Interoception

The example statements and sayings used in this article are an attempt to ‘bring alive’ the concepts they are illustrating. However, obviously, within themselves, the statements and sayings can hold a broader meaning that may challenge the concepts they are attempting to illustrate here, but that is not their intention.

What is Interoception

Interoception is the conscious and non-conscious sensing, interpreting, integrating and regulation of internal bodily signals to provide the individual with a momentary map of their body’s internal landscape and their relationship to the outside world. This is fundamentally important to facilitate the sort of adaptive change that Darwin believed was critical for survival (Paulus et al 2019) regulating homeostasis through the visceral, immune, and autonomic systems, using nociceptive, chemosensory and thermoregulatory information (Bohlen et al 2021). For example, it regulates, temperature, pain, immune, hormonal, and cardiovascular activities, touch, hunger and thirst (Di Lernia et al 2016).

In a dynamically changing world these homeostatic and allostatic mechanisms are relatively stable as violating set boundaries e.g. body temperature can have serious health consequences, therefore we have to encode a preferred metabolic states and any deviations from them. But there are usually no accurate objective representations of subtle physiological fluctuations e.g. if I wanted an accurate representation of my hand I can look at it, but a representation of subtler fluctuations in my physiology that has to be constantly ‘tweaked’ before any overt symptoms occur has to be ‘felt’ by guessing our current physiological state and predicting our future state as a consequence of any internal or external action (Seth & Friston 2016) meaning an individual has to stand back and try to objectively monitor the overall performance of homeostatic and allostatic mechanisms.

Any deviation from our preferred state can’t just be passively endured we have to definitively act in order to counteract them this makes us “pro-active survival-enabled prediction machines” (Ciaunica et al 2021). For example, feeling thirsty is as a mismatch between what we predict our hydration levels should be and what we perceive they currently are. This mismatch can be resolved on a perceptual level by (i) habitually getting used to being thirsty so we change what we predict our hydration levels should be or (ii) using meta-cognitive strategies like distraction. Alternatively, we can resolve this mismatch by deliberately acting on our environment to resolve this undesired state by seeking out opportunities to consume a drink (Spee et al 2022).

Our brain has a constant 24/7 bombardment of every single interoceptive stimuli that obviously can’t be consciously appraised and acted on. Therefore, in order for our interoceptive awareness to infer the causes of its sensory input, explain past events, control present happenings, and prepare for the future, it has to avoid surprise (Brown & Brune 2012) in order to establish continuity and pave a predictable path in order to be adaptive in maintaining optimal physiological and psychological integrity and identity (Seth & Tskaris 2018). It does this by (i) to avoid uncertainty, use previous experience to predict, and based on that prediction, instigate what it believes to be the most appropriate physiological response; (ii) prioritise unexpected, surprising, stimuli (hence most likely to be informative) when deciding how to allocate resources (Fradkina et al 2020). This is how pain, as a helpful interoceptive stimuli, can teach us to adaptively respond to real physical threat and avoid potential harm in upcoming situations (Lim et al 2020).

Therefore, adapting to any deviations from our preferred state is a mandatory requirement for any self-maintaining biological system and a possible unifying principle for understanding perception, action, attention, experience, and learning. Also, more broadly, beyond homeostatic adaptations to ever-changing environments, humans in particular have a preponderance to information foraging being curious and seeking surprise and novelty in non-threatening settings (Spee et al 2022).

Interoceptive information is transmitted to the brain for processing via the vagus and glossopharyngeal nerves and via viscerosensory, somatosensory, chemosensory, and lamina I spinothalamic pathways (C-tactile afferents activated through low force 3cm/sec, stroking) (Bohlen et al 2021).

The origin of interoceptive input

In our attempt to make sense of the world we actively explore our environment and gather evidence making a mental map as we go along. This map allows us to actively imagine what we want for our preferred future and how we can navigate life’s maze by running mental simulations to make it happen. These simulations allow to try and work out what is happening based on the scanty evidence we got “looks like ‘x’ might be going to happen” and “in response to ‘x’ happening, if I do ‘y’, then this should result in ‘z’ happening which would effect how I attain my goal”. The sensory input from doing ‘y’, with ’y’ being an active engagement with the environment, is called interoceptive input. This actual sensory input from actively engaging with our environment (‘y’) is then compared with what we thought the sensory input was going to be (‘z’) to let us know how successful we were in predicting in what ways our actions were to effect how we attaining our goal. Therefore, we have a closed-loop regulation that has constant recurrent counter-streams of processing providing feedback from trying to predict what should happen when we do something relative to our goal, and what actually did happen when we done it (Pezzulo et al 2024).

By allowing us to predict how a situation will unfold to reach our goal (e.g. “I predict I would feel more comfortable if I was warm”) and depending on how we feel in relation to that desired state (e.g. “I feel cold”), our cognitive map allows us to instigate motor activity based on what we predict, or anticipate, the outcome or sensory consequences of these motor activities to be, be it a simple autonomic reflexes (e.g. thermoregulation) to more sophisticated actions (e.g. shop for a coat). These predictions also generate rapid corrective movements when we experience sensory stimulation we were not expecting (prediction errors) e.g. when sitting in a chair and surprised it’s deeper than we predicted, this error may cause our quads to contract to slow the rate of descent. These learnt internal models of the world that predicts how our world will unfold and what impact our upcoming actions will have on this changing environment guide motor movement through two different mechanisms (Liesner & Kunde 2021):

• Predictive based models. In predictive based models it is the intention of achieving a certain goal (e.g. grasping an object) that triggers the motor plan to achieve this intention. Based on this motor plan, one predicts how it should “feel” once this motor plan is achieved and the object has been grasped. The actual sensation whilst grasping the object is then compared with how one thought it would’ve felt in the predicted state and any deviations from this predicted state are bought to our attention; for example, you intend to reach for a cup without looking and this initiates a motor response. You’ve predict what a cup should feel like but when your hand touches the object it doesn’t feel like a cup. This mismatch between what you predicted to feel and what you are actually feeling (‘prediction error’) gets bought to our attention so we can either initiate corrective movements, or, depending on the evidence, it should update how we represent what a cup should feel like.

• Ideomotor models. In contrast, ideomotor reflexes and learning start with ‘motor babbling’. Motor babbling is characterised by purely random movements and behaviours that aim to practice or explore promoting learning centred around a self-rewarding curiosity (Haar et al 2020) (e.g. when babies explore their voice by saying “bababa”). Therefore, motor babbling is not orientated towards a predetermined goal or anticipated outcome, a baby doesn’t say “bababa” because it’s goal oriented towards refining its voice for public speaking, but it’s more of an exploration into the unknown ‘prod it and see what happens’. Over time associations are learnt between these motor actions and what is felt as a consequence of performing these actions which in effect tees up and primes the motor system e.g. learnt associations develop between the motor movement of saying ‘bababa’ and felt experiences such as noise, vibrations and received attention from other people.

  Once these links have been established, and any conflicting ideas have been removed (Massen & Prinz 2009), this process can be reversed; therefore, instead of a sensation instigating a motor action and then there being a felt consequence of that motor action (e.g. ‘I feel tired —> I will physically close my eyes —> I will go to sleep’), simply using our imagination, our mental representation, to recollect the consistently produced consequences of these motor actions activates these motor actions so we can experience the predetermined consequences of our actions and achieve our ‘goals’ (‘I’m tired —> I want to go to sleep —> my eyes just automatically shut and I fall to sleep’). Another example of how a central idea triggers a teed up neuromuscular system is by how simply anticipating or predicting how it “feels” to grasp an object activates the appropriate motor response; but because the strength of the induced action will depend on how strong the link is between what is being perceived and what are the perceivable effects of that action are (Massen & Prinz 2009) e.g. grasping a falling baby will drive a stronger motor movement than grasping a falling piece of paper.

Three dimensions of Interoception

There are three distinct dimensions of interoception (Garfinkel et al 2015):

• Interoceptive accuracy: is the ability to accurately detect and track internal bodily sensations e.g.“Can you accurately report when your heart is beating?” . This can be objectively measured by e.g. taking your pulse. Individuals with high levels of interoceptive accuracy experience higher levels of arousal, but are also sensitive to cues informing them how they can positively self-regulate their behaviour and follow their intuition (Tsakiris 2017).

  Interoceptive accuracy anchors an individual in their body awareness being able to block out, and not get swept away, with exteroceptive signals from the rapidly moving outside world (Tsakiris 2017). This is illustrated in the saying “and breath” whereby predicting, controlling and experiencing ones internal breath anchors oneself against the distractions from the outside world.

  In chronic pain the nervous system is saturated with the constant physical and emotional aspects of pain. This constant deafening ‘noise’ reduces interoceptive accuracy by drawing our attention towards pain related information and away from other interoceptive information. This makes the nervous system reliant on multisensory integration of external inputs (e.g. vision, touch, etc) to create a picture of behavioural and autonomic interoceptive functions; it holds higher value to exteroceptive input when it appeals to our mental representations (De Lernia et al 2016). For example, low levels of interoceptive accuracy during flexion is seen when “I know my own body” and flexion is disproportionately predicted to have catastrophic consequences. This heightens the value of sensing pain as a warning sign to prevent further damage; misinterprets or simply ignores other interoceptive inputs (e.g. stretching sensation); normal proprioceptive input is interpreted as something ‘moving out of place’ and there is an over-reliance on external input that appeals to our mental representations of an ensuing catastrophic injury e.g. touch “I can feel my muscle spasm when I bend forward” (when they’re just feeling a normal muscle being stretched).

  In contrast, acute pain, that has a practical value in protecting against further damage, has a high interoceptive accuracy, so we can accurately feel our internal bodily sensations as to avoid further tissue trauma (De Lernia et al 2016).

• Interoceptive awareness: how we access interoceptive information, by how we explicitly think about, and appraise it; this insight determines how we approach or withdrawal from this stimuli “Do you ‘know’ whether you are accurately or inaccurately assessing your heart-timing?”; “do you ‘know’ whether your beliefs around bending forward are catastrophic or physically warranted?”

  Increased awareness of interoceptive information makes it easier to reappraise, learn from, promote empathy and manage in order to challenge unhelpful mental representations e.g. catastrophic belief systems. Any type of self focused attention improves an individual’s interoceptive accuracy, for example (i) low-level perceptual and bodily aspects of the self e.g. gazing at ones face in a mirror; (ii) high-level, cognitive and narrative aspects of the self e.g. looking at autobiographical words evoking personal memories and traits (Ciaunica et al 2019).

  Conversely, reduced awareness of interoceptive information makes it easier to suppress, harder to learn from and manage and opposes developing empathy. A poor recognition of interoceptive signals promotes genuine self-denial and can reduce processing of positive stimuli resulting in a consistent flat line of emotions contributing to e.g. depression (Brewer et al 2021).

• Interoceptive sensibility: our self-belief in our awareness and ability to be internally self-focused, engaged and responsive to interoceptive processes. “To what extent do you believe you focus on and detect internal bodily sensations?” A low level of confidence in interoceptive sensibility can lead to feeling a low level of control, for example “I get confused as to whether or not I am hungry” and “I don’t know what’s going on inside me” (Khoury et al 2018).

Interoceptive accuracy is central to the construct of interoception underpinning interoceptive awareness and sensitivity (Baltazar et al 2021). How accurate we truly are in sensing interoceptive information (accuracy) is related to how we represent, think about and appraise this information (awareness) but not our perceived self-beliefs about our ability to so (sensibility) (Garfinkel et al 2015).

Khoury et al (2018) broadened the dimensions of interoception to include:

• Interoceptive mode of attention: describes the contrast between a direct, experiential non-judgemental awareness of body sensations and a reflective, labelling or ruminating on interoceptive signals. A direct, experiential non-judgemental awareness of body sensations represents a core aspect of many mindfulness and related mind-body interventions.

• Interoceptive attention quality: tendency to pay attention versus ignore body sensations.

• Interoceptive attitude: between appraising body sensations as helpful (trusting attitude) or menacing (catastrophising attitude). This dictates feelings about the consequences (including somatic consequences) and cognitive (dys)control in relation to interoceptive signals.

These three qualities determines self-efficacy (i) an individuals’ confidence in their ability to focus on a sensation, (ii) an ability to sustain or control the mode of attention, and (iii) ability to attain an anticipated outcome from the experience i.e. minimise uncertainty as to ascertain feelings of confidence and control; refer to ‘interoceptive sensibility”. For instance, a catastrophising interoceptive attitude can lead to increased fear and a more ruminative mode of attention to interoceptive input so they have a tendency to dwell on and magnify the sensory experience so it overwhelms them, i.e. they can’t compartmentalise it in a broader narrative, leaving them feeling as though they have no control in steering their actions to control the catastrophising stimuli (Khoury et al 2018).

This gap between perception and reality is called the ‘trait interoceptive prediction error’ (TIPE). It is a variant of interoceptive awareness, and is the gap between what’s really going on i.e. the raw sensory input (accuracy) and our perceived prior self-belief in our abilities to sense what’s going on (sensibility) (Murphy et al 2019). In order for us to be aware of when we got it wrong, when our prior models predicted that ‘x’ was going to happen, but this guess was wrong, and instead our interoceptive input told us that ‘y’ actually happened we need to have good interoceptive accuracy (Baltazar et al 2021). When our prior models predict something should happen and it doesn’t, this erroneous sensory information gets flagged up, as without a clear and coherent narrative into which to process it, it is deemed ‘wrong’ by seeming incomplete, missing or unreliable. Therefore, how much weight we give to learning from these prediction errors, how surprised we are to be wrong, depends on how we cling on to our prior beliefs as being ‘true’ i.e. if we cling on to something with absolute clarity then any contradicting sensory information (prediction error) will have far more potent effects (Fradkina et al 2020).

