Len Ochs, Ph.D.
106 La Casa Via, Suite 110
Walnut Creek, CA 94598
Copyright 1992 Len Ochs
Previously Published in the Winter Edition of California Biofeedback
Interoception and Comfort
It was at one of those lovely moments of peak confusion sometime just before the age of 10 just after one of my parents informed me that I couldn't possibly be angry at them because they loved me that I made the decision that having feelings would only confuse me, at best, and get me in trouble at worst. Between that time and age sixteen I had successfully banished most traces of my emotion, and had discovered that repression without the toil of exercise was the best way to a perfect set of abdominals. I even forgot that I made the decision not to feel.
My first glimmer that something was amiss occurred when I was a sophomore in high school. It was April 1st and my best friend wasn't in school. There was a rumor that he was dead, which was a amusing because he was a practical joker and the date was not lost on me. The full page cover of Newsday showing his crumpled bicycle fully convinced me that he was indeed dead. Later the contrast between the weeping and wailing of his parents and other friends at his funeral and my cool detachment led me to suspect me that I was missing something.
My mission: find out what I was missing in my reactions. Psychotherapy over the course of my adult life has been of limited value. I went from the authoritarian "Snap out of it" approach, to trying to come up with a feeling in response to "How do you feel about that," ("I don't know."), to expressing myself by raising my voice, screaming, kicking, pounding without feeling, to breathing, Yoga, and relaxation training ("How do I pay attention to my breathing?"), to biofeedback and imagery. My allergies flared and died down. I had periods of unaccountable rage in the process.
I developed world-class TMJ pain, leading me to find my jaw. I went through a one year period during which I couldn't tell if my jaw was tight, or just there. I went through upper G/I problems. The resident doing the upper G/I series apologetically admitted that he could see no pathology. I was criticized by therapists for being too intellectualized, for holding back, for holding in. But how, what, and where eluded me until I read a tiny book called "Me and the Orgone," by Orson Bean.
He told the story of his Reichian analysis, with chapters alternately focusing on theory and his experience. While I didn't care much for the theory, here at last was a clear description of the sensations I knew nothing about: surges, ripples, warmth, tingles in the skin. What followed was 10 years of searching, reading, investigating body-oriented therapies, but feeling little. I found Luthe's books on Autogenic Therapy, but they flopped with me. The irony is that it took me years to see in autogenic therapy another detailed descriptive topography of feeling, beginning with the simple dimensions of heaviness, warmth, and softness.
Then I bought my first biofeedback equipment, and used one or the other of EMG, skin temperature, skin conductance and potential, and EEG each day for two years. EMG taught me to feel the mechanical texture of my muscles; skin temperature taught me to distinguish warmth; skin conductance and potential brought me into intimate familiarity with the feeling of ease and softness of my breathing; but EEG made me tingle. EEG cleared my head so that I could see the greens of the spring trees, and the red oranges of bricks. My need for sleep dropped. At one point I could not stop tingling from head to foot, unless I was doing some very hard physical labor. I remember the thought I had just before the tingling stopped for five years: "Do I really deserve to feel this good?" Notice that these are all mechanical sensations: there was no emotional quality to them.
I worked with patients and watched their reaction to biofeedback and relaxation techniques. Some relaxed, and some didn't. Some needed biofeedback, and some were able to relax without it. Some used muscle contraction biofeedback and were able to relax everything from small spots, to large areas on their bodies. Some were able to use skin temperature biofeedback to warm their hands and feet. Some used skin conductance to dry their hands and discover ease in the action of their breathing they never noticed before.
Interestingly patients could often relax one or more parts of their bodies, and not label themselves relaxed. I was working for a student of Wolpe's at the time and he insisted that if I was able to help a person relax enough body parts, the person would say he felt relaxed. I found this sometimes so, sometimes not. People whose hands were warm, skin conductance and EMG (frontal, trapezii, and lower back) very low (~ 1µV), and breathing slow, talked of still feeling nervous, on edge, not quiet, restless and uncomfortable. An older woman whose parents were lost during WW-II in Germany was as relaxed as I have ever seen anyone on biofeedback equipment; yet, she complained of phobias and nervousness.
