Interoception | Reality Bending Lab

What is the Best Interoception Questionnaire?

Sat, 20 Dec 2025 00:00:00 +0000

Hello👋! We are Róisín and Oliver, two Research Assistants at the lab, and today we are going to be discussing the tricky topic of self-report interoception questionnaires.

Interoception, essentially referring to one’s sensation of their internal body, is a fundamental phenomenon that we rely on in everyday life, and recent research highlights it as a trans-diagnostic underpinning of a variety of somatic and psychological difficulties.

While we know interoception is very important, the specifics are still being worked out. Debates continue on what exactly interoception is, is not, and what it encompasses in terms of modalities or processes. Is it limited to visceral sensations (i.e., from internal organs)? Does it include proprioception (i.e., body position sense)? Pain? What about tactile sensations (i.e., touch and skin)? Does it include the interaction with higher-order processes like attention and beliefs?

This chaotic and moving landscape has been accompanied by the development and repurposing of different interoception (and interoception-adjacent) questionnaires, each with their own philosophies and approach. Carefully choosing a good measure of interoception is crucial to avoid adding to the jingle-jangle fallacy plaguing the field, in which discrepancies and contradictions of results “related to interoception” are driven by differences in what aspect of it is actually being measured.

Moreover, unlike exteroception (vision, audition, etc.), where researchers can easily manipulate external stimuli to validate a participant’s response, interoception presents a unique challenge: the stimuli originate from within the body. Because internal states are difficult to manipulate or observe directly, objective validation is complex. Nonetheless, especially as “objective” tasks like the Heart Beat Counting Task (HCT; Schandry, 1981) have their own methodological drawbacks, self-report questionnaires remain a scalable, practical, and widely-used tools for assessing interoception. Let’s explore the most popular and established questionnaires.

Questionnaires Overview

😨 Body Perception Questionnaire (BPQ)

The BPQ is one of the earliest interoception scales, originally built by Porges in 1993. This questionnaire focuses on the autonomic nervous system, involved in stress responses, and thus is mainly concerned with internal sensing when there are problems (e.g., ’tremor in my lips’, ‘general jitteriness’ being two items for body awareness). This makes the scale beneficial in clinical contexts to investigate maladaptive interoception, particularly in patients who have a dysregulated autonomic nervous system. However, if you are interested in interoception in a wider context, other questionnaires may be more appropriate.

The Autonomic Nervous System (ANS)

🧘‍♀️ Multidimensional Assessment of Interoceptive Awareness (MAIA)

The Multidimensional Assessment of Interoceptive Awareness (MAIA) (the MAIA-2 being the most recent version) is another widely used questionnaire that accounts for body awareness in positive states - deriving from research on emotional regulation and pain. This questionnaire was created because Mehling et al. (2012) believed western medicine focused too much on bodily awareness as a maladaptive trait, even though research was increasingly finding health benefits from a sense of embodiment. It was specifically designed to assess mind-body therapies and was finalised based on data from individuals with various therapeutic backgrounds including yoga, tai chi and breath-work. The MAIA reconceptualises bodily awareness not only as an anxiety-related process but also an integral part of mindfulness. This translates to many of the questions focusing on metacognitive beliefs about one’s body and emotions, as well as some targetting more directly other mindfulness-related processes, such as attention regulation and non-reactivity. The MAIA includes subscales encompassing self-regulation abilities which - while important - might be conceptualized as distinct from core interoception.

🤧 Interoceptive Accuracy Scale (IAS)

More recently, the Interoceptive Accuracy Scale (IAS) (Murphy et al., 2019) took the opposite route, trying to remove contamination by meta-cognitive processes to focus on interoceptive accuracy (distinct from interoceptive attention). It includes 21 questions (“I can always accurately perceive when…”) pertaining discrete, clear, and “objectifiable” interoceptive events, hopefully being meaningful and consistently interpreted across participants (including those who have difficulty perceiving internal sensations).

