Minding the Body: A Meta-analysis of the Effects of Mindfulness Meditation Training on Self-reported Interoception

Minding the Body: A Meta-analysis of the Effects of Mindfulness Meditation Training on Self-reported Interoception | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Minding the Body: A Meta-analysis of the Effects of Mindfulness Meditation Training on Self-reported Interoception Isaac N. Treves, Ya-Yun Chen, Caitlyn L. Wilson, Charles Verdonk, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6792067/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 06 Nov, 2025 Read the published version in Scientific Reports → Version 1 posted 21 You are reading this latest preprint version Abstract Mindfulness meditation training may cultivate interoceptive awareness and provide therapeutic benefit when implemented within mental and physical health interventions. This pre-registered meta-analysis evaluated the impact of mindfulness interventions on self-reported interoception measures and associated relationships with psychological outcomes. Twenty-nine randomized controlled trials with 2,191 participants (77.8% female, mean age 32.8 years) were meta-analyzed using correlated and hierarchical effects models. Interventions included mindfulness-based programs ( k = 15), body-based approaches (incorporating elements like massage, k = 8), and other variations ( k = 6). Five SIMs were tested; the Multidimensional Assessment of Interoceptive Awareness was the most common (22 studies). Results showed a small-to-medium positive effect on interoception measures across all studies ( g = 0.31, p < 0.001, 95% CI [0.21, 0.42]) with low-to-moderate heterogeneity ( τ = 0.16). Mindfulness-based programs demonstrated the largest effects ( g = 0.41). No evidence of publication bias was found. No other moderators, such as practice dosage or clinical sample, were significant. Improvements in self-reported interoception were similar in size to improvements in self-reported mindfulness and were related to improvements in psychological distress. These meta-analytic findings provide evidence that mindfulness-based interventions lead to adaptive changes in the subjective experience of interoception, perhaps contributing to improved mental wellbeing. Biological sciences/Psychology/Human behaviour Health sciences/Medical research/Translational research mindfulness interoception MAIA body awareness meditation meta-analysis Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Interoception refers broadly to the processing of internal bodily signals by the nervous system [ 1 ], and is related to emotional awareness, self-regulation, mental health, and cognition [ 1 – 4 ]. Interoception can be measured objectively, e.g. by testing how accurately one can sense one’s resting heartbeat [ 5 , 6 ], or via homeostatic perturbations of physiological states [ 7 ]. Reduced interoceptive accuracy has been suggested to underly behavioral health difficulties in autism and other neurodevelopmental populations [ 8 ], and is implicated in anxiety and depression [ 9 – 11 ]. Interoception also involves subjective components, including interoceptive sensibility, attention, interpretation, and regulation of bodily signals – which may be measured through self-report using questionnaires. Self-reported interoception is especially relevant in clinical contexts, and the use of questionnaires reflects a standardized effort to delineate symptoms and track changes in symptoms following treatment. Decreased levels of self-reported interoceptive attention and regulation are found in individuals with abnormalities of emotional experience, such as alexithymia [ 12 , 13 ]. Interoceptive catastrophizing (i.e., exaggerated symptom reporting) is common in individuals with somatic, generalized, and panic disorders [ 14 ], and similar reports are found in other conditions including post-traumatic stress disorder, irritable bowel syndrome, fibromyalgia, eating disorders, and substance use disorders [ 15 ]. Given the evidence that difficulties with interoception are related to psychopathology, there is substantial interest in cultivating interoceptive awareness through mind-body interventions [ 15 – 19 ], including those utilizing mindfulness meditation [ 20 , 21 ]. Mindfulness is often defined as a non-judgmental awareness of the present moment [ 22 ], although this reflects a secular distillation from a broader historical Buddhist tradition. Mindfulness-Based Stress Reduction (MBSR) [ 23 ] emerged as a paradigmatic program for training mindfulness in the context of efforts to achieve symptom