The heart of the self: An interoceptive perspective on the psychotherapeutic process

Verbal dialogue remains a cornerstone of psychotherapeutic practice. However, advances in cognitive neuroscience increasingly demonstrate that bodily processes fundamentally shape cognition, emotion and the sense of self. In particular, interoception, the neural and psychological representation of internal bodily states, is now considered a fundamental aspect of selfhood and psychological regulation. Expanding empirical evidence highlights interopcetion's clinical relevance. However, the heterogeneity of this literature presently offers limited direct guidance for psychotherapeutic practice. To address this, we draw on the 'nested hierarchy of the self' model, which conceptualises the self as emerging from nested interoceptive, exteroceptive and mental self-processes. This framework captures the coupled interactions of bodily states, affective dynamics, emotional experience and narrative self-construction. The model clarifies why purely verbal interventions often remain ineffective when the underlying bodily-affective levels of the self are dysregulated. We systematically integrate and organise key neurocognitive findings on interoceptive and embodied self-processes to derive two embodied intervention formats in which the body functions as an active component of therapy. Here, embodiment extends beyond the state of restful attention to bodily signals, to engaging in directed phsyical activities that are specifically designed to align with the nested self architecture. The first intervention stabilises the exteroceptive self and peripersonal space to support functional interoception, thereby promoting safety. The second intervention, termed the 'emotional field', facilitates the reactivation and reconsolidation of distressing emotional experiences through structured bodily postures and movements. Together, these approaches demonstrate how the nested self model can translate interoceptive neuroscience into clinically applicable therapeutic formats.