nih][pmc.ncbi.nlm.nih]

Conclusion: Mind–body interventions and yoga therapy may be associated with improved attitudes toward bodily experiences and increased attentional flexibility; however, claims regarding improved “interoceptive accuracy” require more objective evidence. In clinical practice, body scanning and yoga exercises should be implemented gradually, in an individualized manner, and with caution in individuals with a history of trauma, panic, or dissociation.

Keywords: interoception, body awareness, body scanning, chronic pain, emotion regulation, yoga therapy, mindfulness, narrative review.

 

1. Introduction

Interoception—meaning the sensing and processing of internal bodily signals—plays a role in the experience of emotion, pain, motivation, and self-awareness. In recent years, this construct has become one of the key concepts in explaining the effects of mind–body interventions and yoga therapy.[kabook]

Yoga therapy, as a multi-component system, includes physical postures (asana), breath regulation (pranayama), meditation, and ethical principles, which theoretically may influence pain and emotion regulation through bottom-up pathways (breathing, movement) and top-down pathways (attention, cognition). However, in the research literature, terms related to interoception, body awareness, and body scanning are sometimes used interchangeably, although these concepts differ in definition and methods of assessment.[bornaandishan][emotiv]

Relationship with emotion regulation: Interoception plays a role not only in the experience of pain but also in emotion regulation. Timely recognition of bodily changes associated with emotion (such as an increased heart rate during anxiety or muscle tension during anger) may help an individual choose a regulatory response before the emotion intensifies. Impaired interoception has been associated with difficulties in emotion regulation, anxiety, and depression. Therefore, interventions that improve interoceptive awareness may potentially affect both pain and emotion regulation.[kabook][emotiv]

This article aims to distinguish these concepts, examine clinical evidence regarding their role in chronic pain and emotion regulation, and analyze methodological and conceptual limitations in this field—with particular emphasis on yoga therapy.

 

2. Distinguishing Interoception, Body Awareness, and Body Scanning

For conceptual precision, the following distinctions are proposed:

Concept	Proposed definition	Example of assessment
Interoception	The process of receiving and processing internal bodily signals (cardiac, respiratory, gastrointestinal, etc.)	Heartbeat detection tasks, respiratory perception, gastrointestinal signal perception tasks[bornaandishan]
Interoceptive accuracy	The objective ability to correctly detect physiological signals	Heartbeat counting test without palpation[bornaandishan]
Self-reported interoceptive sensitivity/awareness	An individual’s subjective experience and evaluation of attention, awareness, and manner of responding to internal bodily sensations	MAIA or MAIA-2 questionnaires[emotiv]
Body awareness	A broader construct that includes proprioception, body position, body image, and the overall experience of the body	BAQ, BRQ questionnaires[emotiv]
Body scanning	A guided practice of directing attention to different regions of the body with a nonjudgmental approach	MBSR body scan protocol[mentoor]

The key point is that improvement in self-reported body awareness does not necessarily mean an increase in physiological interoceptive accuracy. An individual may feel that they sense their body better while showing no change in objective tasks involving heartbeat detection or pain. In yoga therapy, this distinction is important because many yoga interventions focus on subjective experience and attitudes toward the body rather than laboratory-based accuracy in detecting signals.[pmc.nlm.nih][emotiv][behnamebrahimi]

 

3. Clinical Evidence: Mind–Body Interventions, Yoga Therapy, and Pain

3-1. 2024 Meta-Analysis of Mind–Body Interventions

The meta-analysis by Gnall et al. (2024) examined changes in interoception in mind–body interventions for adults with chronic pain. This study included 11 studies and 10 unique samples and reported:

• Overall self-reported interoceptive awareness improved: d = 1.168, with p < 0.01

• Seven of eight interoceptive awareness subscales improved: effect sizes ranged from d = 0.28 to d = 0.81

• Pain intensity decreased: d = -1.46, with p = 0.01

• Pain interference in daily life decreased: d = -1.07, with p < 0.001[pmc.nlm.nih]

Critical analysis: These findings are promising, but several limitations must be considered simultaneously:

• The included interventions comprised a range of mindfulness programs, yoga, and combinations of these; therefore, the specific contribution of body scanning cannot be determined.

• Interoception was assessed primarily through self-report (MAIA), while evidence concerning physiological accuracy was limited.

• Pain reduction and improvements in body awareness occurred simultaneously, but this alone does not establish that changes in body awareness caused reductions in pain.

