Full PreFrontal

Ep. 133: Dr. Kelly Mahler - Interoception & Executive Function

December 12, 2020 Sucheta Kamath Season 1 Episode 133
Full PreFrontal
Ep. 133: Dr. Kelly Mahler - Interoception & Executive Function
Full PreFrontal
Ep. 133: Dr. Kelly Mahler - Interoception & Executive Function
Dec 12, 2020 Season 1 Episode 133
Sucheta Kamath

Our body is a screen onto which our inner experiences are frequently projected. Authors, through their writings, vividly illustrate the imprint of the mind onto the body; for example, Caroline Hanson says “Nervousness made her feel nauseous, almost like she had two hearts frantically beating in her chest, instead of one.” The human interoception system processes the internal sensations and let’s us feel what is happening in our bodies and through body-regulation we can strengthen our Executive Function by self-regulating our thoughts, behaviors, and actions without the sense of being overwhelmed. If loving oneself is the greatest revolution, then the body is its frontline fighter!

On this episode, award winning occupational therapist, author, and faculty at Elizabethtown College, Dr. Kelly Mahler discusses how to understand the signals from our body and how cultivating the abilities to know the meaning behind these signals is the key to live a healthy life.

Dr. Kelly Mahler
Kelly Mahler OTD, OTR/L, earned a Doctorate in Occupational Therapy from Misericordia University, Dallas, PA. She has been an occupational therapist for 18 years, serving school-aged children and adults. Kelly is winner of multiple awards including the 2020 American Occupational Therapy Association Emerging and Innovative Practice Award & a Mom’s Choice Gold Medal. She is an adjunct faculty member in the Department of Occupational Therapy at Elizabethtown College, Elizabethtown, PA and is actively involved in several research projects pertaining to topics such as interoception, self-regulation, trauma & autism. Kelly is an international speaker and presents frequently on topics related to the eight resources she has authored:


About Host, Sucheta Kamath
Sucheta Kamath, is an award-winning speech-language pathologist, a TEDx speaker, a celebrated community leader, and the founder and CEO of ExQ®. As an EdTech entrepreneur, Sucheta has designed ExQ's personalized digital learning curriculum/tool that empowers middle and high school students to develop self-awareness and strategic thinking skills through the mastery of Executive Function and social-emotional competence.

Support the show (https://mailchi.mp/7c848462e96f/full-prefrontal-sign-up)

Show Notes Transcript

Our body is a screen onto which our inner experiences are frequently projected. Authors, through their writings, vividly illustrate the imprint of the mind onto the body; for example, Caroline Hanson says “Nervousness made her feel nauseous, almost like she had two hearts frantically beating in her chest, instead of one.” The human interoception system processes the internal sensations and let’s us feel what is happening in our bodies and through body-regulation we can strengthen our Executive Function by self-regulating our thoughts, behaviors, and actions without the sense of being overwhelmed. If loving oneself is the greatest revolution, then the body is its frontline fighter!

On this episode, award winning occupational therapist, author, and faculty at Elizabethtown College, Dr. Kelly Mahler discusses how to understand the signals from our body and how cultivating the abilities to know the meaning behind these signals is the key to live a healthy life.

Dr. Kelly Mahler
Kelly Mahler OTD, OTR/L, earned a Doctorate in Occupational Therapy from Misericordia University, Dallas, PA. She has been an occupational therapist for 18 years, serving school-aged children and adults. Kelly is winner of multiple awards including the 2020 American Occupational Therapy Association Emerging and Innovative Practice Award & a Mom’s Choice Gold Medal. She is an adjunct faculty member in the Department of Occupational Therapy at Elizabethtown College, Elizabethtown, PA and is actively involved in several research projects pertaining to topics such as interoception, self-regulation, trauma & autism. Kelly is an international speaker and presents frequently on topics related to the eight resources she has authored:


About Host, Sucheta Kamath
Sucheta Kamath, is an award-winning speech-language pathologist, a TEDx speaker, a celebrated community leader, and the founder and CEO of ExQ®. As an EdTech entrepreneur, Sucheta has designed ExQ's personalized digital learning curriculum/tool that empowers middle and high school students to develop self-awareness and strategic thinking skills through the mastery of Executive Function and social-emotional competence.

