Peer-reviewed article

Protocol for a Multimodal Investigation of Interoception in Adolescence and Testing Virtual Reality Interventions to Improve Interoceptive Impairments.

Nathan M Boyle, Sarah H Guo, Madison M Angelo, Ann S Choe, Liuyi Chen et al. · 28 Sept 2026

Abstract

BACKGROUND: Psychiatric conditions predominantly emerge in adolescence and represent a leading cause of disability and morbidity worldwide. Interoceptive dysfunction has been implicated in the development and maintenance of several psychiatric conditions and is characterized by disruptions in the perception and interpretation of internal bodily signals. Despite its recognized importance, interoception has not been well-characterized in adolescence-a key developmental period marked by profound neurobiological, physiological, and psychosocial change. Consequently, the precise role of interoceptive dysfunction in the onset and progression of psychiatric disorders remains unclear. Thus, research is needed to characterize interoception in adolescence, elucidate its contributions to psychiatric conditions, and determine interventions that effectively address interoceptive impairments. Importantly, such interventions should be designed with future dissemination in mind-prioritizing accessibility, scalability, and standardization. Virtual reality (VR) represents one promising approach to deliver therapeutic skills that target interoception, which also engages multiple sensory systems (e.g., visual, auditory, bodily signals) during intervention delivery. These immersive and controllable experiences provide a unique platform to systematically target interoceptive processes when delivering evidence-based therapeutic strategies such as mindfulness and relaxation training. By enabling standardized delivery and precise manipulation of multisensory experiences, VR may overcome key barriers to the dissemination and scalability of traditional approaches to intervention. OBJECTIVE: This project conducts a multimodal assessment of interoception and related learning processes in adolescence and tests whether two single session interventions (SSI) delivered in VR improve interoceptive functioning. METHODS: Ninety adolescents (60 with psychiatric disorders associated with interoceptive impairments and 30 unaffected healthy controls) between 12 and 17 years of age will complete a structured diagnostic clinical interview and an assessment battery of questionnaires to characterize the presence of psychiatric disorders, severity of psychiatric symptoms, interoceptive awareness, and related constructs (e.g., sleep, distress tolerance, mindfulness, self-efficacy). Youth will complete validated tasks to assess interoceptive functioning (e.g., cardiac interoceptive accuracy, interoceptive awareness of heart rate) and two associative learning mechanisms (e.g., aversive conditioning and reward learning). While cardiac interoception will serve as the primary outcome measure of interoceptive functioning, secondary outcomes of other systems will be explored (e.g., temporal coupling between gastric rhythms and neural activity). Finally, participants will complete two SSIs in VR (i.e., mindfulness, relaxation training) to examine effects on interoceptive accuracy and awareness. RESULTS: Participant enrollment began in December 2024. Currently, 45 participants have enrolled in study protocol. Participants are 15.3 ± 1.7 years of age on average with a nearly equal distribution of boys and girls. At this time, there are no differences in demographic characteristics between adolescents with and without psychiatric conditions. CONCLUSIONS: Findings will provide novel insights about interoception in adolescence and clarify its role in the development and maintenance of psychiatric disorders. It will provide preliminary evidence on the feasibility and effectiveness of brief VR-based mindfulness and relaxation interventions targeting interoception, helping to inform future early intervention strategies for at-risk youth. CLINICALTRIAL: Open Science Foundation: 9s48q; https://osf.io/9s48q (registered May 4, 2024).