However, sometimes we both want, and need our prior beliefs to be wrong, certain educational safe-spaces such as museums, unfamiliar places or cultural spaces allow for a habitual expectation of uncertainty and ‘wonder’ that challenge our beliefs. This certainty of uncertainty, when attending these places, deliberates an opportunity to expose errors in our prior models for the expressed purposes of learning. The nature and rate of learning in these familiar places is from the discrepancies, or errors, in (i) what our prior models predicted the sensory information would be, and, (ii) what the sensory information actually was. The value of having to abandon our flawed prior models and turn our attention to the sensory information gathering needed to update these models not only confirms to us we can optimally adapt to an ever-changing world, but a world without any surprises or prediction errors would feel unpleasant as we would never experience novelty and learning (Spee et al 2022). However, whilst this novel, unexpected, informative sensory information that patches the holes in our prior expectations forms new and evolved beliefs it is not without its constraints. If, through the learning process, these new beliefs diverged too much from our prior expectations, i.e. they completely shook the foundations upon which we stood, we would have no prior knowledge or experience upon which to successfully execute these new beliefs in the world. Therefore, illustrating that all our prior knowledge, and our expectations based on that knowledge is a lie, makes these new beliefs energetically costly as we have to completely re-learn about ourselves, our environment and how to effectively function in it. This means to function efficiently as self-evidencing agents it is more cost-efficient to on the one hand explore so we evolve ourselves ever closer to the truth, but, not at the expense of uprooting ourselves (Fisher & Hohwy 2024) and abandoning all our habitual rituals.

In the respect of premeditated learning using sensory information gathering attempts to patch the holes in our prior models that reflect the imperfections in both how we perceive the world, and, how we value an object as a target for active engagement. The nature of how we actively “get into”, on a cognitive and affective level, the active engagement with these objects for the purposes of aesthetic learning is an extension of the broader meta-beliefs of our socio-cultural behaviour. Therefore, actively seeking out challenges that provides opportunities for aesthetic learning allows us to experience the reward from training our senses to gain new insights by finding hidden meanings and new perspectives about our socio-cultural environment. By being self-evidencing in the way in which it provides ‘our’ experience of reality it expands personal viewpoints and existential values, emotional experiences, ideals and our perceptions and valued uses of objects. This deeper, more common understanding, may facilitate intergroup communication when other communication mechanisms have failed (Spee et al 2022).

Representations

Representations: what I intend the truth to mean to me

For any given scenario a bland ‘concrete truth’ derived from impersonal sensory information exists. But as emotional beings that impersonal sensory information has to be translated by cognitive processes into a personalised, self-referential meaning that resonates with ‘me’. For example sensory input from hearing the word ‘house’ re-activates associated experiences so that this sensory input, during subsequent processing, can be mapped out onto our relevant representations of the word “house” that has been created across an individual’s lifespan. These representations of hearing the word “house”, that has been labelled with language, will both be literal (e.g. images of walls, roof, etc) and represent emotional associations (e.g. warm and cozy). This allows me to experience my limited number of truths behind hearing the word “house” that represents what my truth, my reality on hearing the word “house” means to me in any given context and moment in time.

Therefore, we don’t require literal models of the world because the literal world is there for us to witness, what we need, is an abstract meaning to random life events to allow these events to come togethers to form ‘my’ story, an experience of my reality of myself and others through the lens of my representations (Danchin 2023). By deriving a personalised meaning and vitality from this story a sense of unity, purpose and ownership to my identity (Dimitrova & Simms 2022) is formed by how it harnesses the interconnected, self-validating wishful beliefs about the world and metacognitive insights of my beliefs about my other beliefs (Fisher & Hohwy 2024). For example, a middle aged bloke’s abstract ‘gangster’ representation of himself doing Eminem on karaoke may differ from the 'more concrete truth’ of the video footage. In this case they have a positive first-hand affective experience of how being gangster is characterised not just by their unconstrained active participation in karaoke, but by how others respond in validating or de-validating that representation i.e. does anyone show him the video footage. Their personal motivations to collect evidence for their persona is from how they interpret socio-cultural norms when aligning themselves to their definition of gangster, and when interpreting the lens through which they view evaluations from themselves and others.

This motivation to tell a story that re-invents reality, is intentionally worded to enforce an order, consistency and unity so that a meaning can be attributed to oneself and the world. This new (neocortical) evolutionary goal allows an experience of oneself as both an autobiographical author and narrator of their own story with total creative freedom. This creative freedom enables a coherent organisational framework to be portrayed in the narrated story so that a meaning to oneself and the world is experienced. This meaning is experienced by how sensory information is transferred up the cortical hierarchy telling in what ways our story was right, and our expectations were met, in order to re-enforce our representations, and in what ways our story was incorrect and our expectations were not met in order to update our representations. How the coherence in the framework of our story is changed to update our representations, or validated to re-enforce them, is by how biological constraints are not seen as inviolable limits but as resources from which to draw from (Veglia & Fini 2017) when processing the web of coherent beliefs and memories that form our representations (Veselis 2018).

Our representations are formed by how incoming exteroceptive, or interoceptive sensory information is measured against how our understanding of facts, and sociocultural beliefs is represented in our semantic memory (Veselis 2018) so we can extract a self-referential meaning from this otherwise bland sensory information. These representations of what we ‘know’ from prior experiences gives weight to incoming sensory information that is novel, whilst offering a comforting familiarity by how it sufficiently matches the common features that span the multiple representations in our semantic memory (Veselis 2018). But the confidence obtained from this comforting familiarity can be misplaced, as seen, for example by how the preferred sensory experience derived from how quickly and easily familiar actions are fluently chosen offer an illusionary sense of control and competence, even when the priming of these familiar actions actually makes our performance worse (Firth 2023). Therefore, the combination of what objectively neutral sensory information actually is, and what our semantic memory expects sensory information to be, creates a ‘sensory mix’ that is consolidated with prior beliefs, events and knowledge so it can be self-referentially processed and encoded in a way that makes it consistent with other memories to form an autobiographical memory. Distant autobiographical memories are then bought together to be joined by the logical and causal links forged by the beliefs. This coherent web of autobiographical memories references our semantic memory to narrate the consistent and coherent smaller stories that forms the overall bigger story of anyone of the representations that stabilises our personality (Veselis 2018).

Therefore our beliefs influence the malleability of the (re)construction of our memories (Veselis 2018) so that the more these memories are (re)constructed, the more they drift away from their original content and towards how we represent the familiar prior socio-cultural beliefs and knowledge with which the original content was self-referentially encoded (Firth 2023). But how beliefs, that colour the lens through which these memories are experienced, are contextualised by perceived evidence depends on the dynamic relationship between the strength of a belief and the strength of perceived evidence for these beliefs. This relationship is bidirectional so that (i) the strength of a belief increases with perceived evidence, and (ii) the strength of the perceived evidence increases not only with more confirmatory objective neutral evidence, but also by how this evidence is purposively self-amplified by our beliefs. This allows our beliefs to shaw themselves up by self-amplifying the validity of the perceived evidence for them (Scheffer et al 2024) and de-validating the evidence that contradicts them (Chen et al 2021) which allows for an embodied sense of ownership over these beliefs and the autobiographical memories they create. This can compromise malleability in our representations from how, on the one hand, our web of beliefs create the ‘right’ self-relevant memories that are tied together and anchored within a coherent narrative to form our representations (Dimitrova & Simms 2022), and, on the other hand, how these now stylised memories that form our representations confirm the very beliefs that created them. An example of hows our perceptions of reality can be confused with reality itself is seen in the backfire effect whereby being more inclined to accept opinions closer to their own individuals entrench themselves in their own opinions when exposed to contradictory evidence (Chen et al 2021).

Encoding representations

Our cognitive knowledge attributes meaning to random sensory information so that the world appears to the individual in a manner with which it is relatable to the individual’s capacities (Schiller et al 2024). As common sense reasoning needed to drive goal-directed actions must be flexible, as to adapt behaviour to the specifics of situations, the overall meaning derived from random sensory information reflects how, in a single event, not all the literal details from a vast array of sensory information is retained, but only that deemed relevant. Extracting from this information an overall meaning that is relevant to ourself allows it to be categorised and ordered into a hierarchy (Kaup et al 2024) based on its strength of contextual relevance so it can deliver that “what it’s like for me” to have a sensory experience.

Therefore, how we self-referentially process bland sensory information is self-evidencing by how it shapes emotional attitudes and gives a sense of belongingness towards streams of thought (Northoff et al 2006) before being symbolically encoded. This symbolic meaning stored in our representations is how generalised, non-specific, abstract knowledge reinforces the value of reliable cues that represent the relevant features when mapping out an appropriate future response, and, in turn devalues unreliable ones that are unhelpful (Kaup et al 2024). The conceptualisation of the significance of an event to derive a bigger meaning can result in reality being mapped poorly making it difficult to operate in (Schiller et al 2024) leading to suspicious mindsets in victim-sensitive individuals (Maltese et al 2016). This distillation of raw, literal, sensory information into cues associated with this symbolic meaning allows for them to be transferred between, and reinforce, different domains (Nguyen et al 2021) to trigger associated learning. For example, when presented with a high quantity of variable sensory information e.g. domain one: many different female faces, combined with domain two: many different pleasant images. As we can’t process such a vast array of faces and images, we symbolically generalise this information to derive a meaning from it that triggers associative learning between two amodal representations, amodal representation one: females and amodal representation two: positive valence (Hütter et al 2014), which cues females<—>positive valence.

The ways in which, in some scenarios, we position ourself towards one end of a continuum so that, from a pool of sensory information, we can manipulate and extract what we deem relevant from it so we can spread it across different domains and derive a bigger meaning from it, and, in other scenarios, we position ourselves towards the other end of the continuum by breaking up sensory information into smaller chunks and compartmentalising its literal features reflects how we derive our cognitive knowledge. Our cognitive knowledge should reflect how, in an highly variable, unpredictable environment we can map a good variation of reliable cues to the appropriate responses. This allows for a more sophisticated and flexible meaning to be inferred from random sensory information that constructs more adaptive probabilistic action-effect representations that drive goal-directed behaviour. This done by three ways:

(i). Sensorimotor system. Developing in the fetal brain (Nguyen et al 2021) sensorimotior representations contain knowledge stored in representations in lower-levels of the cortical hierarchy that is more concrete and literal containing specific details (Kaup et al 2024). They are initially facilitated by genetic factors, and later refined through connectivity changes driven by embodied interactions both before and after birth. Inutero, reflexive independent motor movements, and, tactile senses start to develop at seven to eight weeks. Gradually a link is formed between movements and their sensory outcomes so that by three months of age a sense of self-agency develops whereby, as a free agent, as an author of my own story, I can achieve a predetermined goal by self-producing movements and knowing the probability of their effect (Nguyen et al 2021).

In infants these sensorimotor experiences are initially formed through self-exploratory movements beginning with its own body (Hafner et al 2022) to allow a minimal form of consciousness to emerge from how ‘I’ am the cause of an action and the subject of an experience and that ‘I’ can distinguish between myself and others (Möller et al 2021). As the infant then progresses outwards from its body, having no understanding of causal relations it randomly exploring the unknown, projecting itself on to objects with haphazard actions that have no clear goals. The unbiased broadness of this bodily awareness serves as an unfiltered lens through which what is reflected back to the baby is the the raw, unfiltered felt consequences of these stumbly random actions. Experiential learning through this lens allows the baby to represent a rudimental understanding and ownership over my body schema and distinguish it from other external objects (including things, people, and situations) (Möller et al 2021) that is needed to build an action-outcome database. Accumulated knowledge derived from this database of haphazard movements, means that now, once it knows what it wants i.e. it identifies a goal, it can feel connected to its body by how it can draw from this action-outcome database to tailor make movements. When this schema becomes obsolete during periods of rapid development, e.g. adolescence, so that an unfamiliarity with one’s own body and a blurred distinction between self and non-self ensues. This discrepancy between how I now feel in this new body and what my outdated schema thinks I should feel results in clumsiness and a more malleable bodily self-consciousness until the schema is updated (Raoul et al 2024). But this database encodes bland action-outcome so you know how to immediately respond to a presented stimuli, but with no memory of the past events in which these action-outcome events were derived means this information exists independent of the person. Later in life an ability to, at will, perceive the present moment as a continuation of its own past and prelude as to what might happen in future events, allows causal relationships to be established between stimuli that are not immediately present (Tulving 1985). The evolution and co-existence of these two sense of selfs is essential for reflective awareness and insight (Northoff et al 2006). These two sense of selfs are:

(a) Pre-reflective, experiential minimal sense of Self. This rudimental, affective first-hand awareness of ourself saturating our perceptions, imagination, thinking with a comforting self-familiarity. It is derived from all the separate, rapidly changing, momentary positive/negative, adaptive/maladaptive affective experiences. Being rarely neutral the collective impact from how these individual experiences are summarised allows me to perceive the immediacy of a present moment (Schiller et al 2024). This perception determines how I feel in a taken-for-granted type of way, that is unproblematic by how it lacks the cognitive ability to reflect and articulate what that feeling means to me (Northoff et al 2006). This experience of simply existing moment to moment as not having a past or future that forms supposition as to the world around me, gives a subjective experience of ‘me’ as existing in my body that acts as a lens through which as a subject I expose myself to experiences, actions and thoughts (Tulving 1985). This ‘simply there’ fundamental sense of self-presence gives an implicit self-acquaintance of myself that means I don’t have to explicitly self-reflect to assure myself that I am, for example, from telling my story using first-person pronoun “I” to elicit a sense of pre-reflective self-experience (Piani et al 2024). It remembers only the necessary episodic details needed to respond to immediate events but is unable to reflect on a time or context to derive a fuller autobiographical memory of these episodic details (Tulving 1985), such as from telling my story using third-person pronouns that are objects of reflection distinct from the self e.g. “his” or “her” (Piani et al 2024). Whilst autobiographical details forms complex causal relationships to develop between non-present stimuli and states such as beliefs and values (Tulving 1985) it is our elusive, yet absolute pre-reflective sense of our self-presence, our vital feeling of “I-me-myself”, that gives awareness of this moment, and permeates a sense of ownership over the reflected on past and projected future autobiographical memories (Piani et al 2024) that inform decision-making and behaviour (Schiller et al 2024).