Support the show (https://mailchi.mp/7c848462e96f/full-prefrontal-sign-up)

Sucheta Kamath: Welcome to Full PreFrontal: Exposing the mysteries of Executive Function where we talk about the connection between self regulation, focus, goal management and self awareness. Now there are lots of barriers to accomplishing that. And one particular barrier is to not have a good connections with your emotions or internal states. And there are certain fields and certain experts who have incredible knowledge about that. And it's going to be a treat because our guest specializes in that body brain connection and her name is Kelly Mahler. Welcome, Kelly. Kelly has earned her doctorate in occupational therapy from misericordia University at Dallas, Pennsylvania. Yes, there are at least three Dallas's in this country. So this is Dallas, Pennsylvania. She has been an occupational therapist for past 18 years, serving school aged children and adults and what I gather from her in a pandemic, she has taken a well deserved break so that she can focus on some other amazing endeavors, particularly her writing. She is a winner of multiple awards, including 2020, American occupational therapy associations, emerging an innovative practice award, and a mom's choice gold medal, which is a spectacular honor. Congratulations, Kelly. She is an action faculty member in the Department of occupational therapy at Elizabethtown College in Elizabeth, Pennsylvania. And she is actively involved in several research projects pertaining to the topic of interoception. So this is a very interesting topic, I bet most of our listeners may not have heard the word interoception, but if you haven't, then this is the right place and right time to gather more information about she Kelly is internationally recognized and celebrated speaker and she presents frequently on this topic. And in fact, when I first got to know I thought she was from England somehow I don't know. I think I heard some accent that was British, but not. And Kelly is a prolific author, one of the books that's my particular favorite that actually talked about the eight sensory system. And and before this interview, I was talking to Kelly that, you know, as a speech language pathology, pathologist, a lot of art education is about the brain and in the brain. And I love that occupational therapy, brings it back to the body and then takes it back to the brain. So welcome to the show. And thank you so much for finding time for us.

Dr. Kelly Mahler: Wow, thank you for having me. That was quite a lovely introduction. I I'm very excited to have a chance to be here and talk about interoception.

Sucheta Kamath: Yes. So I always ask this question, since the topic is, is about executive function and our ability to gain insight into self and have that knowledge about who am I as a learner and a thinker? What works for me? What doesn't work for me? When did that knowledge? When did you When do you think you became aware of your own inner capabilities? When did you become self-aware? You think? 

Dr. Kelly Mahler: Hmm, that's a great question. Um, when I realized I became self-aware, it was probably through my work as in as learning about interoception, and really developing my ability to attend to my body, and I'm sure we'll talk about this through an active mindfulness and yoga practice. And I'm really thinking and reflecting upon what my inner experience is, has helped me to gain a much stronger sense of self.

Sucheta Kamath: You know, it's so interesting, I've been asking this question of all the experts that have had and consistently it, the answer comes out that in their early adulthood, and it's so interesting, you and I work with children and young adolescents, and it's so hard if you don't have that ability to introspect and self reflect, then kind of information you gather about yourself is so inadequate, but we expect that or rather, one of the vehicles to become more self-regulated is to develop that self-knowledge. So let's jump right into it. you specialize in interoception. Can you help us understand the term interoception? What does it mean?

Dr. Kelly Mahler: Yeah, that's a great question. And don't let the name fool you. It's something that you probably it's very common sense once I describe it, but interoception is one of your senses in your body. And it allows us to be able to notice important body signals coming from the inside of our body. So it allows us to notice when our heart is racing or our stomach is growling, or our muscles are tense or skin is sweaty, we feel all of those sensations because of this sense, called interoception. And being able to clearly notice those body signals are is really important because they serve as clues to our emotions. So noticing that growling stomach serves as a clue lets you know that you're hungry or noticing those tense muscles or that sweaty skin might serve as a clue that maybe you're feeling anxious or frustrated. And so interception provides us with this very valuable body and motion connection.

Sucheta Kamath: So, you know, I, I went, I did my undergrad in Speech and Language Pathology in India, and we had a very medical model. And so we had wonderful background in anatomy, physiology, pathology, psychology, linguistics, and one of the things in the introduction that I learned a lot about is the proprioceptive feedback and kinesthetic feedback. What is the connection between those two internal systems and the interoception?

Dr. Kelly Mahler: Yeah, so proprioception and interoception are both in our senses. And so they're both gathering information from the inside of our bodies. And so proprioception is your ability or your sense of knowing where your body parts are in space. So you can like hold your arm out to the side, like bent approximately in a 90 degree angle. And many of us don't have to look at our arm to know what position our arm is. And we have little probe receptor, proprioception receptors in our joints and muscles, sending that information to the brain letting us know that our arm is out to the side bend and 90 degree angle. And so proprioception is really helpful in allowing us to move with coordination. And without a lot of thoughts, you can climb stairs without really needing to think like, I need to lift my leg and put my foot down on the next step. Like, we do that automatically because of proprioception. And then that's opposed to interoception, which allows us to know what the condition of our inner body is. So how is the inside of our body feeling?