🍃 Multimodal Interoception Questionnaire (Mint)

The Multimodal Interoception Questionnaire (Mint; Makowski et al., 2025) is the most recent interoception questionnaire, designed with the intention of addressing the caveats and limitations by building on established measures and synthesising the previous research and advances. Fundamentally, the Mint takes a “context-by-modality” approach to item development, encompassing a wide range of (seven) modalities of interoceptive experience (cardiac, respiratory, gastric, etc.) and also controlling for the contexts in which these may appear (covering negative (anxious) and positive (sexual) arousal states). The Mint also incorporates both adaptive and maladaptive aspects of interoception (interoceptive confusion), as well as items targeting different levels of processing.

Importantly, this questionnaire was developed with the aim of addressing some of the methodological shortcomings of previous interoception questionnaires, such as limiting interpretation Variance, state Dependency (the fact that respondents “anchor” their answers to their current physiological state rather than their general trait), and recency effects (recent, salient physical experiences disproportionately influencing scores), in particular by providing a clear contextual reference for each item. The validation study displayed shows strong correlations with the above questionnaires (suggesting that it can be used as a comprehensive replacement), while also demonstrating a superior predictive power for a variety of clinical conditions.

Items of the Multimodal Interoception Questionnaire (Mint)

Others

The Interoceptive Attention Scale (IATS; Gabriele et al., 2021): Attention to bodily signals. Designed as the orthogonal counterpart of the Interoceptive Accuracy Scale, also using consistent phrasing of all statements (‘Most of the time my attention is focused on…’).
The Interoceptive Sensations Questionnaire (THISQ; Vlemincx et al., 2021): Neutral internal sensations (not emotionally valenced), including cardiorespiratory activation, deactivation, and gastroesophageal sensations.
The Interoception Sensory Questionnaire (ISQ; Fiene, 2018): Designed to assess confusion about interoceptive bodily states unless these states are extreme (Alexisomia).
The Interoceptive Confusion Questionnaire (ICQ; Brewer, 2016): Assesses confusion and misinterpretation of bodily signals.
The Body Consciousness scale (BCS; Miller et al., 1981): Awareness of the “private body” (internal sensations) and “public body” (observable aspects of body)

In summary - which interoception questionnaire should I pick?

Interoceptive questionnaires are a product of their time, often molded by specific contextual demands and underlying theoretical frameworks. As our understanding of interoception evolves, so too do the tools we use to measure it. It might seem like the best option is to pick a questionnaire based on the interoception facet you are interested in (e.g., confusion, attention, accuracy, …), but as the field is still developing, and the theorethical models are in flux, it might be more useful to consider using a broader, more comprehensive, theory-agnostic questionnaire that captures multiple facets and modalities of interoception, such as the Mint.

References

Bergomi, C., Tschacher, W., & Kupper, Z. (2012). The Assessment of Mindfulness with Self-Report Measures: Existing Scales and Open Issues. Mindfulness, 4(3), 191–202. https://doi.org/10.1007/s12671-012-0110-9

Gabriele, E., Spooner, R., Brewer, R., & Murphy, J. (2021). Dissociations between self-reported interoceptive accuracy and attention: Evidence from the interoceptive attention scale. Biological Psychology, 168, 108243. https://doi.org/10.1016/j.biopsycho.2021.108243

Kolacz, J., & Bjorum, E. (2023). Measuring Autonomic Symptoms with the Body Perception Questionnaire. The Traumatic Stress Research Consortium . https://www.traumascience.org/s/TSRCMarch2023Newsletter.pdf

Kolacz, J., Holmes, L., & Porges, S. W. (2018). Body perception questionnaire (BPQ) manual. Traumatic Stress Research Consortium.