Opening up our pre-reflective lens to experience my self-familiarity derived from experiences, actions and thoughts involves shifting attention away from the reflections of our autobiographical Self that forms presuppositions that serve to constrict this lens to give coherent self-referential meaning to otherwise random sensory information. Widening our pre-reflective lens accommodates the vastness of chaotic sensory information that is unfiltered by self- and non self-referential categorisation to give a reduces sense of reflected upon self. This expanse of information is incomparable to the stereotyped expectations of our narrow core narratives, offering a genuine pre-reflective experience. This pre-reflective experience leaves us in awe so long as the information only violates our core narratives just enough to expand their level of meaning, without transforming or creating new ones (Taylor & Uchida 2019). This euphoric epiphany can be from giving loving attention to nature, art, contemplative practices, and intellectual disciplines (Kähönen 2023). However, lacking structure this first-hand ‘blur’ muddies the distinction between “I” (self) and external objects (non-self) as being independent of myself. Third-hand objectification of the autobiographical Self structures random sensory information to distinguish myself from others by the self-constructed independent narratives they are ascribed. When critical thinking reflects third-hand on the pre-suppositions from these different narratives their usefulness or need for updating, in light of an objectively neutral measure, can be determined. These third-hand reflections from critical thinking should challenge the temptation to embody the first-hand momentary experience of imposing the ritualistic playing out of these coherent self-constructed narratives on to inanimate objects or abstract concepts. Therefore, detaching from a ‘path of least resistance’ first-hand perspective stops us from ‘knowing’ the printer broke deliberately as we can literally ‘feel’ its malicious intent (Schiller et al 2024), or in various anxiety disorders, such as PTSD, whereby being unable to see imagery from traumatic memories as happening third-hand to a past self, causes a first-hand reenactment of the emotional-related imagery in ones mind's eye as to see and literally experience the emotional and physiological sensations (Tomasino et al 2024).

(b) Reflective, autobiographical sense of Self. This third-hand sense of detaching from our first-person perspective and sees ourself as an object. Being self-knowing this object can reflect on the causal relationships between stimuli, object and events that are not necessarily present. This intentional choreography of my conscious experiences, by how I process objective information in relation to myself, gives it a meaning to me. Emotionally colouring bland literal sensory information in this way by selecting goals and actions based on a predicted sensorimotor-affect outcome allows me to mediate a personalised sense of ownership and belonging over this experience. The ownership is over the experience of how I detach from the first-hand experience of my present self to reflect third-hand on the coherent organisation of my past self’s representation of different meanings from individual experiences stored in its database (Schiller et al 2024) to enable my future self to run the theatrical affective-motor simulations needed to activate the necessary affective-motor sequences that predict achieving a specified goal (Hafner et al 2022). However, when an unpredicted outcome of these actions occurs (prediction error), or there is a failure of automatic processing leading to abnormal contents of consciousness, a momentary increase of conscious awareness of this self occurs (Möller et al 2021).

Therefore representations aren’t formed from passively receiving information but by how a developing sensorimotor-affective systems interacts with the world in the very specific physical, social, and broader cultural environments with which the individual interacted, at the specific moment in time the interactive event was encoded (Reggin et al 2023) so what reflects back to the individual is an illusion of neutral-objectivity (Möller et al 2021). But the greater the motor capacities of the individual the broader the interaction with their environment, and the broader the sensory capacities of the individual the more complete this sensory information can be encoded/decoded, so that these literal perceptions of my body and of other objects and agents relative to myself can form a very detailed action-outcome database that can be utilised for immediate effect (Kaup et al 2024).

These sensorimotor-affective capacities for action and the resulting encoding/decoding of sensory information allow the infant to perceive and manipulate external objects that trigger specific emotions, or be taught actions such as language (e.g. saying the word “ball”), whereby the name of the object being manipulated can be mapped alongside the overall experience of its use (e.g. happy experience of using the ball), how it looks and how using it in different ways elicits different responses (e.g. what happens when you throw the ball) (Reggin et al 2023). As these physical objects/movements are not separated from each other, but are intertwined with their affective experiences an accumulated database of these sensorimotor-affective experiences is formed.

Once an internally generated proprioceptive or external real world goal has been identified, this database allows an experience of me projecting myself on to the world by causing or generating actions to obtain a sense of agency. It does this by how in response to specified goals, even without any external stimulation, simulations from our database are triggered that prime/inhibit the relevant sensorimotor representations, and the affective experience with which these behaviours were encoded, so that we can achieve these predetermined goals. These simulations then activate the movement that allows me to project myself on to the world with the sensory end result of these action being compared against that which was predicted by the database (Glenberg 2015). This allows us to comprehend language (e.g. running motor simulations in response to being told how to put up a shelf) without external stimulation (e.g. visually seeing someone put up a shelf, or without any physical gestures by the person delivering the instruction). Even when the attainment of more complex goals of putting up a shelf necessitates the conscious processing of different sensorimotor schema, e.g. using a screwdriver in a novel context, we are still more conscious of our goals (e.g. grasping the screwdriver) rather than the means by which we achieve them (e.g. the smaller sensorimotor schema associated with grasping). Another example of being more conscious of our goals rather than the means by which we achieve them is when the pre-reflective movement of a dancer co-exists with bodily experience. Even though the dancer is conscious of their goal to complete their routine, being lost in the moment so both body and movement is experienced from a first-hand perspective, intuitively (re)acting in the moment, means that their body is no longer perceived as an object from a third-person’s perspective that has to achieves its goal in block like movements (Legrand 2007).

Once in response to an internally generated goal (proprioceptive or otherwise) the agent has learnt to reflexly simulate a specific motor behaviour to achieve a specified goal, our internal cognitive mechanisms are grounded in our sensorimotor-affective systems so that comprehension is possible. For example, comprehending “cooking” implies simulating the motor and sensory aspects from our actual real-world experience of cooking. This experience, obtained at a particular moment in time, will be encoded alongside the cultural norms, physical environment, as well as a specific social context and framework (Reggin et al 2023). In response to a specified goal this stimulus-response learning simulates a literal model of the external world by modulating activity in the primary sensory and motor areas to drive cognition by reconstructing prior experiences that inferred about the cause of sensory input and the consequences of specified actions. Once these simulations recruit the sensory and motor representations by reconstructing the world and our prior experiences this defines our comprehension so there can seem no need to refer to things ‘outside’ the mind (Meteyard et al 2012). The principle unit of knowledge derived from sensorimotor representations are called schemas. These schemas are formed from the low-level integration of a few, or many different sensory modalities overlap to represent the body (structure, action/position, perception, conception, and emotion) and, relative to the body, the reachable space where all motor activities outside of the body that supports its interaction with the environment take place.

The causal connections between sensorimotor system activation drives the context- and task-dependent development of high-level how and why cognitive skills and representations. For instance on hearing what has happened “a man has drunk all…” will run simulations that reconstruct based on past experience of drinking all of a drink. This will drive a picture of an empty glass, rather than a full glass, because based on these simulations “drinking all of something” is how you empty a glass and why a glass would be empty. This is exemplified when someone performs an action and our own motor system mirrors the same action (Glenberg 2015).

These modal systems are the emotional "go" systems that develop before anyother to dominate in our early years. Just thinking about the affective qualities of an object automatically elicits an impulsive or conditioned habitual response that aims to immediately address concrete concerns in the most direct manner. They form the basis of our emotions (including the emotional processing of implicit memory), fears (including traumatic memories) and passions. It learns to respond in an impulsive and reflexive manner to stimuli using inflexible, stereotypical approach or avoidance behaviour. As such it undermines the amodal systems ability to delay immediate self gratification (Metcalfe & Mischel 1999) in order to engage a sophisticated sequences of actions over extended periods of time in a cohesive manner (Schiller et al 2024) by using reason and self-control (Metcalfe & Mischel 1999).

(ii). Amodal systems. In contrast, amodal representations are hashed together from literal sensorimotor and prior experiences. Being more conceptual and existing beyond that which can be perceived by the physical senses means they represent things that aren’t necessarily present, or have never been experienced, making them easier to intuitively know, or philosophise over in our heads than literally explain. This is why, in contrast to more literal sensorimotor black and white representations that are easier to explain, amodal representations vary across individuals, languages, and cultures. They develop around five years of age where a gradual shift starts towards accepting the sacrifice of impulsive sensorimotor short-term goals in order to attain amodal longer-term goals. To do this amodal systems use a temporal lag to weigh up the relative value of short-term reflexive behaviour versus longer-term strategic behaviour that allows them time to deliberate and self-reflect on a vast quantity of complex physical sensory information from indeterminate concepts, including interoceptive experiences. In light of our prior experiences and beliefs amodal systems then gives this literal external physical sensory information (e.g. hearing “you’re a twat”) an internally generated, broad symbolic meaning that defines its relevance and allows only the relevant information to be extracted (e.g. in this context “you’re a twat”=affection) and form the elementary building blocks of our amodal representations (e.g. those that enable us to understand this specific encounter). Whilst lacking external specific real-world content these broader internally generated symbolic meanings have a consistent and singular interpretation so they can be cognitively processed in different amodal representations (e.g. how our understanding from this specific encounter informs representations in other domains) (Meteyard et al 2012). These different representations can then be categorised across the different representations in the higher-level cortical hierarchy (Kaup et al 2024) to allow broader interrelations and connections to develop between different higher-level amodal domains including those that cognitively ruminate on metacognitive insights derived from our confidence in processing such complexity permitting a more varied modelling of the external world and cognition. This serves to foster the conscientious self-control, or willpower (Kruschwitz et al 2024) needed to delay immediate reflexive gratification and monitor the progress in the emotionally neutral anticipation of future needs around situations, events, and emotions and the selection (and inhibition) of longer-term strategic behaviour to fulfil these needs (Metcalfe & Mischel 1999).

Our beliefs concerning the broader symbolic meanings that form the elementary building blocks to how we represent our understanding of complex concepts is derived from (i) our confidence/familiarity in processing these ambivalent concepts, and, (ii) from monitoring the reliability and solidity of our knowledge that provides clarity by ascertaining “why” and “how” certain events are likely to occur (Borghi et al 2022). But regardless in our confidence to do so reducing complex physical sensory information from indeterminate concepts to broader symbolic meanings will inevitable result in discrepancies and disparities that need to be patched by using novel sensory information to form new beliefs which is energetically costly, or, by tapping into more familiar pre-existing knowledge/belief structures (Borghi et al 2022). Once these gaps in our beliefs/knowledge are patched these amodal representations can surmount to knowledge and form further knowledge and beliefs by how they all interact in a kindred web (Helton & Anay 2023). This is exemplified when presented with incomplete physical information, from seeing only one side of a building, or limited physical cues that indicate an individual’s affective state. Whilst what we can see sketches a coherent web of propositions we have to infer, with different levels of confidence, based on prior experience and beliefs, what the hidden sides of the building or the hidden emotions of the person maybe to get a complete picture.

The more open-ended knowledge derived from amodal representations means these symbolic ‘one size fits all’ representations can be recycled across various different domains. Spanning the domains means that just by talking about, thinking about, or imagining a phenomena, even in its absence, can encode and retrieve these amodal representations along side other, broader concepts that shape their overall meaning and give them a greater richness (Pexman et al 2023). For instance, thinking about winning a particular argument can trigger the sensorimotor networks that simulates the experience of how that specific argument was encoded so a personalised meaning, or ‘truth’, can derived from my broader amodal concept of an argument, e.g. a battle superiority that can be transferred across different related amodal domains that define my arguments as a thing to defend or opposing arguments as a thing to demolish. But through self-reflection and confidence in our assertions critical thinking categorises these representations by recycling them further across the different representations in the higher-level cortical hierarchy so they can combine to form more complex representations that in the long-term challenge the boundaries of my truth in areas such as problem-solving, reasoning and action planning (Kaup et al 2024). By hierarchical planning through task decomposition and commonsense reasoning this allows for a greater repertoire of predictions to be inferred when navigating social situations where direct experience maybe lacking. For instance, eclectic information collated from social experiences can be represented in a far broader array of neurocognitive systems, than that which could exist from the limited experience stored in a ‘a social brain’ per se (Pexman et al 2023).