Sucheta Kamath: And what's so interesting, and of course, you know, what I love about our field is, we take all these things for granted, and you don't know the value or importance, or they're auto functioning until we lose them, or there's an interruption in them, or they never develop that part. And so I had a patient many years ago, and and this ability to, you know, the, one of the tests where you touch, I mean, particularly even cops do that, when somebody is drunk is do you not walk in a straight line and touch your nose and with left and right, pointing finger. And I think it's so fascinating that in certain disorders or disability in brain related disorders, you can actually lose these abilities. So definitely, this is connected to the to the way brain regulates itself or had gathers knowledge about itself. So tell us about the the maybe a quick neural lesson on how does this work at the brain level?

Dr. Kelly Mahler: Well, I can't start at the brain level, I have to start at the body level with a brain. So interoception, you have receptors located throughout your body. And so let me back up all of our senses has a set of receptors in charge of pulling in sensory information. So your sense of sight, your receptors or your eyeballs pulling in information about all that you see outside of your body, or your sense of your sense of sound has receptors in your ears pulling in information about all the sounds around your body. And so interception is exactly the same receptors located this time in the inside of your body located extensively throughout your body. So in your major organs, like your heart, your lungs, your stomach, your bladder, your colon, then we have receptors for interception in your skin, your muscles, even in like the whites of your eyeballs. And so these receptors are pulling in information about the condition of these body parts or how these body parts are feeling. And that information travels up various pathways, mainly either your vagus nerve or your some nerves in your spinal cord, and then it comes up in Atlanta in an area of the brain called your insula. And we all have a right insula and a left insula, deep within your temporal lobe, your side part of your brain. And your insula is what uses these incoming messages and translates them into your emotion. So they use these body signals coming in from the receptors as clues to what emotion or emotion you're experiencing.

Sucheta Kamath: And so I think one of the remarkable things you're pointing out here is the attunement that in order to recognize that these sensory information is coming, you, you kind of need a system that processes it and assigns meaning to it, and recognize its role in functioning. So sounds like it can go wrong either ways hyper, you can do too much of it, or you can do not anything at all. So, tell us what, what is. Of course, just like executive functions, even these skills are on a trajectory of development. So a younger a two year old is less attune than a 10 year old, probably. So how, how do we assess this? And when do we determine? I don't know if this is a good question, but when do we determine that interoceptive failures have become problematic?

Dr. Kelly Mahler: Yeah, that's a great question. And something that the interoception field is trying to figure out, like, we don't know, norms, and like what a two year old should be able to do from in terms of interoception versus a 12 year old versus a 32 year old, like, we don't know what typical, and I use that in quotes, typical interoception looks like and I don't really know if there is a typical introduction, we all have such different inner experiences. So what your body feels like when you're anxious is different than what my body feels like when I'm anxious. And what you feel like when you're thirsty is different than what I feel like when I'm thirsty. So we all have such different inner experiences. But when it becomes problematic, it's when it's affecting your function. So if you're not noticing that feeling of thirst, and you're not seeking out, you, then you're not probably seeking out drinks, or like water on your own, which can lead obviously, to a significant health problem like dehydration, etc. Or if you're not noticing, when your body's giving you signs that you're anxious, you're not going to be independently urged to use all those coping skills that were so good at teaching because you don't notice the need to use those things. So you really have to, like, zoom out and just look at the function and like, or like the observable behavior, and then think about like, could there be an underlying interoception difficulty creating what we see or the challenge that we see on the surface. And like you said, we know that some people can be unresponsive to their internal signals like so they completely miss body signals, like they don't notice when their stomach is growling, or they don't notice when their heart is racing. And so they miss this valuable signals, letting them know that they're, you know, whatever they're feeling. But then we also know that some people, they over feel their inner sense their inner signals. So they either feel so many things going on at once, that it still is really hard to figure out what clue is the most important to their emotional experience, like they just can't make sense of what's happening on the inside of their body. Or there could be one signal that's so intense. Like, for example, in a panic attack, like you might just be so stuck on your feeling of breathlessness or heart racing that you can't shift outside of that, and notice any other body signals that are giving that are happening in your body. So there's such a varying degree of interoception challenges. And so to really look at the underlying picture, and how it's impacting function as like where we're at right now, because we don't have those norms.

Sucheta Kamath: Wow. So I think first of all, what you're doing is you're introducing a new language, because language then concretizes some of the ways we could or should or would be processing information. So I love that that, you know, giving that interoception language so my stomach is growling, for example. And how do I know I'm hungry? So one obvious way is grounding, but it could be irritable. So irritable is a sign of being hungry. But it's it's not a feeling if I have never cultivated the language to describe my feelings regarding an experience in our experience. So maybe Can you walk us through some of the systems in the in the body that we could begin to consider when we talk about interoceptions, and and what would be a most obvious way it responds or gives a signal and maybe less obvious? Is that a good way to think about it? 

