Interoception in Practice with Bo Forbes (LBP 053)

Bo Forbes is a clinical psychologist, yoga teacher, and Integrative Yoga Therapist. She and I had a chance to talk way back in season one, and today I'm delighted that she joins the show again. A central guiding theme of Bo’s work is with interoception, and she has put together the Interoception Tribal Council which is bringing together researchers, primarily neuroscientists, who are looking at interoception and its effect on the whole person’s health both physically and mentally. In this conversation we talk about some of the amazing research that is coming out these days, but we also talk about her own experience putting her interoceptive abilities to the test when she underwent hip surgery this year- which was her 4th hip surgery in 8 years. It’s a really beautiful story of living one’s practice. I hope you enjoy it as much as I did.

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Conversation highlights

  • The creation of the Interoception Tribal Council- who is participating and what are they working on together?
  • How has interoception become a central part of Bo's work?
  • Bo talks about the study by David Creswell which demonstrates that mindfulness leads to reduced inflammation markers in the body.
  • Remarkably, these changes were absent in people who practiced relaxation without mindfulness.
  • The Default Mode Network of the brain- thinking about the past, wishing things were different, imagining what things will be- the tendency it creates towards a negative self-referential way of being in the world. "I am not worthy" or, "I will never get what I need" messages.
  • This DMN (Default Mode Network) plays a huge role in depression. Mindfulness separates this mode from direct experience. This creates changes in the brain related to depression.
  • The Creswell study encourages specifically people to pay close attention to their bodies- even to notice the negative feelings in their bodies- so he was leading them in increasing interoceptive awareness.
  • Bo's hip surgeries- two doctor errors and one hospital error led to 4 surgeries in 8 years. There was a strong PTSD issue with this, and a compelling narrative that made her look closely at chronic pain, the DMN, and interoception.
  • The idea that someone had damaged her body and ruined it forever was pervasive in her life. The tendency to look for and predict the same pain she had felt the day before. It made her very stuck.
  • Bo's choice to not be put under general anesthesia during the surgery- how that changed her interaction with the doctors and nurses.
  • How Bo used her interoceptive practice to manage the experience of being awake through the surgery. Her intimate relationship with her breath and heart rate in order to maintain staying awake for the surgery.
  • The direct impact the lack of general anesthesia had on her rate of recovery. For whose benefit are patients put under? Is it perhaps a protocol that has become so automatic that it never gets questioned? What happens when we question its necessity?
  • Based on the Creswell study, cultivating this interoceptive ability also likely has a remarkable effect on immunity and the experience of pain. It was amazing how many times in the hospital they wanted her to take something but she didn't need it because she only had some soreness.
  • It's also clear from this experience why we don't want to be in our bodies. Our bodies can be like a vacation home that you haven't gone back to in years and it's gone into disrepair- as you approach that home that hasn't been inhabited in a long time its intimidating.
  • We get deliberate training to be out of body and to focus mostly on what is coming in through the visual cortex. Trauma also makes us not want to be in our body. It doesn't feel like a safe space to be in the body.
  • Nervous system hyper-arousal is a form of collective trauma that we all go through in our culture.
  • Being disembodied is also a form of trauma.
  • Connective tissue has this amazing linkage with interoceptive awareness. Using self-care methods like Yoga Tune Up or MELT- these are objects without emotional load that can help us to check in with our bodies.
  • Just putting our hands on our bodies and bringing attention to our bodies and where our hands meet our bodies can be so helpful.
  • In modern yoga in our culture we have a focus on proprioceptive movement. We start with action, "do this". Then if there's time we will add in an instruction to breath. Then if we really have time there might be an awareness based cue. In [Bo's tradition] they reverse that. Starting with an awareness based instruction, from that place of awareness they can breath or move where awareness is growing.

Resources

Bo's beautiful post on her surgery experience The Beauty of Broken

Bo's article on the Creswell study in Yoga Journal

The New York Times on the Creswell study

The Creswell study in Biological Psychiatry 

Farb and Segal research on the Default Mode Network and depression

Dave Vago

Catherine Kerr

Mind and Life Institute Fellow Program

Mindfulness Based Stress Reduction

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