reduction in various physical and mental conditions. Following standard recommendations [ 24 ] we distinguish trainings based in theory and curricula of MBSR as mindfulness-based programs (MBP) from the more general health-based approaches, which we refer to as mindfulness-based interventions (MBI) [ 25 ]. MBSR consists of 8 weeks of mindfulness training through focused attention meditation, body scan meditation, mindful movement (e.g., yoga asana), dialogue and inquiry, and didactic instruction. While cognitive explanations of mindfulness emphasizing attention and emotion regulation predominate in the literature (e.g., [ 26 ]), MBSR was initially conceived for individuals with chronic pain [ 27 ], and transforming the process of sensing and interpreting body signals was always a central part of the therapeutic approach [ 28 ]. Many elements of MBSR involve body-focused awareness and a sustained top-down attentional focus on interoceptive signals [ 29 ]. For example, the most commonly taught focused attention meditation includes the practice of continuously attending to signals of the breath and discerning its movements throughout the nasal cavities, chest, diaphragm, and abdomen. Body scans involve shifting attention throughout the body and observing spontaneously arising signals. Mindful movement involves proprioceptive attention as the body changes position and orientation as well as breath awareness. All of these practices are taught with an emphasis on acceptance, present-moment sensory awareness, non-judgement and self-compassion, and formal and informal practice of these qualities are emphasized in didactics. There is systematic meta-analytic evidence that mindfulness-based interventions involve improvements in certain objective measures of body awareness [ 30 ]. In that initial meta-analysis, we advanced the framework of ‘accurate and correct monitoring’ to identify and categorized body awareness tasks, to include both ‘proximal’ tasks (e.g., heartbeat perception) and ‘distal’ tasks (e.g., monitoring emotional arousal in the body during a movie [ 31 ]). A updated meta-analysis using this framework confirmed a small, heterogeneous effect of mindfulness on objective accuracy, that was most prominent for distal measures [ 32 ]. There was no evidence of differences in proximal tasks, such as heartbeat perception, as we have found previously [ 30 , 33 ]. These dissociations between proximal and distal measures may, in part, reflect process-specific practice effects, as most MBPs do not specifically target heartbeat perception. To date there are few MBPs evaluating a training effect on respiratory interoception. While there are many studies examining the subjective aspects of interoception, there is no meta-analytic clarity about the effects of mindfulness or MBPs on self-reported interoception broadly. Several well-established self-reported interoception measures (SIM) exist, e.g., the Scale of Body Connection [ 34 ], and the Multidimensional Assessment of Interoceptive Awareness [ 35 , 36 ], but they have yet to be meta-analytically examined in the context of mindfulness. One question is whether all measures are equally sensitive to mindfulness meditation training. Distinctions between scales, including the distinction between maladaptive and adaptive subjective interoception [ 12 , 37 ], may inform the understanding of processes involved in MBIs. Statistical differences between scales may be assessed in a meta-analytic framework. Other questions concern the relationships between improvements in interoception and improvements in distress and mindfulness. A recent study found that interoceptive appreciation (measured by the MAIA Body Listen + Trusting subscales) partially mediated the effects of a mindfulness-based program on enhancing the capacity for health behavior change [ 38 ]. If relationships between changes in clinical outcomes and interoception are consistent across studies, this could support measurement of interoception as a process in MBIs, as well as mindfulness didactics focusing on interoceptive awareness [ 40 ]. Previous studies have examined the effects of mind-body interventions on interoception in psychiatric disorders [ 15 , 18 ], but a systematic interrogation of effects on self-reported interoception measures is lacking. In the current study, we meta-analytically examined evidence from randomized control trials evaluating the effects of mindfulness interventions on self-reported interoception, including both MBP interventions structured similarly to MBSR, but also incorporating any interventions with teacher-led