Dr. Kelly Mahler: Yeah, when you're talking about systems, like, Can you give me an example? 

Sucheta Kamath: I was thinking about breathing, then heart, then stomach, you know, then kind of like even our legs like, like feeling you know, like you have done a lot of walking and your legs be like lead? Or you know what I mean? And what, I'll give you a quick example that what is so silly, but you're gonna crack up so bear with me. So I did in one of my ambitious projects was to do a triathlon, but not a massive traveler and a sprint triathlon. So it had three sports And I love swimming. And I'm a swimmer. So I practiced swimming. And I did like a lot of practice with. So I can, you know, I polished that skill. And then I love biking. So I did biking to I hate running and so I did not do running at all. And the worst thing is, I never did them in one day. So I did not anticipate so I need a new individual experiences related to that sport. I never knew what does it feel like to actually come out of wet water with the wet clothes and then put the suit and then get on the bike and bike in that. So completely different experience, right? So I used to like cool body biking in a relaxed way. So I got really like, shortchanged there. But the worst thing was I never practice getting off a bike that has now cooled off because of and then run. So when I landed first time, I couldn't get bearing. I was like wobbling, like, like a toddler. And I looked like a sumo wrestler coming down the road trying to run or something. It was the most amazingly awkward experience. So that was something I was never aware that my body will have to adjust. Because the muscles now have become so exhausted. So is that a right way to think that I first time got introduced to my own body after in different stages?

Dr. Kelly Mahler: I mean, I think we all have new discoveries within our body. I mean, that's what keeps life like fresh and interesting, right? That we we always have some kind of new experience within our bodies. And that's a perfect example. And probably a lesson to anyone out there training for a triathelon to try to do all three in one day.

Sucheta Kamath: Just a note to self, people. Maybe this is one that everybody knows except Sucheta.

Dr. Kelly Mahler: I mean, I think I admire you for even trying to do a triathlon. So more power to you.

Sucheta Kamath: So maybe like in a breathing like cup, like commonly we know, like there's a kind of you feel you're breathing shallow or you're feeling tightness in the chest? What is there any other way that system can prevail itself? 

Dr. Kelly Mahler: Yeah. So I think like, if I understand your question correctly, like, you're pretty much like online with exactly how we do our intersection intervention. And we have something called the interoception curriculum that we, that we wrote, and it's a framework on how do you develop interoception. And we're putting lots of research and evidence behind it. And our outcomes are so exciting. And but the way that the first part of the intersection curriculum works is that we have a broken down into different body parts. And so like, for example, lesson one is hands and all the different ways your hands can feel. And then we go to feet. And then we go to mouth and eyes, and we learn all about the way that these different body parts can feel. And so we're starting with the body parts on the outside of our body, and then we systematically move inside. And that's because the outside body parts are more concrete, they're a little bit easier. And then we slowly work our way in to being aware of all the different ways your lungs can feel your heart can feel your muscles can feel, and so on and so forth. And so, exactly what you're saying is that for each of these body parts, we have set of experiments that we do that the learner, they do the experiment, and it gives them concrete experience.

Sucheta Kamath: What would be a good example of that?

Dr. Kelly Mahler: Like, if we go back to hands, right? We want to teach like, what does it mean to have tight hands versus loose hands? We'll give someone a stress ball say squeeze the squeeze stressful? And how does that make your hands feel? For a lot of us, it would make our hands feel tight or tense or maybe even sore, there's no right answers in our work. Because again, what your inner experience is going to be is different than mine. So we acknowledge all the answers. But we're trying to give that concrete experience of what it means to have tight hands, or what it means to have loose hands or what it means to have cold hands or warm hands. We're doing all kinds of experiments to give that concrete experience. So we're not just assuming that they understand the language because most of our learners, they don't understand the language to use to describe the way your body feels. And also they have a really hard time concretely understanding emotions because our body signals is like is there's emotion words meaning and so we're there is a huge language piece to the work that we're doing. And we're giving concrete experience through our experiments of what it means to feel all of these different things in each body part. And then after we give them that concrete experience, then we move on and we do something called a body check chart, which is just a really concrete way of teaching someone to mindfully attend to each body part and house feeling. So if I'm doing a lesson with you on hands, maybe that week, then I asked you to check in with your hands at different points in the day and tell me how they're feeling. And we have like a nice visual support that helps someone approach this in a very organized way. Because a lot of our learners are dysregulated. And sad as visual supports are so key in helping them to check in with their body parts. And we have like, different different words on the visual that they can use to describe what they're noticing their hands. So they have that language support, too.

