, Volume 7, Issue 5, pp 1170–1181 | Cite as

An Investigation of the Effects of Brief Mindfulness Training on Self-Reported Interoceptive Awareness, the Ability to Decenter, and Their Role in the Reduction of Depressive Symptoms

  • Maria Fissler
  • Emilia Winnebeck
  • Titus Schroeter
  • Marie Gummersbach
  • Julia M. Huntenburg
  • Matti Gaertner
  • Thorsten BarnhoferEmail author


Mindfulness-based interventions for the prevention and treatment of depression are predicated on the idea that interoceptive awareness represents a crucial foundation for the cultivation of adaptive ways of responding to negative thoughts and mood states such as the ability to decenter. The current study used a multi-dimensional self-report assessment of interoceptive awareness, including regulatory and belief-related aspects of the construct, in order to characterize deficits in interoceptive awareness in depression, investigate whether brief mindfulness training could reduce these deficits, and to test whether the training unfolds its beneficial effects through the above-described pathway. Currently depressed patients (n = 67) were compared to healthy controls (n = 25) and then randomly allocated to receive either a brief training in mindfulness (per-protocol sample of n = 32) or an active control training (per-protocol sample of n = 28). Patients showed significant deficits across a range of regulatory and belief-related aspects of interoceptive awareness, mindfulness training significantly increased regulatory and belief-related aspects of interoceptive awareness, and reductions in depressive symptoms were mediated through a serial pathway in which training-related increases in aspects of interoceptive awareness were positively associated with the ability to decenter, which in turn was associated with reduced symptoms of depression. These results support the role of interoceptive awareness in facilitating adaptive responses to negative mood.


Mindfulness Depression Interoceptive awareness Decentering 



This research was funded by the German Research Foundation Grant BA2255 3-1, awarded to Thorsten Barnhofer. The funders had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article to Mindfulness. Thorsten Barnhofer is supported by a Heisenberg Fellowship from the German Research Foundation (BA2255 2-1).

Compliance with Ethical Standards

Conflict of Interest

Thorsten Barnhofer has received honoraria or fees for lectures, workshops, courses, and educational presentations on mindfulness or mindfulness-based cognitive therapy as well as royalties for a book on mindfulness-based cognitive therapy. All other authors declare no conflicts of interest.

Ethical Approval

All procedures performed in the study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments.


This research was funded by the German Research Foundation Grant BA2255 3-1, awarded to Thorsten Barnhofer. Thorsten Barnhofer is supported by a Heisenberg Fellowship from the German Research Foundation (BA2255 2-1). The funders had no role in study design; in the collection, analysis, and interpretation of data; in the writing of this report; and in the decision to submit the article.