But being non-physical the higher-level richness and truth behind what these personalised meanings of theoretical concepts means to me such as metaphorical word meanings, social concepts, truth, liberty (Pexman et al 2023), beauty (Meteyard et al 2012) and time (Casasanto 2007) can’t be directly perceived through the physical senses. My perception of these open-ended amodal concepts can only come alive and be experienced by how, having been recycled across different higher-level domains, they are then played out so that a symbolic meaning can be given to the sensory experiences derived from playing out these actions. Therefore, my literal truth of abstract concepts, i.e. the different meanings I derive from different higher-level amodal domains, can only be understood, structured and embodied, by the combined re-activation of the sensorimotor networks that originally formed them (Kaup et al 2024). For instance, an amodal representation of love that is recycled across different domains such as mental imagery (Reeder et al 2024) and metaphorical language can be partially structured, understood, visualised and talked about in terms of a familiar sensorimotor frame of reference (highlighted) “love is a journey” or “love can be a difficult path”. This enables us to understand what our truth behind love is by reactivating the sensorimotor traces that yield our mentally simulations of the actions, events and referents (Capuano et al 2022) of journeys and paths with varied difficulties in movement and choices between alternatives paths (Khatin-Zadeh et al 2023).

Amodal representations not only applies to knowledge of internal affective information but also to action. These motor representations plan non-specific, more abstract motor programs, represented as a schema, to broader muscle groups or a limb. Such non-specific schema would have a motor program for writing a signature whether it be in fine text on a document, or when using the whole arm to write the same signature much larger on a blackboard (Kaup et al 2024).

(iii). Multiple modal or multiple representation systems: Rather than a black-and white amodal or sensorimotor representation, multiple representations systems exist along a cortical hierarchical continuum. At the top of cortical hierarchal continuum is higher-level (amodal) representations that use (self)control to coordinate the activation/inhibition at the bottom of the cortical hierarchy in lower-level (sensorimotor) representations (Firth 2023) so that a modal (abstract) concepts evoke sensorimotor (and and interoceptive) experiences (Borghi et al 2022). For example, our perceptions of a dog involves the simultaneously processing of higher-level amodal symbolic components (e.g. self-referential beliefs that encode generic attributes of a dog) that determine, based on the strength of these representations, what lower-level sensorimotor representations are to be activated (e.g. the memories of a particular dog’s muzzle that confers with this higher-order representation) or inhibited (e.g. the memory of its tail that doesn’t). Or, when executing action our initial higher-level amodal long-term planning phase (e.g. I want that pen) coordinates different lower-levels of representations on the cortical gradient that gradually become more specific triggering shorter-term sensorimotor representations that motivates action in the control phase (e.g. based on prior experience what specific motor patterns have to fire/be inhbited to grasp the pen).

What representations are deemed salient and more readily activated depends on degrees of learnt self-relevance and the situational context. Situational context may include acute and long-term stress and negative ideation associated with, for instance, a “if I eat unhealthy I will gain weight” narrative, which by inhibiting the higher-level top-down amodal thinking that should have engaged anticipated future emotions around weight loss lowers self-control and promotes reflex approach/avoidance sensorimotor behaviour in the form of unhealthy eating. In contrast low levels of stress from an alternative “eating healthier will keep me healthy” narrative, promotes higher-level amodal actions that engages future anticipated emotions around weight loss to promote self-control and inhibits reflex sensorimotor behaviour around unhealthy eating (Kruschwitz et al 2024).

This theory proposes knowledge can be represented along a continuum who’s endpoints are from sensorimotor reflexive actions e.g. concerning objects close to an individual’s personal space, or, amodal contemplative actions like language, emotion, introspection or objects outside of an individual’s personal space. But regardless of where these actions are located on this continuum, the self-reflection and metacognitive insights from the awareness of the sensory consequences of these actions are encoded across the broad-domain amodal representations (Metcalfe & Mischel 1999). But to be functional these insights need coherency across the different amodal domains by using cognitive and working-memory to manipulate, and brining into line, shorter-term stimulus-response sensorimotor representations, with overall broader amodal long-term goals (Binney et al 2016).

This system gives a coherency to conceptual knowledge in both verbal and non-verbal domains by a hub and spoke system. The central hub is the bilateral anterior temporal lobe (ATL) that is crucial for general semantic representations, including a knowledge of concrete objects and abstract concepts, and “social” processing such as attribution of mental states, moral cognition and processing of affect. The ‘spokes’ are modality-specific areas, whereby convergence of widespread modality-specific information sources into the middle of this central ATL hub (ventrolateral ATL) is a ‘hotspot’. Having uniformly strong transmodal connections this ‘hotspot’ functions in semantic coding and fusion of modality-specific information for the representation of general conceptual knowledge (Binney et al 2016).

Through causal connections between sensorimotor activation and understanding motor competence in infants develops of cognitive skills. A mastery of motor competence in turn drives new goal-directed behaviour and the development of further cognitive skills, including more abstract skills such as understanding causal situations and mental rotation (Glenberg 2015). These core beliefs start to form in the first two years of life (Martin & Santos 2013), forming the foundations upon which the dynamic interplay between the formation of new beliefs and the refining of old beliefs are built. These founding core beliefs are taken as being red and don’t require justification, they are the unchallenged truth, the inherited socio-cultural and generational beliefs that as the broad elementary principles of our first representations of the world (Danchin 2023) inform the socioaffective and sociocognitive processes that shape infant’s early moral cognition (Kassecker et al 2023). As individuals actively look for information to reinforce these early core beliefs about themselves, others, and what others’ beliefs may be (including their false beliefs) they form the main ideals that drive longstanding behaviour and have a powerful influence on shaping the imagery that from the representations in 73-74% of psychotic patients (Taylor et al 2020). These core beliefs are accompanied with a core knowledge that endows infants with an evolutionary capacity to make sense of the physical and social world but the limits imposed by their core knowledge and beliefs can continue operating automatically into adulthood (Martin & Santos 2013), and can revert when attentional resources are stretched (Spelke & Kinzler 2007). For instance by how our core beliefs form the foundation for other beliefs (Danchin 2023) and how our ability to represent other people’s opposing beliefs as babies continues into adulthood (Martin & Santos 2013).

Representations functions in a social setting: from evolutionary origins to modern day

The neocortex navigates our highly complex cooperative and communicative society by developing an array of sensory input from social behaviours so we can script out how we categorise and learn about others, such as their aggressiveness or trustworthiness (Binney et al 2016). It is the comforting familiarity of these self-defining highly personalised multi-representations that can make the pursuit of them feel like our true purpose, our ultimate life-goal. Detaching from the first-person perspective of our present self allows us to adopt a third-person perspective to derive enhance social competence and reflect (Shiller et al 2024) on how we engage strategies that allow us to live out the beliefs from which we can derive personalised meaning. These strategies can include social strategies such as deception, responding to non-verbal cues (Martin & Santos 2013) or expressing confidence in our expectations and beliefs to put over an air of competency (Firht 2023) and adaptive prosocial interpersonal behaviour such as extraversion, empathy (Dimitrova & Simms 2022) and a verbal scale to align genuine levels of confidence (“sure”, “almost sure”, “not sure”, “very unsure”) as a marker of accuracy when working together. These strategies also facilitate cooperative and communicative interactions, such as the development of language (Martin & Santos 2013) that combines simple and metaphorical grammar so that through extraversion (Dimitrova & Simms 2022) we can experience ourself as our very own autobiographical author crafting our ever evolving life story (Cowan et al 2021). Our sociocultural knowledge of other people’s language allows us to draw on their experience to update the higher-level complex top-down beliefs that try to grasp more complex social expectations about, for instance, someone’s trustworthiness, without having to arduously harvest bottom-up feedback from numerous interactions. These outside influences cementing higher-level top-down beliefs in a way that veer them towards being an absolute truth means any confirmatory or contradictory bottom-up evidence isn’t given the attention it deserves, until it a change in these dogmatic beliefs is is deemed neccessary (Firth 2023).

Language, notably metaphorical language that is concerned with how words relate to each other, rather than how they are able to refer literally to things or feelings, informs complex socio-cultural predictions in high-level cortical beliefs. This is because talking about higher-level beliefs around objects and concepts defines their relevance so we can run simulations through the cortico-striatal networks (Benítez-Burraco et al 2023) by coordinating the switching on and off of relevant lower-level sensorimotor processes that originally formed these higher-level beliefs. For instance the metaphor “grasping an idea”, activates the motor system, which controls grasping, when processing of this metaphor (Khatin-Zadeh et al 2023) allowing a bidirectional transformation of a literal interpretation of physically “grasping” into a symbolic meaning that it can be transferred and manipulated across different domains e.g. “grasping at straws” (Meteyard et al 2012). Projecting to others the symbolic meaning from these higher-order beliefs through metaphorical language in order to make unfamiliar events seem relevant to us results in us assuming things have purpose or direction even when they don’t as seen in victim sensitivity (Maltese et al 2016) (refer ‘encoding representations’). The inherent nature of this process is reflected by the development of these cortico-striatal networks allows for better control of primitive lower-level reactive aggression by the evolutionary developed higher cortical structures (Benítez-Burraco et al 2023) for the strategic pursuit of living out these high-order beliefs from which we can derive a personalised meaning (Veglia & Fini 2017).

My memories of my truth: an anchor to me and my place in the world

Establishing a stability in a coherent narrative, by linking present experiences to the remembered past self and the imagined future self (Cowan et al 2021) provides a rich network of knowledge regarding our self-awareness of our personal relevance and emotional values. This knowledge derived from our current, that is part formed from our prior, self-awareness allows us to self-referentially encode real world bottom-up information by manipulating it so that it anchors us with a sense of unity and purpose to ‘my place in the world’. This establishes a sense of ‘in-group/out-group identity’, a place to which a sense belonging gives us a locus of control (Wang et al 2021) for the self-recognition needed to remember and reflect on experiences with a security and comfort derived from how they’re my memories that belong to me (Ross et al 2019). An explicit abstract ownership and meaning to these otherwise bland memories colours them with a self-referential richness characterised by meaning, purpose, and continuity (Cowan et al 2021). This allows more of them to be remembered when they map out self-relevant goal driven behaviour (Ross et al 2019) whilst, at the same time, allowing us to connect to the broader world to give a spiritual sense of meaning and purpose (Hayden et al 2023).

Our beliefs determine not just how bland sensory information is self-referentially experienced and encoded, but also by how it is self-referentially modified when recalling this information as an autobiographical memory. This enables a greater volume of, and a greater descriptive detail to be provided to autobiographical memories (Ross et al 2019) that are embedded in a broader narrative that creates shared meaningful associations between our awareness, thoughts, and beliefs of these memories. This broader narrative is formed by how all our beliefs interconnect to exist in a continuity in order to engender a self-confidence and guidance that serves to reduce guessing, whilst, at the same time, offering enough variation so that novel experiences from one belief can ‘whittle down’ and update other beliefs (Fisher & Hohwy 2024).

Creating an embodied sense of ownership over these autobiographical memories that form our representations (Cowan et al 2021) allows them to represent an extension of our individual self (Wang et al 2021). This awareness of ourself as a multifaceted entity engenders coherence in: (i) self-recognition, (ii) body awareness, (iii) sense of ownership, (iv) sense of agency, (v) self and other differentiation, (vi) awareness of other minds, (vii) awareness of being the same person across the time (Benítez-Burraco et al 2023). By forming stable and integrated representations of the self and others (Dimitrova & Simms 2022) it motivates us to deploy greater cognitive resources to achieve a better coupling between attention, memory, and decision-making (Wang et al 2021) when seeking out opportunities for self-evidencing. Foraging for information to this end feeds growth in the well-informed, self-descriptive representations that offer a greater sense of self-knowledge (Ross et al 2019) in order to help gain a sense of belonging to an ideological coherence of beliefs within a social network (Fisher & Hohwy 2024). That is why, to not be traumatic, outcomes of events must fall within acceptable expectational parameters in order to maintain a sense of orderliness, comprehensibility, and predictability (Veselis 2018), unless of course, the outcome is better than expected (Spee et al 2022). This why critical thinking by challenging our self-limiting values informs the ‘best guess’ navigational decisions when projecting into the the future to plan future goals (Cowan et al 2021).

An example of this is a runner who solely trains at race pace on the route they are to race on. This enables the individual, when determining what pace to run at, to form, from memories of past and present runs, a clear coherent self-representation of themselves relative to their environment e.g. “how will I feel at different mile markers”. Expressing these memories to others strengthen the anchor to which memories are self-referentially attached meaning that any outside contradicting information (e.g. “that pace is too fast for you”) may inform, but not unduly sway their original plan as to what is the correct pace to run at. When, during the race, their high confidence in making ‘best guesses’ as to what their expected levels of fatigue will be at different markers comes to fruition, even more confidence is placed in these self-representations dominated by positive autobiographical stories narrated by the self as an active participant in ensuring the race is unfolding inline with their prior expectations.