It began to look to me as if the behaviorally-oriented clinicians and researchers were invested in an additive fallacy, which states that the sum of a person's relaxed parts permits an individual to claim to be relaxed. Further, each part of a person's body has equal weight (except, perhaps, for the forehead) in leveraging the person into a stated of relaxation.
Whether the whole is greater or less than the sum of its parts is beside the point, especially since the frequently misquoted phrase is, in fact, that the whole is different from the sum of its parts. (There are many instances in which the whole may be less, as well as more than the sum of its parts.) The sum of a bunch of relaxed parts does not necessarily equal a relaxed person. I myself, had learned to exercise many of the mechanical relaxation skills teachable, yet something was still missing for me, leaving me still wondering where "I" was in the scheme of things.
Yet I had conquered my dreaded alexathymia. I could name my feelings. I could point to my limbs and correctly name heavy, warm, soft, tingles. Yet these mechanical sensations, however interesting and pleasant, were still not valuable enough for me to want to maintain.
Let's take a look at what bridged me from discrete interoceptive details to the recognition of comfort as something qualitatively different:
" I remember things that don't fit together, especially the absence of comfort in when I was as relaxed as my meters would read.
" I think of women who touch their chest when they say "My!" or in other ways refer to themselves. What are they doing?
" I remember the patient I had who knew he was angry as did his colleagues when he could hear his feet stomping on the hallway floors of his work place. He, too, conquered his alexathymia and knew what he was feeling: he did use external cues, however.
" Most of my patients knew what they were feeling as well. The content of their thoughts let them know, as in "I'm having angry thoughts and images." Their actions told them, as "I knew I was angry at him when I threw the dish at him," or "...at her when I punched a hole in the wall." Or, their symptoms let them know: "I'm angry because my gut is all twisted."
" I also noticed that the heaviness of the limbs during relaxation of Autogenic Phrases fame did not correspond to the lightness that people talk of when they refer to themselves as happy.
" There was the flautist who could direct a spot of warmth wherever she wanted it to go on her body, even to places away from her periphery (such as her chest or throat), where, in my conception, no decent parasympathetic system could send a spot of warmth.
" And that kiss that my wife gave me that sent my skin temperature soaring when I was connected to the temperature feedback device....
" As I grew increasingly comfortable and relaxed during therapy sessions, patients increasingly made spontaneous comments and insightful connections about their own emotional states and histories. I had to question, probe, analyze, and suggest with less and less frequency.
It was not until I was enjoying the smoothness of the action of my chest muscles as I breathed one day, that I also noticed my chest starting to become warm. Without effort, imagery, or thought. The warmth spread of its own accord. I felt "good." My chest did feel warm. But beyond the mechanical feeling of warmth, I felt good. This marks a change from my perception of mechanical warmth to a clumsy perception of emotional warmth. I label the perception as clumsy because "good" is one end of a primitive bipolar evaluative dimension. "Good" is evaluative, rather than descriptive but it is a beginning and similar to terms many of our patients use.
It was not until I lay in bed thinking angry thoughts one morning that I noticed that my chest felt loose and burning: I felt relaxed and comfortable while I was angry. The idea that I could feel angry, comfortable, and loose surprised and intrigued me. I was thinking about things I was furious about; at the same time I was quite comfortable. I wondered whether the burning I felt in my chest was the legendary "burning rage."
A few months afterward I stood perplexed in the middle of a room with a discernable lightness in the center part of my chest; and I began to suspect that I might be happy. I remember wondering aloud if this could be happiness, and saying to myself, "Yes. I do believe this is happiness. I don't know what about. But I am happy." This happiness was totally divorced from any thought content that I could identify.
It was becoming clearer to me that many people meant the emotional feelings in their chests when they referred to themselves as "I". And since I saw women do this much more than men, I suspected that women tended to have more of a sense of emotion available to them in their chests than did men. This centrally-felt happiness was not an additive phenomenon: no feelings were totaled. I did not feel happiness throughout my body. The feeling was quite limited to the lightness in my chest.
It was not until I observed these events that I began to think of comfort as a particular combination of mechanical warmth, softness, easiness, and lightness of the chest area to which is attached a variety of words such as comfort, quiescence, safety, bliss, ease, and sweetness not to mention "good." It is often accompanied by a very slight dizziness, or lightheadedness which, in extreme forms is referred to as "being in love," or swooning.