Sucheta Kamath: So would you so externally, when you're talking about sounds like you do so used to beginning with extremities? So hands and legs? Would you then be talking about head or neck or chest and and the entire body? Or? And why? Why should we focus on the extremities, or what's the logic in that order.

Dr. Kelly Mahler: And what we learned, I've made a lot of mistakes, a lot of mistakes. And starting with developing awareness of inner inside body parts, like your heart or your stomach, like how your stomach and feel that can be really abstract for some learners, because you can't see it, and you can you have a hard time feeling it. So that's like a mismatch, we're trying to meet the learners where they're at. So starting with, starting with noticing the way your hands can feel like you can observe your hands at the same time that you're feeling them. So it's just a little bit more concrete. And we then slowly work our way up to being aware of inside body parts. So we really set that predictable pattern with outside body parts first, and then we move in and our learners are a lot more successful. And we through the work in the part one of the curriculum, we have 15 different body parts. So it's a cumulative process. So our curriculum is based on adaptive mindfulness. Because right now, the only evidence based intervention for improving interception is mindfulness. But mindfulness is amazing. I have a active mindfulness practice, but it is a mismatch for a lot of people, and where they're at currently. So we adapted mindfulness to make it more successful and available for a wide variety of learners. And so as you move through section one of the curriculum, you become aware of the way your hands can feel, then we add on the feet, then we add on the mouth, and we add on the eyes, and we add on how your ears are feeling. And we slowly build to them being able to check check in with 15 different body parts, and how are all those 15 different body parts feeling? Whereas in like traditional mindfulness, sometimes we'll say like, how does your body feel like that is like, Whoa, like, like, that's way too much way too much.

Sucheta Kamath: And it's saying to somebody, do you want to go to India? Well, yes, but you have to pick a place or region. Yes, exactly.

Dr. Kelly Mahler: That's exactly right. Yeah, it's way too much. So we're slowly building someone's mindfulness skills. And we've been just having such a incredible, incredible outcomes with that work.

Sucheta Kamath: I think what's so fascinating again, I think, and I'm so glad the work you're doing is one. I think in in the we talk a lot about 21st century skills, and and they're so in, it's focused on creating these amazingly independent children who become successful adults. And somehow it is made to believe that you arrive at success by hook or crook. And if there are any barriers, you just overcome them. What I find fascinating in that definition, is the barriers are always going to be there because you're trying to achieve, but if you keep the entire endeavor of life, cognitive or cerebral, then you're really discounting 50% of your being that comes from you being a person embodied in the body. Right. And, and, and I think I'm so glad that the even, you know, the contemplative studies, research in mindfulness is kind of bringing that body mind connection. But talk to us a little bit about the value of doing this work. Because there are like, we know, the research shows that the developmental conditions such as ADHD, depression, anxiety, autism, and not just limited to that, but trauma can actually disrupt the internal communication. Why are these kinds of conditions disrupting that regulation that happens at the body level?

Dr. Kelly Mahler: Yeah, I don't think anyone has that answer yet. I don't know if you know why. These disruptions are happening. I mean, there's some theories. And I think it's different for each of the conditions you mentioned, like for trauma, it might be out of protection, that you're just dissociating from your body because your body becomes a really intense, unsafe feeling place. So that's just out of survival. And again, that's just a theory. It's not well researched yet. And we know that people with ADHD, autism, depression, anxiety. In fact, there's papers published that every single mental health disorder that there is or diagnosis that there is has, is implicated or underneath has underlying poor interoception. There's something going on at the body level. And I think that you know, as ot like, we're, we have our roots in mental health. And the whole mental health field is rooted in cognitive approaches. And like, like you said, like we have completely lost, like, we're just completely forgetting about 50% of our being. And so for bringing this body based work back into it, like, I almost view it, especially from like, the research that I read, as like the body is the first step, then the cognition, the higher level thinking is step two. But so that's why like, a lot of our supports that we're providing, we don't, and I was one of these people, but I was like, way, too, I was way too high for a lot of my clients, like I needed to rewind, and you know, work on the body first to then really be able to help like some of my cognitive behavioral approaches that I was using really make sense to that person.

Sucheta Kamath: You know, it's so funny that I too, was I shared the same predicament for myself, I think, to appear very, I don't want to say legit, that it, it was, it was heady and complex. It's, it's reinforced with this idea that it has to be difficult. And it has to be abstract, right. So a lot of my work too, was very cognitive heavy. And as I have matured, in my own profession, it has come down to basics, like I begin with mindfulness practice, and breathing as a foundation. It's like, I feel like you we are going to take this car for a drive. But let's put some gas, you know, we like the basics is to check that internal mechanism is it's supplemented with something that will allow you to have that connection to the road. Because if you don't help connection, suddenly the car is flying. And then it's not a car anymore.