mindfulness meditation. Given some uncertainty about the scope of SIMs, we use measures incorporated previously in a construct review[ 41 ], and we use cutting-edge meta-analytic techniques to account for correlated measures within studies [ 42 ]. We analyzed moderators including study adherence, study populations and practice quantities to inform theories of interoceptive skill acquisition. Our preregistered questions were: (RQ1): Do mindfulness interventions improve self-reported interoception? If so, which constructs of interoception (e.g. adaptive or maladaptive) are influenced by mindfulness interventions? (RQ2) What characteristics of mindfulness interventions and participant samples moderate effects on self-reported interoception? (RQ3) Do changes in interoception relate to changes in psychological symptoms? Methods Objectives The objective of this meta-analysis was to (RQ1) analyze the effects of mindfulness training on self-reported interoception, as well as test (RQ2) moderation effects, and finally (RQ3) to assess the relationship between changes in interoception, changes in psychological distress, and changes in mindfulness. Protocol and Registration The meta-analysis was preregistered at https://osf.io/yr439 . Several deviations were made. Namely, we used expert input for dimensions of interoception instead of empirical factor analyses, given incomplete coverage of the present measures in empirical factor analyses [ 41 ]. In addition, we renamed ‘interoception’ interventions to ‘body-based’ interventions given that they included interoceptive, proprioceptive and body awareness practices generally. Most importantly, we found inadequate performance of the bivariate meta-analytic models for assessing relationships between changes in distress, mindfulness, and interoception. The models uniformly produced high correlation values, but also extremely large confidence intervals that varied based on model assumptions. For instance, the relationship between mindfulness and distress was significant assuming no sampling covariance, but when positing a moderate sampling covariance it was not significant. For this reason, we characterized the relationships using correlation coefficients and scatterplots, but did not test statistical significance. We followed PRISMA guidelines [ 43 ](Supplement 2: CHECKLIST ). Eligibility Criteria We included only randomized controlled trials of MBIs that involved sustained (> 4 formal hours) practice of mindfulness meditation, defined as practices including: open awareness, breath meditation and body scans, with the focus of present-moment awareness and acceptance [ 44 – 46 ]. Interventions could also include other components such as yoga, walking and massage, as long as they were paired with mindfulness meditation. This decision was made to maintain a pluralistic and inclusive focus of MBIs [ 25 , 47 ]; however, we coded the relevant distinctions between interventions so as to isolate differential effects. Specifically, we categorized interventions as (1) MBPs (i.e., MBSR, MBCT, and other programs with the same training standards and curricular elements [ 24 ]), (2) body-based MBIs that included massage, and (3) other MBIs. We excluded app-based interventions given heterogeneous training durations, more limited adherence, and lack of teacher involvement [ 48 ]. See Supplemental Table S1 for a full list of included studies. For the present meta-analysis, we refer broadly to interoception as the processing of internal bodily signals by the nervous system, and to interoceptive self-report as measuring interoceptive beliefs, attitudes, and thoughts. Studies in the current review must have included data from a questionnaire primarily developed for studying the construct of interoception. We specifically included any questionnaires that were present in a systematic review of self-report interoception constructs [ 41 ] (Table 1 ). We additionally added two questionnaires – the Scale of Body Connection (SBC) [ 34 ] and the Cardiac Anxiety Questionnaire (CAQ) [ 49 ], because examination of their item-level responses revealed compatibility with the measurement of self-reported interoception. It should be noted that the Five-Facet Mindfulness Questionnaire and its ‘Observing’ subscale was not considered a self-report measure of interoception, as the item-level responses primarily assess awareness of external sensory experiences (e.g. sun on face, wind in hair) and general emotional awareness, rather than direct perception of internal bodily signals such as respiration, heartbeat or visceral sensations, which