It was not long, then, before I noticed that I could evoke this state of comfort for myself regardless of incorrect sitting or standing posture, regardless of shallowness of breathing although to be fair my breathing spontaneously seemed to lengthen, slow, and become more abdominal by paying attention to the movement of my chest.
When I asked my patients to attend to the movement of their chests when they were crying, they often stopped crying and were bewildered by the drying of their tears. Couples at each others' throats on their entrance to a session quieted down and afterwards could not think of why they should continue their fight: the energy had gone out of the fight when they attended to their own chest movement; and they could address the issue at hand more openly and without effort to control their discomfort. One woman who scoffed at the idea inadvertently touched her chest as she indicated that she thought the whole idea was ridiculous. I asked her why, then, she pointed to her chest instead of to her elbow when referring to herself. She was astonished and gave in. One psychologist who initially belittled the idea of the chest being a comfort center finally volunteered that he wondered why he sat for hours with his hands folded on his chest after he had come home from hard day's at work.
If I asked patients suddenly to look out the window or at the ceiling they also felt better for a while. However this appeared to be mere distraction, and the problems returned rapidly. Attention the chest comforted them more deeply, and its effects lasted longer.
Real psychotherapists talk of relaxation, desensitization, self-statements, cognitive self-management, assertiveness, imagery, action, analysis, and negotiation. They don't talk about comfort. Love can be embarrassing as a topic to the behaviorally oriented, certainly too soft and vague. Scientist-practitioners tend to be extremely reluctant to stoop to the folk language of the arts and refer to the "heart": strictly the poet's domain. We certainly would not want to stoop to the mystic language of the chakras. The proposition that we have an emotional heart, as distinct from the mechanical blood-pumping heart, is usually seen as new-age mysticism, fuzzy thinking, a focus that has perhaps opened just a tad too much. It is often feared, when "love" is mentioned, that the speaker is really saying that love is all that is necessary, the answer to all of our needs. Unfortunately this often limits the topics of love and comfort to positive concerns of the more humanistic therapists, or to negative concerns of the more rational therapists as the root of mistaken beliefs and evaluations.
When a patient looks uncomfortable a therapist usually inquires about the quality of discomfort. The inquiry may be direct or indirect, questioningly or reflectively ("You look like you feel uncomfortable.") The patient may openly express discomfort in a number of ways. In either case, the therapist often responds in a number of set ways:
1. The therapist asks "How do you feel about that?" if it is not absolutely clear.
2. The therapist asks why the patient feels that way, or when else the patient has felt that way historically, or who else in the patient's history has triggered off such feelings, etc.
3. The therapist may begin an analysis of the rationality/irrationality of the thinking and assumptions which may have triggered such feelings, or ask the patient to observe and record such antecedent conditions.
4. The therapist may begin an assessment of options for expression, action, assertion, and negotiation which may increase the patient's comfort. The therapist may confront the patient about repetitive patterns of denial, deflection and avoidance of recognition of and action in response to such feelings in favor of substance abuse and dependence.
5. Relaxation may be taught to the patient, which may or may not overlap with teaching self-comforting.
The above therapeutic responses to a patient's displays and expressions of emotions are all valid and appropriate in particular contexts. However, as one patient said to me, "Therapists have been telling to make myself comfortable for years; but nobody ever showed me how to do to that." Therapists and there are exceptions tend to talk more about emotions than to show people how to manage them directly and simply. My experience with my own development and with thousands of patients over the past fifteen years has demonstrated that there are simple ways to demonstrate direct emotional self-comforting techniques to most patients. These ways perfectly complement other tools therapists use. They do not invalidate any body of psychological knowledge. They do, however, tend to bring new life into the therapeutic process, empower the patient, and make life more interesting and rewarding for the therapist.
There are four principles which guide a patient to developing self comforting strategies, four principles that psychotherapists don't know:
1. If we learn to recognize simple sensations such as muscle contraction/looseness, warmth/coolness, heaviness/lightness (both in the chest area and in the limbs), we prepare ourselves to move on to the next stages of skill acquisition.
2. With two notable exceptions, if we pay attention to our skin, we automatically tend to become warm at the site to which we attend. The exceptions are when the person has a phobic reaction to interoceptive self-awareness (as with many psychotics, victims of abuse, or chronic illness), or when the person has little or no value for such awareness preferring to pay attention instead to tasks to be done, which should have been done, or which are under way. These are hard driving people who are external goal oriented who tend to fall apart for longer periods of time when they are injured, or suffer other unexpected seriously limiting life changes.