Dr. Kelly Mahler: Great analogy, one of my clients told me and I love this analogy, too. She said that these cognitive practices, is like giving someone a DVD, but without checking to make sure that their DVD players working first, and I thought that that was such a beautiful analogy. And she's an adult in her 50s and has gone through therapy after therapy after therapy. And it was finally like, finally, like, Oh my gosh, like this is why no therapy ever works for me. And she thought it was her fault. But it was it was like No, like, it's, it's because you know, we're just coming into this field of interoception and really understanding how it influences all of the other wonderful things that we do as therapists.

Sucheta Kamath: So another analogy that comes to mind. And is I always say that particularly my work is in self-awareness that should lead to self-devised strategic thinking, because at the heart of all self-management is how do I know what to change about me, so that I can attain the goals I have, for me, that's summarizing executive function. So I feel I always tell my clients and when I do the training that imagine we all carry a flashlight. And and the fundamental function of the flashlight is to shed light upon something. But we intuitively think that flashlight is facing outward, it's facing on the world. So when you talk about this internal introspective skill set, then you turn the flashlight inward. So the perception is that metacognition is that so called metacognition is looking at your thinking about your thinking, and then interoception is looking at your feeling of your feelings. Yes. Um, so I love this idea. Can you walk us through some training exercise with me? What would if I'm struggling with maintaining, I'm a kid who's wiggling a lot in his chair, and is not able to, Or I'm a kid who's putting a lot of things in his mouth. What would be a suggestion for you? Or how would you walk me through this idea of changing my ways about it? 

Dr. Kelly Mahler: Yeah, well, I would help you to become more aware of how your body is feeling and then help you to be able to connect that to like, what is what so now? Now you're noticing the way your body is feeling? Like what is that telling you? Like? What? What is it a clue to like, Is it a clue to the fact that you're feeling wiggly or you're feeling distracted? Or it's a clue that maybe you need to go get a wiggle cushion, because your body's sending you like really powerful messages that you need to move to learn and that's an amazing amazing thing that your body's telling you, you need to listen to that. So go get something to help you wiggle even more, you know, as opposed to I think like some of our old school behavioral approaches, it's like sit still. Yeah, right. And so we're diminishing a person's interoception. Because we're teaching them to, like, ignore that with their body's telling them, right? 

Sucheta Kamath: Become compliant to social norm, where this kind of movement is somehow failing, a personal failing.

Dr. Kelly Mahler: Yes, exactly. Oh, don't even get me started on all the compliance training and everything and following norms out there. I mean, I think we have a lot of work to do in so many different areas. But yeah, to like, really embrace a person's, each person's individual inner experience and their, what their body needs to be successful, is not something we're good at as a society. As a society, our bodies are like, like, a nice, like a football league, we cannot talk about our bodies, like no, don't talk about your bodies, your body is not a thing, like it's just all up here. Just focus your mind and you'll be okay. And, you know, like, thankfully, the the recent emerging research in the interoception field is blowing that out of the water, but we have a long way to go.

Sucheta Kamath: So what is, um, you also talk about eating disorders. And so many young adolescent girls that I work with, are struggling with their body image, their, their relationship to their learning and becoming independent, is so intertwined with the perceived impression that they are trying to fulfill. And, and they kind of are working on muting, more intensely working, I don't see as much as boys doing that. There was an interesting book that just came out, my girlfriend and I were on a walk, and we were talking about this book. And the author talked about that. She had a teenage boys and girls, she has two boys and one girl, and their friends were home and she walks in in the late afternoon and say he was hungry. And all the boys shouted, me, and the girls just looked at each other. They were like, Okay, are we supposed to be hungry right now? You know, like, what's the consensus? And then one girl just said, Now we're okay. And then the other three girls just went along and said, Yeah, we're fine. So there's that kind of pressure? I don't know if you see that. What? What can you talk a little bit about eating disorders?

Dr. Kelly Mahler: Yeah, um, so I can't take credit for being an eating disorder expert. But I'm someone that I speak with quite a bit. We do a lot of code talks together. Her name is Kim Clary, and she definitely has an eating disorder specialist. And she actually has had an eating disorder in the past or self. And what we know from the research is that interoception is definitely affected in many, if not most people that have an eating disorder. And what they're trying to figure out right now is like, which came first? Was it the eating disorder that that muted the interoception signals, or what was it before did they have like a pre existing interoception challenge, which got enhanced by the eating disorder, like, we don't really know what's happening, we just know that it needs to be an important part of the healing process, and really coming back into your body and safe ways. Um, but I mean, we're learning so much, every day, there's new interoception research coming out, and I can't wait to see how we understand these things better in the future, because it's really changing the way that we like we can provide successful treatment for people including individuals that have eating disorders.