are central to self-reported interoception. We only included empirical studies, allowing for preprints, theses, or book chapters, regardless of peer-review publication status. We allowed for all ages and populations of participants. Table 1 Self-reported measures, along with their corresponding interoceptive dimensions and adaptive/maladaptive categorization. Self-reported Measures Interoceptive Dimension Category MAIA-NO, BAQ, SBC-A Sensing Adaptive MAIA-ND, MAIA-SR, MAIA-AR, Attention Adaptive MAIA-NW, MAIA-BL, MAIA-EA, MAIA-TR Interpretation Adaptive VSI, CAQ Sensing Maladaptive VSI, CAQ, SBC-D Attention Maladaptive VSI, CAQ Interpretation Maladaptive Note. All SIMS reported are included. MAIA: Multidimensional Assessment of Interoceptive Awareness; MAIA-NO: Noticing subscale of the MAIA; BAQ: Body Awareness Questionnaire; SBC: Scale of Body Connection; SBC-A: Awareness subscale of the SBC; MAIA-ND: Not Distracting subscale of the MAIA; MAIA-SR: Self-Regulation subscale of the MAIA; MAIA-AR: Attention Regulation subscale of the MAIA; MAIA-NW: Not Worrying subscale of the MAIA; MAIA-BL: Body Listening subscale of the MAIA; MAIA-EA: Emotional Awareness subscale of the MAIA; MAIA-Trusting: Trusting subscale of the MAIA; VSI: Visceral Sensitivity Index; CAQ: Cardiac Anxiety Questionnaire; SBC-D: Dissociation subscale of the SBC. Outcomes of Interest Self-reported interoception measures (SIMs) were extracted from the studies, including each dimensional subscale when possible (e.g., the eight MAIA subscales). We also extracted psychological distress measures, encompassing stress, anxiety, depression, and PTSD symptoms (Supplementary Table S2 ) and mindfulness measures, encompassing total Five Facet Mindfulness Questionnaire (FFMQ) scores, Freiburg Mindfulness Inventory, etc. (Supplementary Table S3). We contacted authors to provide data for SIMs where necessary; for example, when manuscripts did not report scores for individual MAIA subscales. Come Studies were eligible for inclusion in main analysis if they reported outcomes on SIMs, even if they did not report mindfulness or distress measures. Systematic Search We conducted two searches on July 7th of 2024 of PubMed, ProQuest, PsycArticles, and WebOfScience. Search One: (mindfulness OR meditation) AND (interocept* OR “bodily awareness” OR “body awareness” OR “somatic awareness” OR somatosensory OR visceral OR proprioception) AND ("questionnaire" or "inventory" or "scale" or "rating" or "instrument"). Search two: (mindfulness OR meditation) AND (BAQ OR MAIA OR SAQ OR PBCS OR BPQ OR VSI OR “Body Perception Questionnaire" OR "Body Awareness Questionnaire" OR "Self-Awareness Questionnaire" OR "Multidimensional Assessment of Interoceptive Awareness" OR “Visceral Sensitivity Index”). We additionally searched reference lists of identified studies and conducted an AI-assisted search on Undermind which supplied articles matching a natural language query (Supplementary Text S1). Only studies published before July of 2024 were included. Study Selection Search results consisting of citation data and abstracts were first screened for duplicate publications. Next, all abstracts were evaluated based on two main criteria: an empirical study (examples of excluded articles were review papers and protocol papers) and content relevance (based on mindfulness and interoception or body awareness). Remaining studies were screened by reviewing the methods section and full paper to further evaluate whether the study met all inclusion criteria. All inclusion/exclusion coding was conducted in duplicate, once by IT, and then independently by CV or YY. Data Collection Process A coding manual was developed by the first author to guide the extraction of study descriptive and effect size data. Extraction of these data were conducted by IT and confirmed independently by CV, CW, YY, or JQ. Coding disagreements were discussed by the team. Data Items We extracted the following descriptive variables: duration of intervention in training weeks, subjects in mindfulness and control conditions (after dropout), mindfulness condition type, control condition type, age, percentage female (using reported gender), population type (normative, physical health condition, psychopathology, and other), and interoception measure/dimension. Intervention type was determined as following: (1) ‘mindfulness-based programs’ (MBPs) involved manualized interventions of at least 8 weeks that closely followed MBSR or MBCT, (2) ‘body-based interventions’ involved meditation but also extensive body-focused practices e.g. massage, sexual awareness, eating