This can be in contrast to someone else, who whilst being physiologically superior from higher-tech training, has never left the gym and gone for a run. Therefore, during the race, they have no confidence in their incoherent unstable and disintegrated representations of themselves running the course e.g. whilst they may have a theoretical literal truth that predicts a certain pace will ensure the race will unfold in a certain way, through lack of experience they can’t translate this literal truth into a self-referential language that can be represented in a way that means anything to them. Offering no sense of agency and self-direction as to what will happen as a consequence of them continuing the race, these ill-advised mental representations have to be quickly updated by giving more weight to sensory information hashed together through the lens of worry and rumination, focusing on, for instance, fatigue and distance to go. Therefore, whilst being physiologically superior to the person from the previous example, their ill-conceived mental representations are dominated by negative autobiographical stories that characterises the self as a passive participant with no choice but to accept the narrative as a fixed trait that can’t be challenged. In such a story a sense of agency can only be regained by defensive or self‐sabotaging behaviours (Cook & Artino et al 2016) resulting in an inferior performance.

Challenging representations with critical thinking

However, this self-limiting perspective restricts how far we can see beyond how our representations define what our reality means to us means we have to question our dogmatic modelling of the beliefs that forms our representations. Questioning the dogmatic construction and self-amplifications of these beliefs that motivates us, upon first impression of objectively neutral sensory information, to bend it to the expectations of these biased beliefs (Scheffer et al 2024) makes us beholden to reality by using critical thinking to ask “if our reality is right, how can contradicting phenomena exist in the real world that says it’s wrong?” (Danchin 2023). This illumination of contradictions that says “the world is not what we thought it was and we need a different strategy” should, in context, serve to update our representations.

How do we determine what action elicits the confirmatory or contradictory information to say in what way our representations are right or wrong? Under low stress conditions an optimism bias should naturally exist whereby the beliefs that make up our representations are self-validated with positive information. This encourages us to see the world through the lens of our individualised representational beliefs so we execute actions in-line with these beliefs. The need to selectively experience sensory information from these actions initially profligates these beliefs of how we are altering real world events, but then, slowly these beliefs get whittled down by (i) accumulated conflicting evidence, and, (ii) how the need to preserve higher valued conflicting beliefs coincidentally destabilises interconnected lower valued beliefs (Fisher & Hohwy 2024).

So even under healthy conditions seeing things ‘our’ way with normal representational biases fails to explain how a contradicting phenomena came to pass. But by unwinding the coherently orchestrated web of self-justifying beliefs, that constructs the elementary principles of our representations, all the way back to the originating conjectured core beliefs a genuine attempt can be made to push the limitations of our fundamental understanding of reality to comprehend the presence of contradictory phenomena. The power of repeatedly combing through this coherent web of beliefs to iron out the originating unchallenged core beliefs, builds new representations with as few and as simpler elementary principles as possible to create an ever finer understanding of the world that increasingly understands contradicting phenomena. This avoids mistaking ‘our abstract truth’ for ‘the truth’ and paratising some vision of the future justified by a shallow incoherent mimicry (Danchin 2023). Such entrenched dichotomized beliefs around absolute beliefs or disbeliefs can only operate in a controlled environment as the use of minimal cognitive resources with little perceived evidence doesn’t suit real world ambiguity (Scheffer et al 2024). Conversely, more nuanced people can entertain a wider range of sensory evidence to update beliefs as they are more tolerant to real world ambiguity and require more perceived evidence for a slower change in strength of beliefs (Fisher & Hohwy 2024).

Representations: mapping our path through life

As a self-conscious multifaceted concept representations are formed by interacting with the world and seeing it as a mirror that we can look at ourself in. This interaction with the world involves shifting between egocentric stances, whereby other people are represented in relation to our self-perceptions (“you”), and allocentric stances whereby other people, with their independent beliefs and emotions, are represented separately from our self-perceptions (“he/she/they”) (Benítez-Burraco et al 2023). This self-reflection serves to interprets what the meaning behind the actual, or anticipated information is, allowing our representations to then try to predict what events lead to this information being produced in the first place and then anticipates what the consequence of our actions will when we respond to this information in a purposeful manner. The predicted consequences of our actions forms interconnected beliefs about the relative value of goal-directed actions so that only actions that are appropriate to the task are selected and all others are inhibited. This can be seen when playing hide and seek whereby confidence in predicting the consequences of an action to achieve a goal (i.e. finding the person hiding) is valued based on (i) low-level beliefs about ourselves by asking “where would I hide. Behind the tree or a wall?”, (ii) high-level beliefs about others’ by asking “where would they hide. Behind the tree or the wall” and (iii) highest-level beliefs about how good are they at playing the game by asking “how will they change their tactics in response to my previous actions?” (Firth 2023)

Therefore, akin to a map our representations reflect affective and physiological information that appraises where we are, how we got there and where we can head to seek out the relevant resources for psychophysiological balance. However, this map is not a A-Z but one drawn from memory that remembers, and infers, in different locations our past emotional experiences and desired future states, as well as offering the ‘best guess’ geographical predictions that needs external ‘real world’ sensory feedback (from, in this example, looking for landmarks). This allows us, in-synch with the experience of our own body as being safe by trusting our self-regulatory mechanisms and bodily sensations (interoceptive sensibility), to update our map in order to make both new geographical predictions and, at the same time, gauge our effectiveness in doing this by constantly regulating and anticipating the future needs and challenges in our environment (allostasis) (Galves-Pol et al 2021). But the (re)construction of the memories that make this map is malleable, especially when done repeatedly and when these memories are being used to simulate novel events, make the memories of events differ from that what actually occurred during the event (e.g. overthinking when trying to find a street so you focus in on familiar landmarks so that it blurs overall geographical awareness).

A collection of these tainted memories produces a ‘loosely based on a true events’ narration of the story that is our ‘conceptual self’ (Veselis 2018). The conceptual self tells the story of the experience of our unique self-identity, the stability provided by our self-esteem that maintains a consistent enough level of perceived true self-worth relative to others as to guide self-appraisal relative to an event, and guides self-direction and self-reflection in the pursuit of coherent and meaningful goals. This ability to step back and effectively derive specific meaning from a story that ties together how the individual sees the past, present and future “who I am, who you are, what’s my worth, how I am doing and what I aiming for” (Dimitrova & Simms 2022) clings on to the belief that these tainted memories paint of a life that is orderly, comprehensible, structured and predictable (Fisher & Hohwy 2024). Therefore, these maps that form our representations must:

(i) Form a structural representation of our inner and outer world that encompasses the basic ways by which we differentiate ourself from others. This representations of the ‘interpersonal self’ results from the nature of our social interactions that are defined by how we relate to our own, and others beliefs and emotions (Benítez-Burraco et al 2023) and is akin to a tube map. A tube map’s goal is to provide just enough “where am I” and “how do I get to where I’m going information”, without overwhelming the individual with every detail of the underground (e.g. depth of the station, proportionate distance between the stations). To this end representations provide the essentials to provide the best guess probability of us reaching our destination by anticipating outer world variables (e.g. closed tube stations), inner world variables (e.g. our navigational strengths and weaknesses), and the interpersonal variables (e.g. assessing someones approachablity when asking for help) (Gladziejewski 2015).

(ii) Be adaptive so that representations can be challenged by seeing if what they predict comes true does. Looking up from the map to gather anticipated, or ‘real world’ sensory information provides feedback to navigational decisions so corrections can be made as outdated maps can lead us astray (Gladziejewski 2015).

(iii) Direct interactions with representations can be detached to guide cognitive actions. Sitting at home with a map planning a journey, making future predictions by learning the layout and formulating metaphorical autobiographical concepts using simulations and imagery (Gladziejewski 2015). Although we typically experience the world from our own eyes, when we retrieve autobiographical memories we can flexibly shift our first person viewpoint from inside to outside the body, seeing ourselves in the memory. However, retrieving autobiographical memories that were never experienced engages a reconstructive processes that reshapes memories that whilst may lead to literal inaccuracies in the representations they form (St Jacques et al 2018) can be symbolically or metaphorically of value.

Therefore, using representations to construct our reasoning to random sensory information enriches this bland information, such as, for instance, in the face of a joke, without a compatible top-down narrative with the nature of the joke, it would be perceived literally as piece of sensory information. This would result in us either taking the joke literally, or have us scrambling at a cross roads trying to determine whether we are the type of person that perceives the joke as funny or offensive. A perceived defect in the ability of our representations to navigate us in an environment, i.e. by being unable to predict how we operate and how our actions will impact the environment, can lead to feelings of insecurity, uncertainty and unpredictability. This results in an excessive reliance on gathering sensory information to regain certainty and control (Farfan et al 2020 & Teng et al 2016) e.g. feelings of incompatibility with a joke, or within an environment that the joke was told, can lead to excessive gathering for cues, that, for instance, cement a predetermined notion that the joke was funny or unfunny, in order to ascertain some level of control within this alien environment.

Updating representations through self-abandonment: opportunity or disaster?

New beliefs that form self-explanatory representations of ourselves and the world have to, on the one hand, diversify from our prior (pre-existing) beliefs so we grow and don’t make the same mistakes, but yet on the other hand maintain congruency with these prior beliefs so we don’t render our old beliefs obsolete and lose a sense of who we are (Veselis 2018). For this to occur our old ‘prior’ models and beliefs and our new updated models and beliefs, to be functional, must exist between two opposites poles: (i) overly precise prior models, with well-defined highly precise expectations. These models self-referentially encode and personalise sensory information in a very predictable, unquestioning, run on the mill way. Forcing sensory information into a very well defined, unyielding box means it is processed in a very predictable, tedious way so we stay steadfast to our same old behaviour in the face of randomly occurring events. This yields a relative insensitivity of the current experience and a reaffirmation of prior expectations and beliefs; and (ii) very vague prior models with very fuzzy ill-defined expectations. These priors lack the clarity to form the belief systems that map out how we self-referentially encode bland current sensory information into autobiographical memories. Normally these autobiographical memories, formed from how current sensory input intertwines into the previous memories and beliefs that form our priors, should form a clear narrative into which sensory information is processed. This narrative is our story with any run of the mill, predictable sensory information that falls in line with this story being ignored in our subconsciousness, and in turn any surprising novel twists to this story in the form of unpredictable sensory input being flagged up to our consciousness. Therefore, an ill-defined story with no clarity to any prior knowledge or beliefs over what we can expect from ourselves and our environment means that none of the sensory information can fall in line with this story making it all unpredictable, novel and warranting our valued attention. In a safe space of learning this lack of clarity is represented as holes in our prior models that can be patched by bringing highly valued positive sensory input to our attention to give a sense of growth through learning, but, in less safe spaces trying to patch these holes in our prior models with negative sensory overload can be disorientating, overwhelming and, ultimately unsuccessful (Spee et al 2022).

In a perceived safe predictable setting, with positive prior expectations about ourself and others, we are natural optimists being more inclined to integrate better-than-expected good news into our prior expectations and, consequently, less inclined to be pessimistic by integrating worse-than-expected information. This helps maintain positive beliefs around self-efficacy, positive emotions, reduced stress and sense of agency. This positive perspective motivates the individual to comfortably break away from prior preconceptions, and through information gathering, learn at a moderate pace to not only work out boundaries, but the interaction of variables within them boundaries with the aim of exploring new and novel possibilities.

However, in a perceived unsafe, unpredictable settings, worry and rumination form negative prior expectations that centre around top-down predictions anticipating worst case scenarios. In response to these predicted catastrophic scenarios strategies have to be executed to regulate the emotional impact from the individual’s repeated failings in the external world (i.e. falling short of an objective measure) and in their internal world (i.e. failing to establish homeostatic balance in the nervous system). The cost value of this emotional impact means individuals are less optimistic, seeking more balanced (symmetrical) information in the form of good and bad news, to quench the anxious uncertainty generated by these prior expectations. From here two strategies can be employed to regain a sense of control and self-efficacy (Beron et al 2024) to foster a unified sense of self (Liesner & Kunde 2021): (i) executing a self-fulfilling prophesy that seeks reassurance through the reception of good news. As a strategy this deliberately aims to temporarily lower self-efficacy and increase stress in order to not only avoid complacency (Beron et al 2024) by perpetuating the worry cycle (Teng 2016), but executes actions that facilitates greater levels of relief when more optimistic and desirable information is received (Beron et al 2024) e.g. fishing for a compliment; and (ii) executing a self-fulfilling prophesy that seeks reassurance through correctly predicting the reception of bad news. This strategy actively suppresses any contradicting prediction errors, from optimistic or desirable information, to again lower self-efficacy and increase stress in order to avoid complacency (Beron et al 2024) by perpetuating the worry cycle (Teng 2016), and also, ensures the bad news being experienced is within the confines of the safe, predictable boundaries that was always predicted (Bohlen et al 2021) e.g. self-sabotaging behaviour.

Therefore, unlike, in safe environments that promotes the breaking away from prior preconceptions to explore the new and exciting possibilities, unsafe environments places excessive weight on absorbing emotional impact through the use of rigid and inflexible tried and tested pre-mediated strategies. These unyielding non-specfic top-down strategies refuse to be updated by specific contradicting bottom-up sensory information that represent real-world contextual fluidity (Paulus et al 2019). This compulsive need to obtain certainty, and avoid uncertainty, over future events means this process, despite its negative impact and punishing emotions, can actually be valued as an effective problem solving tool (Teng et al 2016). However, the manipulation of bottom-up sensory information just to experience the comforting familiarity of playing out these top-down anxiety quenching self-fulfilling prophesies has a two fold effect:

(i). As learning rates increase in volatile environments (Beron et al 2024), including the learning of the perceived value of these maladaptive strategies, the individual can imprison themselves in a self-sustaining loop that constantly anticipates what this worry and ruminative style of top-down thinking predicts (Di Lernia et al 2016). This is seen in Generalised Anxiety Disorder, where a high value on hypervigilant threat appraisal and negative thoughts about an up-coming event (White et al 2016) leads individuals into believing that catastrophic worrying can actually be helpful in obtaining certainty and resolving their problems (Hirsch et al 2019).