Sucheta Kamath: That's that's another I had not even think a thought about it until I came across your work and started reading about, you know, your collaboration, but also addressing about bringing attention to that developing a healthy relationship with the body. So as we think about this, what are some five like, thinks that we as an average person, who may or may not even know their interoception problems, we can think about or to align ourselves and and develop a more meaningful relationship, so that we can anchor ourselves back into that wholesome thinking being?

Dr. Kelly Mahler: I think, like the number one thing is really just to take time to pay attention to your body. And that's so hard to do. I mean, many of us are just busy, busy, busy, go, go go. And we don't have a lot of time to like, just pause and check in with our body. We're, we're so strapped for time, our body is screaming at us. And we're like, oh, we're fine. Like I can eat, I can eat an hour, I can go to the bathroom in an hour, right? And so just give yourself like, I think just knowing that there is a science behind why this is so important. And just taking time, even if you have to set an alarm on your cell phone to go off to just take time. Just take 30 seconds to just tune in, scan your body and see how it's feeling can be really helpful. And and number two, like if anyone's out there as a parent, I think Number one are, the best thing that we can do is just start talking the interception talk from an early age. And just like talking about the way our bodies feeling first, and then as our child grows, helping them to discover the way that their body is feeling, and that has not only helping our child grow and develop a healthy relationship with their body, but also talking about the way our body feels out loud, and helps us to tune into our body naturally. So again, it's like a, it's a double bonus there, you're improving your own interoception and your child's. And I think like leading up to where I hear from so many people, they try mindfulness, and they fail at mindfulness. And I think that's because traditional mindfulness isn't a match for where a lot of people are at currently, but we can get there. And so just know that if you're trying mindfulness, it's okay to like, really be not good at it, I was horrible at it, I still am working at being better at it. So it's okay. This is hard work for many of us, and many of us have not tuned into our body our whole lives. So just giving yourself just being kind to yourself. And I don't know what number I'm up, I'm just gonna say one more. 

Sucheta Kamath: Oh, you're on four. You have two more.

Dr. Kelly Mahler: Okay, number four is to do things for yourself that promote comfortable feelings in your body. Don't wait until your body is so uncomfortable. And you're so you know, you're so ground down, you're so overwhelmed, you're so stressed out, do things proactively, to help your body to feel good. And I think I'm gonna just leave it at that if that's okay,

Sucheta Kamath: Great. And so I have to kind of comment on all these things you said, which is just so exciting. And, and thank you for just giving us some direction, because I think these are simple things. I so one is I you know, are very early on working with, because I have worked in rehab setting working with occupational therapist, or in many, many settings I picked up on the waited, you know, like putting eye pillows that are weighted with with sandbags, or, or putting some weighted pillows on your body when it hurts. So that has been very helpful to me when, and what my kids did not have any sensory integration issues. But what I would do is to kind of like when they were sick, I would kind of put weighted blankets. And that just would give incredible sense of security and calmness, which I recommend highly an idea. And second thing I want to tell you is it's so funny when now when my husband and I, when we got married, I would would talk about feeling bloated, when like right before my periods. And it was so funny. I think that language was very strange for my husband, who, as a man had never experienced being bloated, I guess. And he, I mean, he's a physician. So he understood conceptually, but I don't think it was part of his any repertoire of describing personal relationship to his body. And and I found that so amusing, like, he wouldn't understand it like so we have two different internal experiences. And he never had language for my experience, which you would never think right. You would think you know what I'm talking about? No, he did. But that kind of made was very surprising to me. And he to this day, like I bring that up, and he finds it amusing. Like why did you? Why do you care so much about that I said, while I was so I had taken it for granted that when I have an experience, automatically, the world will understand it because they somehow in their journey would have understood it. But if you never get periods, then you will not understand some parts of that experience. And that had never occurred to me. And then, of course, you know, I think part of our work when we work with clients, so many of their complaints are so odd and different and unique that we become our context is much larger, I feel that we have accepted over time, oh, that can happen, that can happen as well. And lastly, another thing that you talk about mindfulness. For last 12 years, I have had a very big mindfulness practice as well. And I'm recently going through Jack Kornfield, and Tara Brach's mindfulness training, and I have a week of silence coming up in two weeks. So I'm going to be completely isolated by myself. And one of the things on the agenda is walking meditation, eating meditation, and non movement meditations. So it's an interesting way of like, understanding that completely being immersed within silence with your body. That that will be one of my few experiences. Have you done something like that? Have you what kind of mindfulness training have you done? 