awareness and hunger monitoring, and (3) ‘other MBIs’ interventions included the small set of heterogeneous studies remaining. Interoceptive awareness dimensions were defined and categorized by expert input from SK and WM in the context of a maladaptive/adaptive framework from [ 37 , 50 ] where interoception consists of sensing, attending, interpreting, and may be maladaptive or adaptive (maladaptive is not continuous with adaptive). The categorizations of study measures are shown in Table 1 . In the case of one study with two similar control groups (both active), we combined the groups (and pooled their means and standard deviations) [ 51 ]. Intervention impacts on interoception were measured as standardized mean differences, corrected using Hedges’ g adjustment for small samples [ 52 ], with positive effect sizes favoring the mindfulness group over the control group. For calculating standardized treatment effects, we applied the following approaches (in decreasing preference): (1) Group differences adjusted for baseline measures (using analysis of covariance or regression adjustment) (2) Group differences in mean change scores (post-intervention minus pre-intervention scores). Other reported statistics (e.g., mixed effect model estimates) were used when appropriate based on standard meta-analytic methods [ 53 , 54 ]. Risk of Bias Bias assessment was adapted from the ROB-2 [ 55 ], with modifications to fit the focus of the current study. As the study exclusively involved self-report measures, evaluation of bias related to objective outcome measurement was deemed not applicable. The bias evaluation process was as follows: At least two authors of IT, YY, CW, JQ and CV independently rated the risk across several domains, including 1) randomization bias, 2) bias due to deviations from intended interventions (e.g., issues related to blinding in the present study), 3) bias due to missing outcome (i.e., objective measurements of attrition) 4) outcome bias (i.e., attrition differences between groups) and 5) reporting bias. This estimated risk in each domain was then compared between raters. Any disagreements were discussed and resolved by a third author, YY. After inter-rater agreement was reached, studies were classified as having low, some concerns, or high risk of bias. Methods for quantifying study quality are detailed in supplement ( Supplementary Text S2). Analysis Analysis was conducted in R 4.3.1 using the metafor and MAd packages [ 56 , 57 ]. For RQ1, to assess overall mindfulness intervention effects on interoception, we conducted a correlated-and-hierarchical effects (CHE) meta-analysis with robust variance estimation [ 42 ]. This model allows for inclusion of effect size estimates for multiple outcomes from the same study (e.g., subscale of a single interoception measure or multiple measures of interoception) and makes tentative assumptions about the intercorrelation between such estimates. We developed these assumptions using correlations between the outcomes reported in the literature in order to specify an assumed sampling variance-covariance matrix (Supplementary Table S4 ) . We used robust variance estimation methods to allow for the possibility that these and other model assumptions about the variability of the effect size estimates might not be correct. We reported the overall average effect size estimate, heterogeneity estimates (tau) at the study level and effect size level, and a 67% prediction interval describing the distribution of effects that would be observed in new studies. We conducted sensitivity analysis by repeating the summary meta-analysis while omitting one primary study at a time, and by winsorizing outlier effect sizes. We then (RQ2) examined for whom and under what circumstances mindfulness interventions produce effects on interoception measures i.e. testing meta-analytic moderators. Using separate meta-regression analyses for each moderator, we examined sex, age, mental health condition vs normative, physical health condition vs normative, sample size, duration of intervention (weeks and minutes, with and without home practice), preregistration status, control type (passive vs active), control type (includes mind-body characteristics or not), adherence (session attendance) and quality of study (ROB-2). Meta-regression models were estimated using the same working model as in RQ1. To compare meta-analytic effects across intervention types with two levels, we used the clubSandwich package to conduct cluster-robust t tests with Satterthwaite degrees of freedom. To compare meta-analytic effects across