3. If we pay attention to the movement of the center part of our chest when we feel angry, sad, or hurt, we will most probably automatically feel comfort in addition to warmth, the exceptions in principle two notwithstanding. Further when specifically looking at our chest sensations as emotions, we begin to place these sensations into a context in which they are perceived as emotions, rather than as mechanical sensations. At first it takes the deliberate query about these central sensations to make one see that they are indeed emotions. When a mechanical feeling becomes an emotion it loses its peripherality, and becomes more of a central motivation for us. For instance, my hot finger makes me withdraw my hand from the stove top; central warmth makes me want to move toward somebody.
4. While principles two and three can be demonstrated rather simply and effectively, and taking into considerations the constraints of principle two, true integration depends on the consistent and steadily increasing use of these principles both in therapy and in real life. Hard work.
Patients will often say "This is all very nice, but what do I have to do to comfort myself, showing the devaluation of sensing as a recognizable tool to bring oneself comfort. Attention shifting is an action, if an inner one. In a similar fashion, therapists tend to unnecessarily complicate the process of emotional self-regulation, and not see attention this kind of attention shifting as a useful activity.
Perhaps the hardest thing for a patient to grasp is that shifting one's attention to one's chest alone will begin to bring comfort. It often sounds ridiculous, in fact. The face validity of associating comfort with awareness of chest movement is rather low, to say the least; and one needs to be prepared to spot, understand, and communicate why such an action does not bring comfort when it doesn't.
When patients begin to move their attention from the following phenomena, and toward noticing and understanding their chest sensations, they begin to move beyond what they know. Patients tend to know and identify their emotions in several ways:
1. by their thoughts: ("I have angry thoughts.")
2. by their symptoms: ("My gut is twisted. I must be angry." "I'm smiling. I must be happy.")
3. by their actions: (I'm throwing a dish through the air; I must really be angry.)
4. by their images: (I see myself walking to the bridge to jump off; I must be depressed.")
Moving the more competent patients beyond this knowledge can accelerate therapy and delight patients. Therapy may not be accelerated in difficult cases; however the focus of therapy changes and in some ways becomes more concrete, palpable and rewarding for patients and therapists alike.
The capability of finding warmth and comfort generally does not have to be learned. These capabilities are already built-in for us. Phobic, or task-oriented, and highly intellectualized people do need to rediscover these skills, however; and it can take a long time in some cases. It is important to learn to recognize simple, seemingly insignificant sensations such as chest movement and warmth, to discriminate them and others one from another, to discover that sensing them is the same as finding comfort, to discover that they comprise emotional sensations regardless of the source of the emotions, and to rely on this kind of interoception in daily life as both a source of guidance and as a comfort. It is interesting that so few people, patients and therapists alike, know how to comfort themselves simply.
This is a good place to say something about visualization, since visualization is used so widely today. There is a danger in misusing and overusing imagery, and a danger in the misuse of the word "imagery," in general. "Imagery" has become a technical word that now includes sensory experience. Lay people restrict the word "imagery" to the domain of the visual, and this is one time I agree with lay people. To equate sensory experience with visual imagery and subsume them both under the category of "imagery" is to excessively point to the head as the center of consciousness and thus collude with societal forces to support somatic unconsciousness. And while awareness of thinking and imagery may indeed be the center of consciousness for many individuals males, in particular the devaluation of body, and in particular emotional awareness severely restricts the actualization of human potential.
Linguistically separating imagery from interoception more clearly explicates a somatic focus for attention and equates the sensory with the visual. Practically I have found it hard for the more sophisticated to keep visual imagery from substituting for and interfering with sensory awareness, limiting their repertoire of self-management tools. While there is nothing inherently wrong with visualization, its overuse today limits the development of resources for sensory awareness and discrimination. My experience of doing therapy with therapists shows that they, themselves, are quite handicapped in this way. Once aware of the distinctions and dangers, however, a patient's talent for imagery can be used in exquisite, skillful, and subtle ways to enhance interoception.
Permitting sensory experience to assume its rightful place along side of visual imagery will permit people to touch, rather than to just imagine their own hearts to bring comfort to themselves.