3-2. Interoception-Based Yoga Intervention for Chronic Pain (2025)

A pilot study of a 6-week interoception-based yoga intervention for chronic pain reported that the intervention was associated with:

• A significant increase in interoceptive sensitivity (p < 0.05)

• A significant increase in interoceptive accuracy (p < 0.05)

• A significant reduction in pain intensity (p < 0.05)[pmc.nlm.nih]

Analysis: This study is one of the early investigations to assess both interoceptive sensitivity and accuracy within a yoga-based intervention; however, its single-group design and limited sample size (26 enrolled, 24 starters, 19 completers) limit conclusions regarding definitive efficacy or causal relationships. The authors themselves also emphasized that the study was not adequately powered to draw conclusions regarding efficacy.

3-3. Short-Term Body Scanning in Chronic Pain

A trial of a 10-minute body scan in 55 patients with chronic pain reported immediate reductions in some measures of distress and pain-related social interference in a clinical setting; these differences were not observed in the participants’ usual living environment. A pilot study of a brief mindfulness intervention (including a 15-minute body scan) in persistent pain reported that the intervention was associated with increased pain self-efficacy at one month.[mentoor]

Analysis: These studies suggest that even very brief mindfulness interventions can produce immediate effects in clinical settings; however, long-term effects and generalization to everyday life require more regular practice and probably longer interventions.

3-4. Yoga for Chronic Low Back Pain: Cochrane Review

The 2022 Cochrane review of yoga for chronic nonspecific low back pain reported:

• Low- to moderate-certainty evidence that yoga, compared with no exercise, produces small and clinically insignificant improvements in function and pain

• Yoga produces little or no difference compared with other back-related exercises

• Low-certainty evidence that yoga increases the risk of adverse events (mainly temporary increases in pain) compared with no exercise, but no difference compared with other exercises

• No serious adverse events were reported[link.springer]

Analysis: This review indicates that yoga may be a safe option for chronic low back pain, but its effects are small and similar to those of other forms of exercise.

 

4. Theoretical Mechanisms: Caution in Interpretation

4-1. Bottom-Up and Top-Down Pathways

Yoga therapy may theoretically act through two pathways:

Bottom-up pathway:

• Breath regulation → changes in respiratory sinus arrhythmia → increased vagal tone → reduced arousal

• Mindful movement → improved proprioception and body awareness → reduced fear of movement

Top-down pathway:

• Mindful attention → changes in the interpretation of pain → reduced catastrophizing → reduced pain experience

• Acceptance of experience → reduced avoidance → increased gradual activity

Analysis: These models are theoretical, and direct evidence regarding which pathway predominates in which individual remains limited.

4-2. The Insula and Related Networks

Some neuroimaging studies have reported changes in activity or connectivity in the insula, anterior cingulate cortex, and hippocampus following mindfulness and yoga interventions. These regions play roles in pain, emotion, and interoception.[emotiv][link.springer]

Critical analysis: These findings should not be interpreted as demonstrating a linear and definitive relationship. Most of these studies have focused on meditation rather than yoga therapy alone. In addition, many studies have small samples and should therefore be interpreted cautiously.

 

5. Body Scanning in the Context of Yoga Therapy: Limited Evidence

Body scanning as a distinct and standardized exercise has not been extensively studied in yoga therapy. Practices involving attention to the body and observation of bodily sensations are used in some yoga therapy approaches and practices such as Yoga Nidra; however, these practices are not necessarily identical in structure or purpose to the standard MBSR body scan. Direct evidence regarding body scanning in yoga therapy is limited, and much of what is known is extrapolated from MBSR studies.

Key differences:

Feature	Body Scan in MBSR	Body Scan in Yoga Therapy
Timing	Usually 30–45 minutes, performed independently	Usually 10–20 minutes, as part of a sequence
Context	A separate mindfulness practice	Part of a therapeutic yoga sequence
Emphasis	Purely nonjudgmental observation	Combination of observation with breath regulation and relaxation
Evidence	More studies in chronic pain [9,11]	More limited evidence, often combined with other components[pmc.nlm.nih]

Important note: Direct extrapolation of MBSR findings to yoga therapy should be approached cautiously because the context, purpose, and implementation of the practice differ.

 

6. Author-Proposed Protocol: Gradual Body Scan

Note: This protocol is an author-proposed intervention based on practical considerations for patients with chronic pain and requires clinical validation.

Stage	Time	Implementation guidance
External orientation	1 minute	Eyes open or half-open; attention to the environment and contact of the feet with the ground
Position selection	1 minute	Comfortable sitting or lying position; ability to change position at any time
External–bodily anchor	2 minutes	Alternating attention between bodily contact and sounds in the environment
Scanning neutral areas	3 minutes	Begin with the soles of the feet and palms; observe pressure, temperature, or contact
Gradual expansion	3 minutes	Gently move attention toward the calves, hands, and shoulders; without forcing attention toward painful areas
Optional contact with the sensitive area	1 minute	Only if ready; observe the sensation for several seconds and return to a neutral area
Ending and orientation	1 minute	Gentle movement; open the eyes; attend to the environment and record the experience

Appropriate facilitator language:

• “If it feels appropriate for you, bring your attention to the contact of your feet with the ground.”