intervention types or self-report measures with more than two categories, we used the wildmeta package [ 58 ] to conduct Wald tests of the null hypothesis that average effects are equal across categories, with clustered wild bootstrapping to determine significance levels of the tests. While we calculated meta-analytic effects for all measures, we did not test for differences among all self-report measures statistically, given the large number of measures. Instead, we tested for differential effects between adaptive and maladaptive dimensions of interoception, provided that at least four studies included measures for a given dimension. We also statistically compared MAIA vs other self-report measures, given the preponderance of studies using the MAIA. To examine (RQ3) the relationships between interoception, distress and mindfulness, we assessed relationships between the pre-post effects in each domain. We provide scatterplots as well as Pearson’s and Spearman’s correlation coefficients where appropriate so as to provide information about the size of relationships. The observed correlation coefficients imply both baseline and latent change contributions to the effect and thus were not assessed for statistical significance. We were unable to disentangle the contributions using bivariate meta-analytic models due to a limited number of studies (see Deviations). On an exploratory basis we examined whether effects on mindfulness were significantly different from effects on interoception. Selective Reporting and Publication Bias Psychological research is affected by selective reporting bias (occurring when affirmative and statistically significant results have a higher probability of getting published [ 59 ]) and so-called ‘data contingent’ analyses [ 60 ]. We used two different approaches to evaluate potential bias due to preferential reporting of statistically significant results: funnel plots to detect if small samples disproportionately report larger effects, and three-parameter selection models (using the metaselection package) which explicitly model the probability that a finding is reported based on the sign and statistical significance level of the effect estimate. To account for correlations between effect sizes, we used cluster-wise bootstrapping to calculate percentile confidence intervals for the selection model parameters. Results Selected Studies A PRISMA flow diagram is shown in Fig. 1 . Study characteristics Twenty-nine randomized controlled mindfulness interventions with self-report interoception measures were identified. For an overview of study characteristics, see Fig. 2 . The studies involved 2,191 participants ( M = 32.78 yrs, SD = 10.33 yrs), the majority of whom were female (77.82%). No studies involved children or adolescents, indicating a possible lack of investigation of mindfulness-based interoception changes in developmental populations. Sixteen studies involved participants with mental health conditions (trauma, depression, substance use, chronic pain of non-physical origin), six involved normative samples, four involved physical health conditions, and the remaining three had other characteristics (e.g. pregnancy; 61]. The average sample size for the mindfulness interventions was 44.4 participants, and 36.8 participants for the control interventions. The majority of mindfulness-based interventions were mindfulness-based programs (e.g., MBSR), encompassing 15 studies ( n = 1,255 participants). Thirteen of these studies were of the standard length (8 weeks) with one of 9 weeks [ 62 ] and one of 12 weeks [ 63 ]. Three of the studies used identical programs, control conditions, and measures with different samples, and the authors provided data in aggregate [ 64 – 66 ]. These studies were collapsed for synthesis. The second most common category was body-based mindfulness ( k = 8, n = 581), including studies that involved mindfulness meditation supplemented with massage ( k = 5, e.g., [ 67 ]).The majority of these studies were 8 weeks, with two more extended training programs [ 68 , 69 ]. Finally, six remaining studies (‘other’) ( n = 426) involved mindfulness practices but did not follow a standardized program; these were variable in length (1–9 weeks). Eighteen of the twenty-nine studies had active controls (e.g. relaxation, low-dose comparators, therapy, massage without meditation). Sixteen studies were preregistered, although interoception was only a primary outcome in three studies [ 51 , 69 , 70 ] (psychological distress was more typical). Measures of interoception mainly consisted of the MAIA (21/29) followed by