Makowski, D., Neves, A., Benn, E., Bennett, M., & Poerio, G. (2025). The Mint Scale: A Fresh Validation of the Multimodal Interoception Questionnaire and Comparison to the MAIA, BPQ and IAS. https://doi.org/10.31234/osf.io/8qrht_v1

Mehling, Price, Daubenmier, Acree, Bartmess, & Stewart. (2012). The Multidimensional Assessment of Interoceptive Awareness (MAIA). Plos One, 7(11). https://doi.org/10.1371/journal.pone.0048230.g001

Mehling, W. E., Acree, M., Stewart, A., Silas, J., & Jones, A. (2018). The Multidimensional Assessment of Interoceptive Awareness, Version 2 (MAIA-2). PLOS ONE, 13(12), e0208034. https://doi.org/10.1371/journal.pone.0208034

Miller, L. C., Murphy, R., & Buss, A. H. (1981). Consciousness of body: Private and public. Journal of Personality and Social Psychology, 41(2), 397–406. https://doi.org/10.1037/0022-3514.41.2.397

Murphy, J., Brewer, R., Plans, D., Khalsa, S. S., Catmur, C., & Bird, G. (2019). Testing the independence of self-reported interoceptive accuracy and attention. Quarterly Journal of Experimental Psychology, 73(1), 115–133. https://doi.org/10.1177/1747021819879826

Paola Solano Durán, Morales, J.-P., & Huepe, D. (2024). Interoceptive awareness in a clinical setting: the need to bring interoceptive perspectives into clinical evaluation. Frontiers in Psychology, 15(1244701). https://doi.org/10.3389/fpsyg.2024.1244701

Porges. (1993). Body Perception Questionnaire. Umd.edu. https://terpconnect.umd.edu/~sporges/body/body.txt

Schandry, R. (1981). Heart Beat Perception and Emotional Experience. Psychophysiology, 18(4), 483–488. https://doi.org/10.1111/j.1469-8986.1981.tb02486.x

Sherrington C. S. (1906). The integrative action of the nervous system. Yale University Press.

Vlemincx, E., Walentynowicz, M., Zamariola, G., Van Oudenhove, L., & Luminet, O. (2021). A novel self-report scale of interoception: the three-domain interoceptive sensations questionnaire (THISQ). Psychology & Health, 38(9), 1–20. https://doi.org/10.1080/08870446.2021.2009479

The Heart can Lie: A Preliminary Investigation of the Role of Interoception and Theory of Mind in Deception

Wed, 13 Nov 2024 00:00:00 +0000

Audio Summary

Listen to a podcast summary of the paper!

How do we know what is real? The 'Affective Reality Theory'

Tue, 11 Apr 2023 00:00:00 +0000

I thought it would be interesting to summarize an idea developed during my PhD on “fictional reappraisal”, i.e., on the effect of the belief that an emotional stimulus is not real (Makowski, 2018). That of Affective Reality, which is a hypothesis about the role of affective reactions in the formation of reality beliefs.

The premise it lies on is that we have entered a “post-truth era”, in which the distinction between real and simulated (“fake”) objects has become virtually impossible based on physical characteristics alone. In other words, technology has developed so much that we can forge (or will be able to in the near future) “artificial” ¹ content (e.g., text and images with AIs, and even environments with VR) that is indistinguishable from its original counterpart. For instance, face generation algorithms are so advanced that it is impossible nowadays to tell the difference with the naked eye between a real photo and AI-generated image.

Once we agree on this premise of objective equivalence between reality and simulation, the question of how do we form judgments and make decisions about the reality of objects arises. In the absence of clues within the stimuli, we are left with with other sources of epistemological information, such as contextual cues (in the case of news, who is the author, what is the outlet it got published, etc.), and internal cues (subjective characteristics: how does it relate to our knowledge, how does it make us feel, etc.). The latter is of particular interest to us psychologists.