(ii). It lowers interoceptive accuracy. The absolute need to preserve top-down anxiety-riddled dysfunctional beliefs, with their autonomic hyperarousal increasing allostatic loads, can be accomplished by lowering interoceptive accuracy. Actively suppressing any less threatening, optimistic interoceptive bottom-up information that would otherwise challenge these dysfunctional top-down beliefs preserves this blurred reality. Ultimately this leads to a loss of self-confidence (White et al 2016) as when interoceptive accuracy can’t be lowered enough to preserve these dysfunctional beliefs, the unpleasant and uncomfortable experience from the overwhelming prediction error triggers anxiety, worry, threat appraisal and inappropriate approach or avoidance behaviours (Paulus & Stein 2006).

The byproduct of lowering interoceptive accuracy to this end is that individuals become unable to differentiate between, for example, surprise and fear, cardiac or gastric activity and disgust, increased heart rate and anger, temperature or fear, increased heart rate and blood pressure (Brewer et al 2021). They attribute benign bodily sensations to pathology, by, for example, confusing harmless sensations and pain (Bohlen et al 2021) and possess difficulties recognising cues related to feeling hungry or full contributing to eating disorders (Brewer et al 2021). In advanced cases when strategies to lower interoceptive accuracy are deemed inadequate, and the sensory input is that overwhelming, a complete avoidance of all perceived triggers has to be employed, as in the case of agoraphobia (Paulus et al 2019).

Representations and predicting neural input and driving neural output

Once internally construed representation from the cortical hierarchy interprets interoceptive information by inferring (or predicting), the most likely cause (posterior) of these incoming sensory signals (Gladziejewski 2015) it drives down these top-down predictions to resolve, or suppress, any mismatch in conflicting bottom-up interoceptive information that contradicts this prediction (prediction errors) (Seth & Tsakiris 2018) and instigate the appropriate motor and autonomic responses based on their predicted outcome. For example, (subconsciously): bottom-up interoceptive data: low blood sugar; mental representation of interoceptive data: “I feel hungry, it’s probably because my blood sugar is low”; autonomic response based on mental representation: “I predict if I elicit x physiological response I will no longer feel hungry”.

In this example a representations in lower-level priors, that act at lower levels of consciousness, automatically acts in a manner drawing on fairly concrete prior experience e.g. interpreting low level hunger signals and instigating that can be resolved by instigating the appropriate physiological response. However when a discrepancy exists between what these top-down lower-level representations predicted was going to happen (“x physiological response should elevate blood sugar as not to feel hungry anymore”), and the ascending data that signals what really is happening (“but I’m still hungry”) leads to a prediction error (Joshi et al 2021). When these prediction errors aren’t suppressed or can’t be resolved they are deemed newsworthy and gets flagged up as a ‘wake-up call’ so that “I’m hungry I must eat something” gets transferred up the cortical hierarchy to representations in higher-level priors that predict eating something will cease feeling hungry. However, these representations centre around ourself, and at the highest level of cognitive processing are our representations in the higher levels of consciousness that consider other people and our environment. Using these high-order representations to achieve our goals involves scratching together knowledge of both ourself and others when utilising reasoning, language, planning, and decision making that juggle more complex variables than the more concrete ones in our lower-order representations, for instance when trying to predict whether, or how, it would be socially acceptable to eat during a meeting. To try and predict, and instigate the correct response based on these predictions these higher-level representations have to receives information from low-level processes in order to ascertain a level of confidence it one process relative to another, and from this feedback decide how these lower-level systems are to be coordinated by directly controlling the activation of some low-level processes by altering their function (e.g. fine tuning the daintiness of nibbling a biscuit during a meeting) and inhibiting others (that would scoff a bowl of pasta) (Firth 2023).

Attending to the sheer quantity of sensory input, including prediction errors, and formulating action plans in higher-level representations over a 24 hour day our is an arduous task. To make this process more energy efficient we have to select what sensory input gets flagged up the cortical hierarchy so our higher-level representations, through repeated practice, can memorise how to habitually fire the appropriate low-level action process that develop preferential, intuitive, inflexible behaviour that is difficult to dislodge (Firth 2023). For energy efficient homeostatic and social functioning these healthy intuitive and inflexible behaviours are dependent on good sensory (including interoceptive) awareness (Baltazar et al 2021) and adaptive open-minded representations that are inquisitive to any prediction errors that contradicts them. However, the more the memories, of how a sensory stimulus to a higher-order representation habitually fires/inhibits certain low-level action representations are (re)constructed, the more these self-referentially encoded memories drift away from their original efficient action behaviour and towards more familiar prior socio-cultural beliefs and knowledge to encourage maladaptive behaviour (Firth 2023). Therefore, by being mindful, non-judgmental and open-minded we can accept prediction errors seeing them as wake up calls that challenge and update the socio-cultural beliefs that characterise our representations.

In order to maintain stable and integrated representations that form our perceptions we employ strategies that shift weight to either our prior expectations and predictions (top-down priors), or, to any anticipated, or actual, raw untainted incoming sensory information (bottom-up information). This shifting of weight defines to what degree we tip the scales in favour of either (i) our top-down prior expectations, in order to give a point of reference so that we can measure in what way the sensory information has successfully, or unsuccessfully, met out prior expectations and predictions, or, (ii) raw, untainted bottom-up sensory information (Reeder et al 2024). For instance, in the example above, healthy strategies can be employed when hungry to shift weight towards healthy top-down expectations that predict a sensible quantity of food can achieve perceived satiety in order to explain away prediction errors generated from the bottom-up sights and smells from food that would tempt the individual to over-indulge. However, in cases when you don’t know whether you’re going to eat later, healthy strategies can be employed again, but by this time shifting more weight to bottom-up sensory information that perceives how hungry you are, and what you can ascertain about your environment to help update the top-down models that try to predict when you will get a chance to eat later or not. Therefore, whether functional, or dysfunctional, our perceptions are shaped by the degree to which we tilt the scales to favour maintaining the top-down internally generated comforting predictability of our status quo, or to what degree we favour exposing ourselves to bottom-up external information that can generate novelty and unpredictability.

This makes the recurrent counter-stream of ‘best guess’ predictions from our representations being confirmed or denied by anticipated or ‘real world’ feedback in a cyclic closed-loop a highly personal and subjective experience. It forges an understanding of how our prior expectations integrates our interpreted past, present and projected future experiences, reflects the level of coherence (Dimitrova & Simms 2022) in our unique self-awareness and our subjective experience of being present in the here and now (Ciaunica et al 2019).

Interoception and sense of self

Some perceptual effects of motor activities are “public”; motor control of the eye enables you to perceive more or less, the same sensory event as anyone else looking at the same thing. However, interoceptive stimuli is more private, it is unique to only me, no one can else can experience and rationalise my interoceptive stimuli; it involves how I alone can control and feel sensory, interoceptive, stimuli that arise from my body and is apparent only to me; this engenders a sense of ownership that ‘my body belongs to me’ ensuring stability and unity, anchoring oneself in an ever changing, public, external environment (Tsakiris 2017). This sense of how I inhabit my body and my interpretations of the world in belonging to a practical, purposive place with possibilities that I am entwined and embodied with (“that is so me”) is different from seeing things in a purely object-type way. This embodiment of ourselves and ourselves in the world is why it is the interaction of our interoceptive and exteroceptive senses that has a substantial impact on shaping our sense of self (Ciaunica et al 2019).

Our self consciousness coordinates and integrates divergent information from:

• Sense of agency: a robust, slowly learnt (Ishikawa et al 2021) experience of control, that based on my context, my knowledge and beliefs that form my judgements and intentions that I am the author, and can predict the consequences of, my own actions. It is therefore dependent on top-down predictions being confirmed by bottom-up information derived from either motor actions or social or environmental cues (Braun et al 2018).

• Sense of ownership: a quickly learnt, adaptable (Ishikawa et al 2021) feeling, largely dependent on integrating bottom-up information such as visual or somatosensory inputs (Braun et al 2018), as proprioceptive signals stem from ones own body as an innate self-reference of where ‘my’ body is in space, an integration of proprioceptive signals can also promote a sense of body ownership (Liesner & Kunde 2021). This allows us to relate to, and understand, the first-hand narrative that integrates diverse experiences into a single awareness (Dorhary et a 2021) creating a sense of belonging, being grounded (Wang et al 2021) in the familiarity of being ‘me’. This awareness represents the brain’s attempt to make sense of reality, integrating tightly bound bottom-up information, to create a caricature that represents an embodied ownership over an external object, our body parts, personality, qualities, values and the characteristic ways we engage with ourselves and others. This constructed caricature also gives ownership over an illusional continuous identity by forming a conveniently cracked lens through which the ‘present me’ can see a persistent identity with the ‘past me’ and ‘future me’ (Dorhary et a 2021).

This integration by the self-consciousness makes the brain believe these events have occurred in the same time-line and have a causal relationship in order to minimise uncertainty (Ishikawa et al 2021) so we can intertwine ourselves with the experience of how we completed an intended action within our environment (agency) and embodied this experience (ownership) to develop the ‘minimal self’ (Forch & Hamker 2021, Riva 2008).

The minimal self is the most fundamental embodied experience an individual has of belonging to their own body, their sense of self, the intrinsic unity between their self-consciousness and the world to which they merge with and become rooted in; it forms the most basic experience of being a subject of a given experience. It is not a grandiose third person awareness of oneself as an object, or a conscious evaluation that labels ones experiences. It is a first person perspective that contains only the minimum to experience the core of ‘what-it’s-like-for-me’ feeling. This feeling defines how the individual, as an unseen point of origin, intends to broadly orientate themselves towards the world, framing how they interact with their environment so this internal feeling of individual identity can externally manifest itself; how this manifestation materialises enables the individual to become self-acquainted so they can foster predictions about the meaning of being ‘me’ (Klar & Northoff 2021), and integrate sensory information and mental representations to reduce prediction errors about the sensory consequences of volitional actions (Ishikawa et al 2021) and the likely causes of sensory signals (Ciaunica & Crucianelli 2019).

Interpreting and trying to infer what these afferent nerve signals mean to us as individuals is unavoidably burdened with prediction and uncertainty. For example, we can interoceptively sense, and objectively measure, an increase heart rate but how do we interpret what that means? Is it determination? Excitement? A sense of challenge? Fear or threat? Biologically a challenge response is characterised by increased cardiac output and a decrease total peripheral resistance, and in contrast, a threat response is characterised by no change or a small increase in cardiac output and no change or an increase in total peripheral resistance (Uphill et al 2019); however, our brain, receiving this interoceptive information as nerve signals, not as descriptive biological text, has to interpret, predict and infer what the cause of this interoceptive information is if it is to define what it means to us, and then elicit the appropriate motor or autonomic responses based on our own prior experiences. This is why, through the evolutionary enhancement of the connectivity between cortico-striatal networks accommodated simple grammar with metaphorical language (Benítez-Burraco et al 2023), we rely on our own unique interpretation of autobiographical metaphors to identify how we feel “I got butterflies in my stomach” or “I feel a bit off” as opposed to relating to how we feel in purely detached biological terms.

These bottom-up afferent interoceptive signals should ascend the nervous system informing each level, or hierarchy, as to what’s happening in the body. In this ‘raw’ untainted form interoceptive signals are accepted, without prejudice or bias, so they can be appraised in a less sensitive and more open-minded inquisitive nature. This flexible mindset allows any bottom-up sensory data, that conflicts with what we predicted it was going to be, to challenge and mould our perceptions. This bringing together of (i) our representations, our perceptions of what we have learnt from prior experience to be the ‘truth’ and constructs our predictions that anticipate what the bottom-up interoceptive data is going to be, and (ii) what the raw, untainted, interoceptive data actually is, leads to a greater understanding and ownership of ones own body. This ‘bringing together’ process, closing the discrepancy between what we predicted to feel and what is truly felt, by changing our mental representations to fir the interoceptive data, is called ‘reducing the prediction error’.

Closing the prediction error doesn’t just occur by changing our mental representations to match the interoceptive data, we can also, selectively change the interoceptive data to match our mental representations, whilst, placing an excessive value on sensory data that reinforces the values that define our mental representations; this allows us to perceive the world (and self) not as it is, but as it is useful to do so (Seth & Tskaris 2018). Allowing our prejudices and biases, especially those cemented through worry and rumination, to rigidly contextualises the prior experiences that form our mental representations skewers, to varying degrees, our perspectives and self-awareness of our interoceptive input to lower interoceptive awareness. Therefore, it is the strength of our prejudices and biases, in what direction we turn our attention and where the blindspots in our imagination are, that dictates our need to maintain a sense of control and certainty in light of challenging or contradicting interoceptive data (Lim et al 2020). Actively engaging in this self-fulling prophesy of changing interoceptive data (active inference) reduces the prediction error by forming a convenient justification for the values of the prior experiences that form our ‘truth’, our mental representations (perceptual inference). *: refer to ‘generative models of predictive coding’.