• “There may be a distinct sensation, or there may be no particular sensation; both can be observed.”

• “If attending to this area becomes uncomfortable, you can return to the sounds around you or to the contact of your body with the surface.”

 

7. Safety Considerations: Differentiating Levels of Caution

Level	Conditions	Recommendation
A) Relative caution	Severe pain or flare, panic, health anxiety, history of trauma	Start with a low dose, use external anchors, and allow the person to stop
B) Requires modification and specialist supervision	Significant dissociation, complex PTSD, severe emotional instability	Therapist support, shorter sessions, ongoing assessment
C) Requires specialist assessment before practice	Active psychosis, active mania, acute or unexplained medical symptoms	Referral to a physician or psychiatrist before beginning the practice

Yoga safety: The systematic review by Cramer et al. (2015) reported that yoga in randomized controlled trials was comparable to usual care and exercise with regard to serious adverse events; however, non-serious adverse events (temporary pain, muscle strain) were reported more frequently in some studies. The 2022 Cochrane review also reported that yoga, compared with no exercise, increases the risk of adverse events (mainly temporary increases in pain), but does not differ from other exercises and no serious adverse events were reported.[link.springer][pubmed.ncbi.nlm.nih]

Important note: These statistics concern general yoga as studied in clinical trials and do not necessarily apply to individualized yoga therapy supervised by a trained therapist.

 

8. Discussion and Analysis

8-1. Correlation, Concurrent Change, and Mediation

Three concepts should be distinguished:

• Correlation: Better interoception ↔ less pain

• Concurrent change: Intervention → better interoception; intervention → less pain

• Mediation: Intervention → change in interoception → reduction in pain

Only the third can support a potential mediating role, and even then, an appropriate research design is required. Current evidence is predominantly of the second type, and mediation has not yet been established.

8-2. Self-Report Versus Physiological Accuracy

Studies indicate that self-reported interoceptive awareness increases; however, this increase does not necessarily correspond to increased physiological accuracy. A 2025 meta-analysis of mindfulness and interoceptive accuracy examined 41 studies and 2,411 participants and reported a small positive association (r = 0.13), but also reported a very wide confidence interval, high heterogeneity, indications of publication bias, and generally low study quality.[behnamebrahimi]

Therefore, an intervention may have a greater effect on attitudes, acceptance, and the manner of attending to the body than on the ability to accurately detect physiological signals.

8-3. Methodological Challenge: Separating Components or Studying an Integrated System?

A methodological tension exists in yoga therapy research:

Viewpoint 1: Yoga should be separated into its components (asana, pranayama, meditation, body scanning) in order to determine the effect of each component.

Viewpoint 2: Yoga is inherently an integrated system, and separating its components is inconsistent with its nature. Yoga should be studied as a multi-component intervention.

Analysis: Both perspectives have advantages and disadvantages. Separating components is useful for understanding mechanisms, but it may not correspond to the way yoga therapy is implemented clinically. A middle-ground approach may be to study both combined interventions and single-component interventions.

8-4. Why Do Most Studies Rely on Self-Report?

• Low cost: Questionnaires are less expensive and faster than physiological assessments.

• Ease of implementation: In busy clinical settings, laboratory-based tasks are time-consuming.

• Clinical relevance: For patients, the subjective experience of pain and daily functioning are more important than accuracy in counting heartbeats.

Nevertheless, exclusive reliance on self-report has limitations, and future research should also include objective measures.

 

9. Conclusion

Mind–body interventions and yoga therapy may be associated with improvements in some dimensions of self-reported interoceptive awareness and reductions in pain intensity and pain interference; however, the specific contribution of body scanning and the mediating role of interoception require more rigorous research. Early pilot studies of interoception-based yoga have reported promising findings, but their single-group designs and limited sample sizes restrict definitive conclusions.[pmc.nlm.nih]

In clinical practice, body scanning and yoga exercises should be implemented gradually, individually, and cautiously in individuals with a history of trauma, panic, or dissociation. Direct evidence regarding body scanning in yoga therapy is limited and is largely extrapolated from MBSR studies; therefore, direct generalization should be approached cautiously.

Future research should:

• Use larger samples and higher-quality clinical trials

• Include both self-report measures and objective measures of interoception

• Examine the contribution of different yoga components

• Test mediating mechanisms using longitudinal designs and mediation analyses

 

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