  1. Avery, J. A., Drevets, W. C., Moseman, S. E., Bodurka, J., Barcalow, J. C., & Simmons, W. K. (2014). Major depressive disorder is associated with abnormal interoceptive activity and functional connectivity in the insula. Biological Psychiatry, 76(3), 258–266. doi: 10.1016/j.biopsych.2013.11.027.CrossRefPubMedGoogle Scholar
  2. Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression Inventory-II. San Antonio: Psychological Corporation.Google Scholar
  3. Bieling, P. J., Hawley, L. L., Bloch, R. T., Corcoran, K. M., Levitan, R. D., Young, L. T., … Segal, Z. V. (2012). Treatment-specific changes in decentering following mindfulness-based cognitive therapy versus antidepressant medication or placebo for prevention of depressive relapse, Journal of Consulting and Clinical Psychology, 80(3), 365–372. doi: 10.1037/a0027483
  4. Bornemann, B., Herbert, B. M., Mehling, W. E., & Singer, T. (2015). Differential changes in self-reported aspects of interoceptive awareness through 3 months of contemplative training. Frontiers in Psychology, 6, 504.Google Scholar
  5. Craig, A. D. (2002). How do you feel? Interoception: the sense of the physiological condition of the body. Nature Reviews Neuroscience, 3(8), 655–666.CrossRefPubMedGoogle Scholar
  6. Critchley, H. D., Wiens, S., Rotshtein, P., Ohman, A., & Dolan, R. J. (2004). Neural systems supporting interoceptive awareness. Nature Neuroscience, 7(2), 189–195. doi: 10.1038/nn1176.CrossRefGoogle Scholar
  7. Delgado-Pastor, L. C., Ciria, L. F., Blanca, B., Mata, J. L., Vera, M. N., & Vila, J. (2015). Dissociation between the cognitive and interoceptive components of mindfulness in the treatment of chronic worry. Journal of Behavior Therapy and Experimental Psychiatry, 48, 192–199. doi: 10.1016/j.jbtep.2015.04.001.CrossRefPubMedGoogle Scholar
  8. Dunn, B. D., Dalgleish, T., Ogilvie, A. D., & Lawrence, A. D. (2007). Heartbeat perception in depression. Behaviour Research and Therapy, 45(8), 1921–1930. doi: 10.1016/j.brat.2006.09.008.CrossRefGoogle Scholar
  9. Dunn, B. D., Galton, H. C., Morgan, R., Evans, D., Oliver, C., Meyer, M., … Dalgleish, T. (2010a). Listening to your heart. How interoception shapes emotion experience and intuitive decision making, Psychological Science, 21(12), 1835–44. doi: 10.1177/0956797610389191
  10. Dunn, B. D., Stefanovitch, I., Evans, D., Oliver, C., Hawkins, A., & Dalgleish, T. (2010b). Can you feel the beat? Interoceptive awareness is an interactive function of anxiety- and depression-specific symptom dimensions. Behaviour Research and Therapy, 48(11), 1133–1138. doi: 10.1016/j.brat.2010.07.006.CrossRefPubMedPubMedCentralGoogle Scholar
  11. First, M. D., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (2002). Structured Clinical Interview for DSM-IV TR Axis I disorders, research version. New York: Biometrics Research, New York State Biometric Institute.Google Scholar
  12. Fresco, D. M., Moore, M. T., van Dulmen, M. H. M., Segal, Z. V., Ma, S. H., Teasdale, J. D., & Williams, J. M. G. (2007). Initial psychometric properties of the experiences questionnaire: validation of a self-report measure of decentering. Behavior Therapy, 38(3), 234–246. doi: 10.1016/j.beth.2006.08.003.CrossRefPubMedGoogle Scholar
  13. Füstös, J., Gramann, K., Herbert, B. M., & Pollatos, O. (2013). On the embodiment of emotion regulation: interoceptive awareness facilitates reappraisal. Social Cognitive and Affective Neuroscience, 8(8), 911–917. doi: 10.1093/scan/nss089.CrossRefPubMedGoogle Scholar
  14. Garfinkel, S. N., & Critchley, H. D. (2013). Interoception, emotion and brain: new insights link internal physiology to social behaviour. Commentary on: "Anterior insular cortex mediates bodily sensibility and social anxiety" by Terasawa et al. (2012). Social Cognitive and Affective Neuroscience, 8(3), 231–234.CrossRefPubMedPubMedCentralGoogle Scholar
  15. Garfinkel, S. N., Seth, A. K., Barrett, A. B., Suzuki, K., & Critchley, H. D. (2015). Knowing your own heart: distinguishing interoceptive accuracy from interoceptive awareness. Biological Psychology, 104, 65–74.CrossRefPubMedGoogle Scholar
  16. Gecht, J., Kessel, R., Mainz, V., Gauggel, S., Drueke, B., Scherer, A., & Forkmann, T. (2014). Measuring decentering in self-reports: psychometric properties of the experiences questionnaire in a German sample. Psychotherapy Research : Journal of the Society for Psychotherapy Research, 24(1), 67–79. doi: 10.1080/10503307.2013.821635.CrossRefGoogle Scholar
  17. Hart, W. (1987). The art of living: Vipassana meditation as taught. (S. N. Goenka, Ed.). New York, NY: Harper Collins.Google Scholar
  18. Hautzinger, M., Keller, F., & Kuehner, C. (2009). Beck Depressionsinventar Revision. Frankfurt: Pearson Assessment.Google Scholar
  19. Hayes, A.F. (2013). Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach. New York: Guilford PressGoogle Scholar
  20. Herbert, B. M., & Pollatos, O. (2014). Attenuated interoceptive sensitivity in overweight and obese individuals. Eating Behaviors, 15(3), 445–448. doi: 10.1016/j.eatbeh.2014.06.002.CrossRefPubMedGoogle Scholar