Prior precision refers to the confidence we have in the top-down prior expectations that form the representations by which we measure, or fail to measure bottom-up sensory information against. These prior expectations can be precise, offering confidence in their predicitions, or imprecise so we feel we are just guessing, strong or weak, and flexible or inflexible depending on the situation we find ourselves in. For example, you should have precise prior expectations for a friend’s face so you can recognise them. However, if you know your friend has shaved their beard your prior expectations of what they will look like should become less precise and more flexible so that you can measure any visual information against these ‘looser’ expectations of their appearance. Alternatively, when detecting a stimulus that does not change identity, but, can appear at different contrasts having a precise, inflexible, and narrow prior expectations for that stimulus can be beneficial, for example, looking at a friends face from an angle that makes them unrecognisable (change in contrast), means you might miss them unless you stay steadfast to the characteristic features that you have modelled as being indicative of them (precise, inflexible narrow priors resistant to being updated by a change in contrast). Therefore, the mental representations of ourselves and the world become maladaptive when they become unresponsive to sensory information that highlights the anomalies, that should, in any given context, update our prior beliefs and expectations (Reeder et al 2024).

Commonly, however a combination of these processes occurs to reduce the prediction error, some contradicting interoceptive data tweaks our mental representations (increasing interoceptive awareness), whilst other contradicting interoceptive data gets suppressed or explained away (decreasing interoceptive awareness). Reducing the prediction error so we feel how our self-consciousness provides a sense of predictability and ownership, characterised by performing an action, correctly predicting the outcome of that action and embodying the experience so we feel intertwined with it (Riva 2018) allows us to feel fully immersed and present (Riva 2018) and in touch with ourselves and the world (Ciaunica et al 2021). This fosters a sense of control (Lim et al 2020) that maximises the evidence for self existence (Ciaunica et al 2019) as the prediction error diminishes by the interoceptive data confirming our mental representations, and, symbiotically, our mental representations confirming the interoceptive data so they become intertwined leaving no doubt that we can shape our own narrative. This is why, when a prediction error does occur, characterised by something unexpected happening, individuals feel amiss or disconnected from their bodies (Ciaunica et al 2021), e.g. strolling along without a care in the world, correctly predicting where your feet will land, and then unexpectedly stumbling.

Underpinning all this is how our perceptual experiences, that are dependent on our interactions with others and the environment (Ciaunica et al 2021), defines our logic in constructing tests that measures the consequences of our actions that should reinforce adaptive, and challenge maladaptive thought processes (Lim et al 2020) so that we interact with the world in a way to find out more about ourselves. This determines in what direction we grow and evolve,"stultus est sicut stultus facit”, being equally as applicable to exteroceptive and proprioceptive signals,

For instance, when biasing pain perception catastrophisers become easily overwhelmed by uncertainty, anxiously anticipating, and being hypersensitive to the threat of pain. Through worry and rumination they dwell on repetitive, fearful, negative, unhelpful thoughts making it logical to pre-empt the certainty of catastrophic consequences by fostering a hypervigilent inflexible mental representation of their pain, their condition and level of disability; these representations are not prepared to bend to any information that challenges them (prediction errors) in an attempt to regain control and forge a path to safety; blinkered to the rewards associated with finding more open minded, challenging, novel solutions and preferring safer, more predictable, familiar, behaviours that appeal to preferential biases and ideals (Brewer et al 2021) results in an ‘unmoderated, predetermined hypersensitive-to-warning-signs’ mental representation of pain that predicts an unyielding imaginary level of threat (Lim et al 2020) or pain during a particular movement; “just the thought of touching it sends pain through me”. A logical appraisal after the event can be just as inflexible by failing to fully appreciate the maladaptive nature of their response and in turn reinforce learned associations that underpin habitual actions (Lim et al 2020).

Therefore, our mental representation informs how we choose a motor activity based on what we predict we will feel, and process, as a consequence of that motor activity. This interpretation of events is unique to us and reaffirms an awareness of ownership when the predicted sensory consequences of a motor activity matches the actual sensory consequences (Tsakiris 2017). This predictability makes these actions feel more self-generated and intended (Blakemore et al 2000), as they are highly anticipated so the individual is ready for them, being less distracted and focused on the sensory consequences of the upcoming event (van Kemenade et al 2016). For instance, how we lower our heart rate, predict what we will ‘feel’ as a consequence of actively lowering our heart rate, and actually ‘feel’ what we predicted we would fosters a greater sense of unity, stability and ownership, than someone else objectively measuring our heart rate and telling us we’re relaxed because our heart rate just happens to be low.

Generative (predictive) models of predictive coding

Generative models: perceptual inference and active inference

We are constantly generating representations to predict future states of the external world and our internal world. The knowledge in these representations used for making predictions exist at different levels within this hierarchy. Knowledge stored at higher-level representations is abstract containing no specific features, but moving downward to the other end of the hierarchy, knowledge in lower-level representations become increasingly more specific (Kaup et al 2024). Therefore, this ‘generative model’ by constructing representations explains, or infer, what gave rise to the sensory inputs it receives. In this process, each level of the processing hierarchy receives bottom-up sensory input from the level below and top-down predicted guesses from the level above; the bottom-up sensory inputs are then contrasted or “matched” against what our top-down predictions anticipated these inputs would be; if there is a mismatch between what these top-down learnt predictions anticipated, or guessed, what the information was going to be, and what the bottom-up input is saying the information actually is, then a ‘prediction error’ occurs; closing this error gap, through synaptic plasticity, to get better at predicting the future can be achieved by generative models (perceptual inference and active inference).

These two models constantly interact in the following way: perceptual inference: prior experience: mental representations —> top-down predictions guess what bottom-up signals are going to be as a consequence of a movement being performed —> active inference: engages actions to instigate this movement, during the process of which, feedback (bottom-up signals), confirms or denies (prediction error) our perception-based predictions —> perceptual inference: this learning process updates our predictions by contextualising this sensory information in order to illuminate where our blindspots are. The aim is to select the appropriate action that confirms our perceptual-based predictions and minimise the prediction error.

For this process to occur smoothly we need good interoceptive accuracy (Baltazar et al 2021) and a symbiotic relationship between how well a motor action was performed, active inference, i.e. did the action produce the desired consequences, and the updating of our expectations from this, our perceptual inference, “if the actions did (or didn’t) produced the desired response I anticipate it will (or won’t) do again”.

• Perceptual inference.

The perceptual process is an interaction between the brain’s model of what is to be expected, e.g. the expected chain of events, and its comparison to the actual sensory evidence (Paulus et al 2019). If interoceptive information conflicts with what we anticipated, what we always knew to be true, and can’t get explained away, it gets openly flagged up as a prediction error and transferred up the cortical hierarchy. Therefore our perception is not what we sense, but a compromise between the top-down expectations from our mental representations beliefs around what we should be sensing and the bottom-up sensation of what actually is experienced (Paulus et al 2019).

An optimal perceptual system ensures the least amount of energy will be spent in updating the prior models we have of ourselves and our environment in anticipation of, or during, a flood of sensory information. To accomplish this our top-down prior expectations about what the bottom-up sensory information is anticipated to be, or actually is, is deployed prior to our perception of it. This allows us to have in place our own unique top-down model already in situ and firing so that we can measure bottom-up sensory information against. This means sensory information that was predicted by our prior models, e.g. a typical heel strike whilst walking, can be kept in lower levels of consciousness, and sensory information that was unpredicted by our prior models e.g. unexpectedly missing a step, can be registered in higher levels of consciousness. In an optimal system when we experience any contradictions to our top-down prior expectations we should ease up on the confidence we have in the precision and clarity of our prior expectations and tilt the scales to increase confidence in sensory information, e.g. unexpectedly missing a step means our prior model of the terrain was unreliable and we should rely on more sensory information derived from looking ahead for further obstacles, listening attentively to people pointing out further obstacles and proprioceptive feedback whilst walking. Conversely, less sensory precision making us feel as though we were guessing, e.g. a vague noise, should tilt the scales to favour one’s confidence in more precise top-down prior expectations to fill in the blanks, e.g. using prior knowledge to work out what the source of the noise could be. This natural inclination to conserve energy by minimising any unexpected, or unpredicted sensory information (prediction error), either during sensory stimulation, or, in anticipation of sensory stimulation, by either adaptively updating our prior expectations, or maladaptively by actively manipulating the sensory information (active inference), is inherent to the interpretative nature of top-down mechanisms of perception (Reeder et al 2024).

This efficient, conscious awareness of any deviations to what we predicted, and openly accept any conflicting sensations to what we anticipated enables us to rapidly make sense of sensory inputs as to see how precise our models of the world are we can adapt them, through, for example, contemplative techniques such as equanimity, curiosity, or acceptance (Khoury et al 2018). This allows us to generate the most accurate model of the world and help guide the most adaptive behaviour in nature’s inherently uncertain environments (Paulus et al 2019). By closing these prediction errors in this way uses a flexible mindset that allows our mental representations to be moulded by bottom-up interoceptive data so that mental representations and interoceptive data gelling into one. Therefore, confidence in raw, untainted, interoceptive information creates a ‘fluid interoceptive landscape’ so we can be flexible in our predictions and flexible in processing our experiences and expectations (Bohlen et al 2021) allowing us to grow and learn from our previous experiences (Brown & Brune 2012) using mindfulness principles (Khoury et al 2018).

Even though in order to build this cognitive flexibility we can interact with sensory information in multiple ways to define how we experience the richness of reality, this perceptual experience must be true and not delusional (Reeder et al 2024). For a ‘true’ perceptual experience we need to be able to successfully differentiate what is perceptually real (externally originated memories) and what is imagined or day-dreamed (internally originated memories i) (Lavallé et al 2023) and then compare this against retrieved memories (internally originated memories ii). Being able to discern real experiences from imaginary experiences, allows them to be encoded vividly as either real or imagined personalised memories that future experiences can be measured against. Therefore, the clarity of these memories, that experiences can be self-referentially processed against, help successfully guide decision-making by informing how to predictably act in accordance to a stimulus. It does this by allowing the individual to mentally time travel into the past and future and explore alternative outcomes to give a sense of agency (Kwon et al 2022) and identify the origins of the knowledge, attitudes and beliefs (Garrison et al 2017) by which we metacognitively encode, consolidate, and retrieve sensory information against. False memories, recalling false internally generated imaginary events as actually having happened, is influenced by prior knowledge, mental state, emotions, and context influence resulting in (i) flawed encoding of sensory information that constructs memories and integrates new information with old memories; (ii) an excessive familiarity and generalisation from the overall meaning derived from the general gist of events. This forms fuzzy representations of events without the clear context that would be derived verbatim from a more detailed representation; (iii) inaccurate reconstruction of memories during memory retrieval and flawed retrieval monitoring that remembers these false memories with great sensory detail (Lentoor 2023).

Therefore, memories don’t come with a label citing their source they have to be implied from cues relating to the overall nature and meaning of events (perceptual details), the direct facts verbatim (contextual detail) and the complex mental processes in encoding and recalling the information (cognitive operations) (Lavallé et al 2023). So trying to memorise a list ‘sparrow, hawk, robin’ (externally originated stimulus), involves encoding this sensory information verbatim and, in clear parallel, encoding the gist associated with the meaning behind these words e.g. they’re all birds (Lentoor 2023). However, when there’s not a distinct parallel between these two packages in this one memory process, i.e. (i) a memory from an externally generated stimulus, the bird names on the list, and (ii) a memory the internally generated meaning and associations derived from this list, e.g. the word ‘bird’, then these two separate memory packages merge into one so that, incorrectly, it is recalled that the word ‘bird’ was on the list.

This faulty integration of what should have been two separate and distinct memory packages into one, as to blur fact from fiction (Lauzon et al 2022) in our perceptions, is more potent if we reference this memory against (i) a previous memory with a strong self-referential bias (Lentoor 2023), e.g. previous memories of a bird phobia or love of birds; (ii) a previous memory, whereby there’s no clear distinction between the real events and the imagined events, and the imagined events are painted in the memory with elaborate colourful imagery. As what is perceived, incorrectly as a ‘true’ memory, is in fact an illusion (Kwon et al 2022), and this illusion is visually very colourful and vivid, what is injected into our mind’s eye is a clear visual narrative that lacks any real substance. Therefore, using such a memory as a false narrative to tie together and reference future memories against makes them memories also illusional and accompanied by an overwhelming sensory richness e.g. in the form of hallucinations. Conversely, previous memories that are illusional, but, this time, have a less elaborate visual nature (e.g. aphantasia), still provide a false narrative by which to interpret future memories against, but these memories are less visually overwhelming and have more of an abstract quality to them (Reeder et al 2024). Even subtle errors in information gathering from being unable to tell if a memory was perceptually real or imagined, or, by the characteristic nature of the lens through which individuals appraise themselves and an event, can significantly alter how memories are reconstructed and retrieved (Lentoor 2023).