Dr. Kelly Mahler: Well, I don't know. If I wouldn't be a match for the sitting completely still mindfulness, I like my movement, mindfulness much more. And that probably speaks to my journey and where I'm at, and I need to keep going. But I'm in it right now I'm in a place where I feel like it's okay if I need to move in order to tune into my body. So I do a lot of walking mindfulness. And I've just someone was just telling me about, I think something called forest mindfulness. I'm not sure exactly forest bathing is what it's called, I think, Well, no, I don't know what that was. But I love going into the forests and just being in that like just being present. And like noticing everything around me noticing how everything around me is making me feel like I just love that. And just an aside, I like love when I find pinecones in the forest and I can be like it is the best feeling to me in the world is on my feel good menu. And like it is a whole day I in the forest, finding pinecones to crunch and just being with nature.

Sucheta Kamath: Pinecones in real life or everyday life is the the bubble wrap. That I love project bubble wrap. And it's so funny about pinecones. So we went to Yosemite many, many years or redwood forest and it's illegal, sorry, listeners, but to pick up the pinecones because they pinecones can be three feet tall, like really big one. So anyway, we I got one pinecone for because I'm like obsessed with pinecones. And I was feeling so torn that, oh, pinecones are bad, but I love them. So yeah, I think that's one of the things that we when my kids were younger, and we did a lot of hikes and is is alphabet meditation. So you go through the forest and look at tree shapes and identify a to z alphabet, in the shape of the twigs and the branches. And and that would one of the hardest, of course is B and anything with the round piece. But that would be something that we would do as a family and that always became an adventure meaningful adventure. Kelly, you're such a fascinating researcher and that your work is just incredibly meaningful. Thank you for sharing it. As we come to the end. Do you have any recommendations, any books that have made a big difference in your life, or you recommend our readers do grow internally?

Dr. Kelly Mahler: To grow internally...

Sucheta Kamath: Or whatever you love, anything you will recommend will be fantastic.

Dr. Kelly Mahler: Oh my goodness, I have read so many fantastic books. This must be one of the hardest questions I've ever been asked. I don't know why this is popping in my head. But I love Malcolm Gladwell's work and his book Blink. I love that. 

Sucheta Kamath: I love it. Yes.

Dr. Kelly Mahler: I'm also Daniel Kahneman his book on Thinking Fast, Thinking Slow. Like, I love that I loved that book so much. And I mean, those are the two that are that are popping in my head. I'm also a big believer in Brene Brown. I'm not sure how it applies back to interoception. But just being vulnerable and sharing your experience out there I think is so is so important to do.

Sucheta Kamath: And you know, I think sorry, we are we have come to the end, but I can't you just made me think about this. I think that vulnerability is such an important aspect of interoception. I had not thought about that. And and do you? Is there any research about difference between men and women in terms of interoception abilities? 

Dr. Kelly Mahler: Yeah, I think there's only like two studies looking at that, um, so not enough. And I and I have to go back and read them. So you might want to look this up to make sure I'm clear, but I just remember being really surprised about the findings. And I think that one of the studies found that the men scored better on the interoception measure, or they scored better in some aspect of interoception, which surprised me just from a society standpoint. This is just across the board more stereotypical but most men in our society are like taught like really don't have emotion, it it's not cool to show your emotion. So just hide that stuff stuffed down, where women were a little bit okay, like a little bit more to be able to be expressive of that. So that really surprised me. But now you're making me want to go back and read the study.

Sucheta Kamath: There's something about it that surprised me. That's so fascinating. Yeah, I'm, I'm always confused. I had another researcher. She's a fellow speech pathologist. And and she was talking about this communication skills that you know, the myth, the belief is that women are better communicators than men and then the research shows actually there's hardly any difference between men and women. So we are kind of carrying some of our cultural beliefs and imposing them so I'm I'm kind of very intrigued by it and definitely will look that up. Well, thank you for being with us. We Yes, we are at the end of this amazing conversation. I'm sorry. If I kept, I'm not letting Kelly go. But this again has been a fantastic episode where we have discussed these important topics. I always my goal for you all was to really introduce a topic that you probably have not thought about or heard of, unless you're dealing with children or adults with actual some issues with interoception. So I'm glad to introduce that topic through Kelly, an expert who, again has a very well rounded wisdom about it. As we end this, if you love what you're listening to, please feel free to share and give us a review on our podcast and until next time, stay connected with your body. Thank you so much, Kelly.

Dr. Kelly Mahler: Thank you.