  21. Herbert, B. M., Pollatos, O., & Schandry, R. (2007). Interoceptive sensitivity and emotion processing: an EEG study. International Journal of Psychophysiology : Official Journal of the International Organization of Psychophysiology, 65(3), 214–227. doi: 10.1016/j.ijpsycho.2007.04.007.CrossRefGoogle Scholar
  22. Herbert, B. M., Herbert, C., & Pollatos, O. (2011). On the relationship between interoceptive awareness and alexithymia: is interoceptive awareness related to emotional awareness? Journal of Personality, 79(5), 1149–1175. doi: 10.1111/j.1467-6494.2011.00717.x.CrossRefPubMedGoogle Scholar
  23. Herbert, B. M., Blechert, J., Hautzinger, M., Matthias, E., & Herbert, C. (2013). Intuitive eating is associated with interoceptive sensitivity. Effects on body mass index, Appetite, 70, 22–30. doi: 10.1016/j.appet.2013.06.082.PubMedGoogle Scholar
  24. Hölzel, B. K., Lazar, S. W., Gard, T., Schuman-Olivier, Z., Vago, D. R., & Ott, U. (2011). How does mindfulness meditation work? proposing mechanisms of action from a conceptual and neural perspective. Perspectives on Psychological Science, 6(6), 537–559. doi: 10.1177/1745691611419671.CrossRefGoogle Scholar
  25. Kabat-Zinn, J. (1990). Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness. New York: Delta Trade Paperbacks.Google Scholar
  26. Kerr, C. E., Sacchet, M. D., Lazar, S. W., Moore, C. I., & Jones, S. R. (2013). Mindfulness starts with the body: somatosensory attention and top-down modulation of cortical alpha rhythms in mindfulness meditation, Frontiers in Human Neuroscience, 7(JAN), 12. doi: 10.3389/fnhum.2013.00012
  27. Mehling, W. E., Wrubel, J., Daubenmier, J. J., Price, C. J., Kerr, C. E., Silow, T., & Stewart, A. L. (2011). Body awareness: a phenomenological inquiry into the common ground of mind-body therapies. Philosophy, Ethics, and Humanities in Medicine : PEHM, 6(1), 6. doi: 10.1186/1747-5341-6-6.CrossRefPubMedPubMedCentralGoogle Scholar
  28. Mehling, W. E., Price, C., Daubenmier, J. J., Acree, M., Bartmess, E., & Stewart, A. (2012). The multidimensional assessment of interoceptive awareness (MAIA). PloS One, 7(11), e48230. doi: 10.1371/journal.pone.0048230.CrossRefPubMedPubMedCentralGoogle Scholar
  29. Parkin, L., Morgan, R., Rosselli, A., Howard, A., Sheppard, A., Evans, D., Hawkins, A., Martinelli, M., Golden, A.-M., Dalgleish, T., & Dunn, B. (2014). Exploring the relationship between mindfulness and cardiac perception. Mindfulness, 5(3), 298–313.CrossRefGoogle Scholar
  30. Paulus, M. P., & Stein, M. B. (2010). Interoception in anxiety and depression. Brain Structure & Function, 214(5–6), 451–463.CrossRefGoogle Scholar
  31. Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40, 879–891.CrossRefGoogle Scholar
  32. Sanfey, A. G., Rilling, J. K., Aronson, J. A., Nystrom, L. E., & Cohen, J. D. (2003). The neural basis of economic decision-making in the ultimatum game. Science, 300(5626), 1755–1758. doi: 10.1126/science.1082976.CrossRefGoogle Scholar
  33. Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2013). Mindfulness-based cognitive therapy for depression (2nd ed.). New York: Guilford Press.Google Scholar
  34. Teasdale, J. D. (1999a). Emotional processing, three modes of mind and the prevention of relapse in depression. Behaviour Research and Therapy, 37(Suppl 1), S53–S77. Retrieved from CrossRefPubMedGoogle Scholar
  35. Teasdale, J. D. (1999b). Metacognition, mindfulness and the modification of mood disorders. Clinical Psychology & Psychotherapy, 6(2), 146–155. doi: 10.1002/(SICI)1099-0879(199905)6:2<146::AID-CPP195>3.0.CO;2-E.CrossRefGoogle Scholar
  36. Terhaar, J., Viola, F. C., Bär, K.-J., & Debener, S. (2012). Heartbeat evoked potentials mirror altered body perception in depressed patients. Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology, 123(10), 1950–1957. doi: 10.1016/j.clinph.2012.02.086.CrossRefGoogle Scholar
  37. Watkins, E. (2004). Adaptive and maladaptive ruminative self-focus during emotional processing. Behaviour Research and Therapy, 42(9), 1037–1052. doi: 10.1016/j.brat.2004.01.009.CrossRefPubMedGoogle Scholar
  38. Watkins, E. R. (2008). Constructive and unconstructive repetitive thought. Psychological Bulletin, 134(2), 163–206. doi: 10.1037/0033-2909.134.2.163.CrossRefPubMedPubMedCentralGoogle Scholar
  39. Werner, N. S., Schweitzer, N., Meindl, T., Duschek, S., Kambeitz, J., & Schandry, R. (2013). Interoceptive awareness moderates neural activity during decision-making. Biological Psychology, 94(3), 498–506. doi: 10.1016/j.biopsycho.2013.09.002.CrossRefPubMedGoogle Scholar
  40. Williams, J. M. G., Crane, C., Barnhofer, T., Brennan, K., Duggan, D. S., Fennell, M. J. V, … Russell, I. T. (2014). Mindfulness-based cognitive therapy for preventing relapse in recurrent depression: A randomized dismantling trial, Journal of Consulting and Clinical Psychology, 82(2), 275–86. doi: 10.1037/a0035036

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Dahlem Center for Neuroimaging of EmotionsFreie Universitaet BerlinBerlinGermany

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