This reduced ability to monitor and keep a grasp on reality is utilised in mind control where through manipulation you are mistakenly made to believe you are the progenitor of your own thoughts, and is also characteristic of the delusions and/or hallucinations associated with psychosis. Delusions and hallucinations arise when individuals lose all trust in their ability to process bottom-up sensory information. They in turn place so much reliance on top-down information that they mistakenly believe this more imaginative internally derived top-down information as having originated from the real bottom-up information that would have otherwise generated more ‘true’ externally derived memories (Lavallé et al 2023). Contracting within themselves by clinging on to these internal high-level priors makes them resistant to being updated from any mistrusted external sensory information so that focus is shifted to preserving maladaptive top-down beliefs over contradictory bottom-up sensory evidence (Reeder et al 2024) and in the absence of a unitary experience of self‐agency from the ability to reliably predict the outcome of self‐generated actions (Lavallé et al 2023) a need for active inference to live out self-fulfilling prophecies.

• Active inference.

Active inference involves performing actions based on our expected observations, e.g. checking to make sure something is where we thought we put it, in order to produce sensory input, e.g. visual confirmation, to test and resolve any differences between our predicted and actual observations, e.g. it’s where I thought it was; an important point to note is that the motor output that produces these actions, that we gain sensory information from, is not fired from a point of ‘neutrality’, or reality, but is fired from the expectations and predictions that characterise our mental representations i.e. we actively performed a motor action to confirm something was where we expected it to be in order to resolve any discrepancies between expectations and actual observations. In order to gain or learn from the sensory input from these motor actions they have to produce the desired consequences, e.g. to see if something is where we thought it was we’re better off using our eyes than our ears, and we have know how certain or uncertain the consequences of these actions are (Fradkina et al 2020). As our motor and autonomic nervous system are constantly firing, constantly predicting, expecting, what the sensory feedback will be from these actions, it maintains the system in an expected state (Gladziejewski 2015).

Although homeostasis entails maintaining physiologically essential internal variables (e.g. glucose level, blood pressure) within tight ranges all the time allostasis deals with the regulation of bodily states through change; therefore active inference, by performing actions to change incoming sensory data can ‘head off’ any undesirable changes (Ciaunica et al 2019). When these predicted sensory consequences of active inference don’t come to fruition, e.g. ‘as a consequence of my actions I though x would happen but y happened instead’, active inference fails to head off any undesirable changes. This highlights an error in this system (prediction error) that should refer back to perceptual inference in order to adjust the individual’s mindset, so that models or representations used to predict the sensory consequences of actions promote flexible learning (Smith et al 2020).

However, being unprepared to close the prediction error by using a flexible mindset to change our top-down predictions (high interoceptive accuracy) the prediction error can only be closed by changing the bottom-up input (low interoceptive accuracy). To do this active inference can actively drive activity so sensory data can be suppressed, reappraised, distracted from (Khoury et al 2018) or motor activity can actively change it. Being confident in the belief of ones predictions, ‘the things we always knew to be true’, can form dysfunctional beliefs and expectations that become immune to any exteroceptive or interoceptive information that challenges them. Therefore, to draw, what would liked to be, the ‘right’ conclusions, involves actively changing either exteroceptive or interoceptive sensations to meet prior expectations (Bohlen et al 2021) to feverishly keep the individual within expected bounds. Conveniently ‘flipping’ interoceptive information in this way, so ‘what we always predicted can come true’, excites autonomic reflexes that creates visceral feelings; these feelings fulfil the needs of the anticipated predictions as to avoid surprise and experience an emotional or motivational moment in time; this experienced moment will project forwards to influence what is felt in the future in an elegantly orchestrated self-fulfilling prophecy; for example actively drawing attention (e.g. auditory or visual) to information that supports and maximises the expectations that appeal to biases (perceptual inference) and therefore fails to illuminate where the individual’s blindspots are.

This can be seen in visual illusions, e.g. the ponzo illusion, where strong priors are based on learned stimulus regularities, i.e. if there are two objects of equal length one close to you and one far away, the one farther away, should appear smaller. This belief, that is true in a three-dimensional world, is so strong that it transferred to a two dimensional world, i.e. a drawing on a piece of paper. Therefore, when two lines of equal length are drawn on to a piece of paper so that one line looks closer than the other, the sensory information that can see the two lines are of equal length is actively over-riden by the belief that the line that seems more distant is bigger than the line that seems closest (refer ‘figure one’) (Reeder et al 2024). The alternative to using active inference to ‘head off’ contradicting sensory information is to experience repeated prediction errors in the form of failure in the external world (i.e. falling short of an objective measure) or in the internal world (i.e. failing to regulate homeostasis in our nervous system) that can, given a certain mindset, go from being informative to creating mental health problems (Paulus et al 2019).

 Figure one: Example of active inference. The Ponzo Illusion.

Generative models and Obsessive Compulsive Disorder

In Obsessive Compulsive Disorder there is a high level of confidence in expecting a diverse chain of damaging events (e.g. because of … you might not have checked it properly, if you don’t check it properly highly precise catastrophic consequences are predicted to happen). What makes these highly precise predictions about what ‘is’ going to happen so catastrophic is that the individual feels out of their depth and intimidated in an environment with potential danger around every corner. ‘Being out of their depth’ centres around fear and anxiety that any learning from prior experiences that makes guesses as to what motor action will produce what sensory information, their memory, (e.g. checking once should foster a certainty that the task has been safely completed) is deemed irrelevant; it is believed these ill-informed predictions will leave the individual unable to navigate this threatening environment (Fradkina et al 2020) and there is an inability to form new maps that predict how actions can successfully adapt to the uncertainty and complexity of the terrain (Sharp et al 2021). Therefore, feeling ill-equipped and out of their depth, unable to predict how their actions will perform in, and how to adapt their actions to successfully interact with, the environment, gives a sense of abandonment so certainty can only be obtained by collecting high value sensory information from recent observations (e.g. further checking); this in turn makes the individual hyper-responsive to sensory information, that is finely combed for any imperfections, giving excessive weight to any unpredictabilities and prediction errors (Fradkina et al 2020).

However, no matter how well motor actions are performed to gain highly valued, but volatile, sensory input, the sensory stimuli struggles to achieve its goal in experiencing the sufficient approval and certainty required to reduce the prediction error and quench the anxiety of these catastrophic predictions (e.g. checking has to elicit the ‘perfect’ sensory stimuli); this incites further motor action (e.g. further checking) and also validates jumping between an array of different actions (e.g. I predict checking in this way, as well as that way, should provide certainty) in order to gather more high valued self-confirming sensory information.

This whole process reflects a failure in the use of learning from prior experiences (perceptual inference) to reappraise and re-contextualise sensory information (active inference) to reduce the prediction error, and make even trivial deviations from predictions feel more catastrophic than what they are; with a lack of self confidence in the individual’s ability to use their prior experiences, their memory, to predict what the sensory effects of their motor actions means, and what change they will produce in their environment as a consequence of them actions, means they can’t instigate goal directed forward thinking with any level of certainty. This creates feelings of incompletion and a lack of direction leaving the individual caught in a loop, unable to move on. This uncertainty in using their adaptive goal-orientated forward thinking results in indecisiveness and volatile behaviour, and so logically, there develops a reliance on self-confirming sensory stimulation. Being reliant on self-confirming sensory stimulation can take the form of simpler habitual behaviour (Fradkina et al 2020) that in response to a stimulus reduces intolerance to uncertainty with a comforting ritualistic, stereotyped behaviour that gathers familiar and highly predictable information in a stable way. As a general rule simple models, so long as they provide enough certainty and accuracy, will always be favoured by the brain as they have a very low complexity cost. This means their ritualistic ‘that’s good enough’ motor actions, or behaviour, they prescribe e.g. overgeneralised, lazy stereotypes, lacks the more flexible thinking that is adaptive towards a desired goal; however in day-to-day use these simple models allows for an overall broader behavioural repertoire, e.g. ritualistic behaviour in driving uses minimal attention freeing up capacity for more complex models, e.g. looking out for hazards on the road (FitzGerald et al 2014). This sensory information gathering is seen in other anxiety disorders where individuals can even invest in actions with uncertain short-term consequences in order to gain informative input that can provide long-term certainty (Teng et al 2016).

Treatment for impaired Interoeption 

Impaired interoception can be from the physiological signal itself, perception (consciously or subconsciously) of the signal, or identification (labelling/recognition) of the signal (Brewer et al 2021).

Increasing interoceptive sensitivity to positive and negative emotions can increase self-regulation and learning (Brewer et al 2021), promote pain tolerance, contextualise worry about pain sensations, foster a healthy emotional awareness and place more trust and attention to bodily information (Joshi et al 2021). This can be seen in optimistic individuals who translates goals into behaviours through reinforced learning by being sensitive to, and being able to appraise any inconsistencies between their expectations and what turns out to be the reality. Having good interoceptive accuracy, enables them to be sensitive to, and learn from these prediction errors so they can move on from any previously anticipated worries by experiencing the reality and creating positive-rewarding expected values for future thoughts; this can be seen even when the reality confirms any previously anticipated worries but is appraised positively as an essential learning experience that is crucial for creating positive expectations for the future. In contrast, less optimistic individuals, with a hypervigilant threat appraisal system that places a higher value on anticipating and worrying about an up-coming event are less sensitive to learning from any contradicting, positive, bottom-up information that occurs during the actual event; this fails to challenge the frustrations from their dysfunctional patterns and update their pessimistic mental representations (White et al 2016).

This is why, when superimposing external symbolic interoceptive information to compensate for interoceptive dysfunctional patterns the following principles must be adhered to: (i) ‘a seed can not grow in stone’ the individual must be malleable to external input to determine their own interoceptive information; (ii) ‘drip feed in manageable instalments’ this external input must feed information into the subordinate interoceptive level that can be consistently integrated in the interoceptive matrix, without excessively violating the internal consistency and causing substantial prediction errors. This enables the interoceptive system to adapt without triggering a cascade of stressful autonomic responses by oscillating between activation and deactivation to improve the balance of the autonomic system, re-framing the interoceptive representations (Di Lernia et al 2016).

• Mindfulness.

Mindfulness practice aims to promote emotional regulation and a more open and inquisitive mindset. This means that conclusions don’t have to be drawn from mental representations formed from worry and rumination. This enables the individual to be truly self-confident in embracing the complexity of a constantly shifting external world (Joshi et al 2021).

This positive framework, entertaining curiosity towards interoceptive, exteroceptive and proprioceptive sensations, promotes the use of bodily information as a useful resource. By adapting internal representations to varying contexts, in order to re-appraise and re-interpret interoceptive information, it enables the individual to identify interoceptive information and effectively intervene (Brewer et al 2021). This can be encouraged by using vivid mental imagery with its associated somatic and emotional evaluation to encourage concrete logical thinking, that can otherwise be suppressed, by worry, characterised by more generalised verbal thinking (Teng et al 2016) that effortlessly skips from one negative topic to another, impeding problem solving and trapping the individual in a worry cycle (Hirsch et al 2019).

Therefore, using mindfulness to encourage a more flexible mindset adapts and changes to bottom-up information in order to learn how to reduce the discrepancy between perceived and true interoceptive information. This is opposed to trying and reduce the discrepancy between perceived and true interoceptive information by suppressing bottom-up information to meet a rigid inflexible mindset. Shifting interoceptive information in this way from being threatening, promoting fear-based reactions, to being informative promotes flexible adaptivity (Joshi et al 2021) and learning (Brewer et al 2021) by cementing positive stimuli and reappraising negative stimuli as a positive learning experience. 

• Attentional Bias Modification Training.

When worry and rumination cumulates in high levels of threat and uncertainty the individual becomes highly motivated to pre-empt and avoid errors by focusing on negative, threat-related information. This heightened sensitivity to errors can be reduced by Attentional Bias Modification Training that attempts to reduce the tendency of individuals to selectively allocate attention to negative, threat-related information (Klawohna et al 2020).

• Osteopathy.

Osteopathy can effect interoceptive sensitivity by (Bohlen et al 2021):

• Deep touch and osteopathic mobilisation significantly increases interoceptive accuracy in patients with chronic low back pain.

• Myofascial release techniques increase interoceptive sensitivity, but not significantly.

• Afferent C–tactile fibers are stimulated during affective, low force, dynamic touch possibly playing a role in restoring impaired interoceptive function, body awareness, homeostatic regulation, allostasis, emotion, and affective disorders. The primarily function of C-tactile afferents is to provide information about the homeostatic and emotional effects of touch, rather than the properties of what or who is being touched. Activation of these C-tactile receptors on the skin then may specifically relate to the positive consequences of interpersonal touch, such as reducing feelings of social exclusion, soothing pain and communicating social support (Ciaunica et al 2021).

  Social affective touch can start in foetal development when the foetus, entirely covered in fine hair (lanugo hairs), moves in the amniotic fluid to directly stimulate these C-tactile afferents; this activates the hypothalamus and insular cortex that promotes an anti-stress effect via the release of oxytocin and stimulates the foetal growth. Also, foetuses spend a significant amount of time in tactile exploration frequently touching certain body areas, such as the lips, cheeks, ears, and parietal bone, creating a self-stimulatory pattern, which enhances innervation. Importantly, when the foetus touches the forehead, innervation increases, and the boundary migrates allowing the foetus to move on to touch a new innervated boundary until the whole body is fully innervated. Additionally, it has been shown that maternal touch of her own abdomen increases arm, head, and mouthing movements in the foetus having more impact than maternal voice in the foetus's movements. Later in development, well before humans are able to recognise themselves in a mirror to perceive themselves from a visuospatial perspective, they experience themselves and their surroundings via the proximal senses where touch represents a fundamental step in the development of both self- and other-awareness, as well as self-other distinction (Ciaunica et al 2021).

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