Interoception and Self-awareness in Anxiety and Stress-related Disorders: A Transdiagnostic Framework for Emotional Regulation

Anxiety and stress-related disorders are characterized by distorted bodily awareness, heightened threat perception, and impaired emotion regulation. Recent advances in cognitive neuroscience emphasize interoception, the perception and interpretation of internal bodily states, as a central mechanism linking physiological signals with emotional and cognitive processes. This review synthesizes evidence on how interoceptive accuracy, sensibility, and metacognitive awareness contribute to the development and maintenance of anxiety and stress-related conditions. Neuroimaging and psychophysiological findings implicate dysfunctions within the insula and anterior cingulate cortex as neural correlates of altered interoception. The review further highlights key assessment tools, including the heartbeat detection task, heartbeat-evoked potentials, and the Multidimensional Assessment of Interoceptive Awareness, and discusses emerging intervention strategies such as mindfulness-based therapy, biofeedback, and interoceptive exposure. Conceptualizing interoception as a transdiagnostic process provides a framework for improving both diagnostic precision and therapeutic personalization in anxiety and stress disorders.