the SBC-Awareness (5/29), SBC-Dissociation (3/29), CAQ (1/29), BAQ (1/29) (see Table 1 for further categorizations). Risk of Bias Risk of bias is shown in Fig. 3 and Supplementary Figure S1 . The primary source of bias across studies was related to blinding ( k = 17), as the majority of studies did not have instructors blinded to the intervention aims. Many studies were rated as ‘some concerns of bias’ for randomization, as many studies did not perform allocation concealment, and a few contained meaningful baseline differences between treatment and control groups. Most studies showed adequate reporting, and differential attrition between group was not a major area of potential bias. A full summary of study risk of bias is found in Supplementary Table S5. Study Synthesis (RQ1) Across all studies, there was a positive, small-to-medium average effect on self-reported interoception ( k = 29, 89 correlated effects, g = 0.31, p < 0.001, 95% CI = [0.21, 0.42]) (Fig. 4 ). Heterogeneity was low-to-moderate, with a total heterogeneity \(\:\widehat{\tau\:}\) of 0.16 (between-study \(\:\widehat{\tau\:}\) = 0.14, within-study \(\:\widehat{\tau\:}\) = 0.09) and a 67% prediction interval of [0.15, 0.48]. We found no evidence of publication bias either through funnel plots (Supplementary Figure S2 ) or three-parameter selection models. Counter to typically expected selective reporting processes, the three-parameter selection model estimates indicated selection in favor of non-affirmative findings ( \(\:{\lambda\:}_{1}\) = 1.19, 95% CI = [0.46, 2.99]), leading to a slightly larger adjusted average effect size estimate of g = 0.35, 95% CI = [0.23, 0.51]. The omnibus effect was robust to outliers; the maximum change in average effect based on leave-one-study-out sensitivity was +/-15%, and winsorizing did not change the average effect size estimate. Moderation Analyses (RQ2) All effects are shown for intervention type (design) and measures that include more than four independent studies in Fig. 5 . We statistically examined design and interoception measures independently to maintain adequate power for moderation comparisons. Effects for all designs were significant: MBPs ( k = 15, g = 0.41, p < 0.001), body-based interventions ( k = 8, g = 0.19, p < 0.05), and other mindfulness ( k = 6, g = 0.23, p < 0.05). There was no overall significant moderation by design ( p = 0.14), but pairwise contrasts revealed MBPs had larger effects than body-based interventions (B = 0.22, p = 0.048). For self-report measures, we compared the constructs of adaptive sensing ( g = 0.29, p < 0.001), adaptive interpretation ( g = 0.28, p < 0.001), adaptive attention ( g = 0.31, p 0.4). Comparisons between SIMs were similar when examining MBP studies only. Of the SIMs, MAIA not-worrying ( g = 0.15, p = 0.11) and MAIA not-distracting ( g = 0.12, p = 0.11) showed the smallest effects of any measure (Fig. 5 ). No other moderators (e.g. active vs passive controls) were statistically significant (unadjusted p s > 0.2) (Table 2 ). When examining only MBPs, likewise, no significant moderations were observed (Supplementary Table S6). Table 2 Moderation effects across all studies. Name Beta CI-Low CI-High P-value Percent Female 0.00 -0.007 0.004 0.523 Mean Age -0.01 -0.019 0.005 0.225 MH Sample vs. Not -0.06 -0.269 0.156 0.581 MH Sample vs. Normative -0.09 -0.523 0.350 0.629 PH Sample vs. Not -0.02 -0.405 0.366 0.887 PH Sample vs. Normative -0.04 -0.466 0.382 0.809 Sample Size 0.00 -0.003 0.004 0.724 Weeks Intervention -0.01 -0.039 0.017 0.358 Quality 0.01 -0.062 0.078 0.784 Practice Min Excluding Home -0.04 -0.249 0.163 0.378 Practice Min Including Home -0.01 -0.386 0.366 0.913 Session Attendance 0.67 -2.045 3.377 0.545 Preregistered 0.02 -0.198 0.244 0.826 Active Control 0.11 -0.134 0.346 0.355 Mind-Body Control 0.14 -0.446 0.724 0.525 Note. Betas represent standardized effect for relationship between effect sizes and moderator. No FDR-correction was applied as no p -values met significance. CI: confidence interval; MH Sample: mental health condition sample; PH Sample physical health condition sample. Bivariate Analyses (RQ3) We examined changes in distress and mindfulness for the studies that reported those outcomes. Effect sizes on distress were small-to-moderate ( k = 24, g = 0.28, p < 0.001, CI = [0.16, 0.39]). Effect sizes on mindfulness were small-to-moderate ( k = 17, g = 0.27, p < 0.001, CI = [0.16,0.38]). In the sample of 17 studies reporting mindfulness, the effect on self-reported interoception was slightly larger ( g = 0.34), although the difference was not statistically