I feel you, bro - The insula

The insula is known as the interoception center. This part of the brain allows you to be aware of and connect with all of your internal sensations and experiences. An example of this might be when you feel hungry, warm, or nervous. The insula is extremely important although it is often overlooked. That is because without a strong and regulated insula it is difficult to identify not only  physical sensations but also emotions. Remember, emotions are always experienced in the body as well as the mind. One way to think about this is that when I say “I feel (mad, glad, sad, scared) what I am saying is that I am noticing my body’s response to an emotion – not the emotion itself. When we can feel into the body and connect with internal sensations those sensations provide critical information about the emotion you are experiencing. These feelings are quite different depending on the situation. For example, you may notice that when you experience love for someone it feels different in the body than when you experience anger about an injustice.

In the context of trauma, the insula becomes dysregulated, thus interrupting someone's ability to feel into the body and work with physical sensations. For instance, in traumatized brains the insula may be under activated, hyperactivated, or hyperreactive (meaning overly sensitive) to shifts in the internal sensations. When it is over activated there can be emotional reactivity and outbursts (also known as emotion under-modulation). When it is under activated there may be numbing or dissociation. Both of these extremes are commonly seen in PTSD.

One of our goals in the treatment of trauma is to build a strong but regulated insula. A more regulated insula allows improved interoception, and as a result, experience fewer emotional outbursts and dissociative symptoms including numbing. Additionally with a strong insula people are better able to feel into their own bodies, identify the emotions they are experiencing, and regulate them more effectively.