We refer to the process of forming reality beliefs as simulation monitoring (Makowski et al., 2019), which is a somewhat controversial term (that some ² have considered as almost counterintuitive). The reason for this term, instead of something along the lines “reality appraisal” ³, is the assumption that reality is our default mode of experience. In other words, we are not well equipped (neurocognitively speaking) to detect and classify things as non-real, as these objects are very recent in our evolutionary history. Thus, according to the Affective Reality Theory, by default, the brain considers the origin of its experiences as real… but this “belief” is, most of the time, not even fully formed, remaining implicit and subconscious (i.e., we don’t spend all our cognitive resources with a constant “this is real. This is real too. That too.” labelling). This default mode acts as a higher-level, transparent prior over our experiences, providing a scaffolding and structuring our perception, thoughts and reactions. We do not actively appraise the world as real (it is the baseline position), but instead can ask ourselves whether it is simulated, hence simulation monitoring.

The Affective Reality Theory posits that reality beliefs (the tendency to believe that something is real, as opposed to non-real) is related to emotions and/or bodily reactions through a quadratic (inverse U-shaped) relationship..

The Affective Reality hypothesis posits that simulation monitoring is strongly connected to “affective processing” ⁴ through a quadratic (inverse U-shaped) relationship. This means that stimuli associated with a stronger emotional and/or bodily reaction will preferentially bias our judgment towards “reality”. In other words, things that elicit feelings and/or bodily arousal, ceteris paribus, will be more likely to be classified as “real” (as opposed to fake). In fact, strongly emotional events will even “feel” more real: this transparent default prior and subconscious belief (“agnostic-real”) will be replaced in high-intensity scenarios by an explicit and conscious impression that the stimulus is very real, and, if logic opposes, that it “must be real” regardless.

Isn’t it the other way round, you might wonder: that real stimuli (as opposed to ones believed to be non-real) are associated with a stronger emotional reactions? And that it is the believed reality that drives the emotional response? Indeed, we do believe that there is a two-ways relationship between simulation monitoring and emotions. But it is not exactly that beliefs of reality are associated with stronger emotions, but rather that beliefs that something is not real leads to a lower emotional response (the usage of fiction as an emotion regulation strategy - “fictional reappraisal” - was the main topic of my doctoral dissertation). In fact, the Affective Reality theory posits that this regulatory effect of simulation monitoring starts to dominate after a certain point where the emotion becomes too strong and unbearable: beliefs such as “it can’t be real”, and other forms of reality denials are invoked automatically to protect us and help us cope with distressing information.

To summarize this summary, the Affective Reality hypothesis claims that from mild to relatively strong emotional stimuli, the effect of affect on simulation monitoring dominates (+affect → +reality) and will bias our judgment towards “reality” (strengthening awareness and confidence), up until a point where the emotion regulation benefits of unreality will be automatically invoked (-reality → -affect), increasing the likelihood and confidence of judgments of simulation (potentially far into psychopathological terrains).

Open questions

The Affective Reality theory is for now a working hypothesis that we are trying to empirically prove or disprove at the Reality Bending Lab. Moreover, some questions remain open:

Is it actually embodied reality or emotional reality? While we used the term “affective” reality to remain general, the question of whether it is emotions as a subjective psychological reaction, or merely bodily arousal (reactions of the body, e.g., stronger heart rate variability), that is the key ingredient remains unclear. The role of interoception (the ability and tendency to detect, track, attend to and rely on internal signals), while likely important, also remains to be specified.
Is it the affective context or stimulus that matters? Let’s assume we have affective reaction concomitant to the experience of an object, but not directly related to the object. Would that bias simulation monitoring? Does perceived causality between a bodily reaction and the object of experience matters?

Notes

You may notice that I used different words related to the concept of “unreal”, such as simulated, fake, artificial, virtual, simulated, fictional. While they can be used interchangeably in the context above, they are not exact synonyms. ↩︎
Like that pesky reviewer 2, obviously. ↩︎
Note that “reality monitoring” already exists as a concept and refers to a (possibly related) mechanism involved in tracking the origin of an experience (e.g., a memory) as internal vs. external. ↩︎
“Affective” is in this context used as a generic term to encompass emotions, feelings and bodily activity (the question of which exactly of these aspects is the key remains to be answered). ↩︎