Psychology Colloquium: Interoception and Mental Health with Yoni Ashar: Deconstructing Chronic Pain

Chronic pain is the leading cause of disability nationally, and its prevalence is increasing across age groups. Medical treatments for chronic pain are often ineffective, hindered by difficulties identifying peripheral tissue causes of pain. Psychological treatments typically view pain as a lifelong, chronic condition to be managed, aiming to help patients live gracefully with pain. Here, I integrate advances from neuroscience, psychology, and medicine to argue that most chronic pain is driven by functional changes in predictive processing, fear-avoidance learning, and interoceptive/somatosensory processing. Critically, this suggests that many cases of chronic pain can be “unlearned”— with symptoms mostly or completely eliminated. Based on this theoretical grounding, we developed a novel psychological treatment framework, Pain Reprocessing Therapy (PRT). A core component of PRT is the reappraisal of somatosensory and interoceptive sensations as brain-generated and non-dangerous. In a recently completed clinical trial (N = 151), 66% of patients randomized to PRT were pain-free or nearly so at post-treatment, as compared to less than 20% of controls (Ashar et al., 2022 JAMA Psych). Using patientreported outcomes, natural language processing methods, functional MRI, and qualitative analyses of post-treatment interviews, we found that pain reductions were supported by a) reductions in fearful pain beliefs, b) reattributing the causes of pain to mental or brain processes, c) functional changes in prefrontal and primary somatosensory regions, and d) broader changes in emotional functioning, consistent with hypothesized treatment mechanisms. Our findings upend traditional diagnostic and treatment paradigms, suggesting that many cases of chronic pain may be largely “constructed” by cortical and subcortical processes supporting sensory inference and meaning making. Building from this and related previous work, I describe describe future research directions investigating the role of interoceptive and somatosensory process in non-pain mental health conditions (e.g., anxiety disorders, PTSD, addiction), with a focus on interventions targeting attention to and appraisals of bodily feelings linked to maladaptive health behaviors.

Speakers

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  Yoni Ashar

  Weill Cornell Medical College