significant ( p = 0.1). The relationship between increases in self-reported interoception and decreases in distress was positive ( r (22) = 0.25, rho (22) = 0.36) (Fig. 6 ). The relationship between distress and mindfulness ( r (14) = 0.77) was strong, and the relationship between mindfulness and self-reported interoception ( r (13) = 0.36) was positive(Supplementary Figure S3 and S4). Bivariate model estimates were unstable and highly sensitive to sampling covariance assumptions, likely because the quantity of studies reporting multiple types of outcomes was too small (e.g., k < 50) to estimate correlations between the latent variables of impacts on distress and impacts on mindfulness. Consequently, we did not interpret the parameter estimates from the bivariate model. Discussion In the current meta-analysis, we conducted the first systematic evaluation of self-reported interoception in studies employing mindfulness-based interventions. Across 29 studies with over 2,000 participants, we identified a small-to-moderate positive effect (g = 0.31) across all designs and measures. Prediction intervals did not cross zero, suggesting that future mindfulness interventions are likely to yield beneficial self-reported interoception outcomes with reasonable certainty. Heterogeneity was low-to-moderate, and publication bias based on statistical significance was not evident. In terms of moderation, Mindfulness Based Programs, based on MBSR, had larger effects than the body-based approaches included in our analysis. Lastly, we identified positive relationships between interoception improvements and decreases in distress, although we were unable to assess statistical significance based on the limited number of studies. First, we discuss the size and implications of the omnibus effect. Prior studies on objective body awareness measures found small effects with wide confidence intervals (e.g., r = 0.13, CI = [-0.36 to 0.62] [ 32 ]), which were limited to certain types of study designs and measures. The current result on self-reported interoception measures (SIMs) was larger, more precise, and consistent across study designs and measures. Researchers have acknowledged that mindfulness and other behavioral interventions may move self-report more than objective measures [ 46 , 71 ], but until the current study there was little meta-analytic evidence. The observed effect on SIMs was in the range of effects observed on trait mindfulness ( g s = 0.28–0.49, [ 47 ]), which is often used as a primary measure of treatment efficacy in mindfulness interventions. Notably, in studies from our sample that included both mindfulness and interoception outcome measures, the effects on interoception tended to be larger. Given that the therapeutic approach of programs like MBSR emphasizes the process of sensing and interpretation of body signals [ 21 ], our findings support the use of SIMs as primary measures in mindfulness studies. Several studies included here have reported the role of interoceptive awareness measures or dimensions as mediators or partial mediators of clinical outcomes in MBIs, especially in populations with depression. Fissler et al. [ 72 ] reported that the effects of a brief mindfulness intervention on depression symptoms were mediated by changes in a path where score increases on multiple MAIA subscales were serially related to decentering, which reduced depressive symptoms. DeJong et al. [ 73 ] reported that among a population of patients with depression and chronic pain, the positive effect of MBCT on depression severity was mediated by MAIA, specifically ‘Not Distracting’. Finally, Schuman-Olivier et al. [ 38 ] demonstrated that the effect on health behavior change initiation from a MBP among primary care patients with depression was partially mediated by MAIA ‘Body Trusting’, while health behavior change was mediated by ‘Body Listening’ among those without depression. These studies suggest that self-report measures of interoceptive awareness may be clinically relevant mediators. However, the most optimal shifts in interoceptive processing may differentially depend on disorder and outcome measured. As we only compared general categories of psychopathology, physical health conditions, and normative populations in the current meta-analysis, these differences need further study. Our findings support the possibility that interoception, and particularly the self-reported aspect of interoception, is a key process targeted in mindfulness training. However, numerous questions remain about the potential underlying mechanism(s) of action. For one, there was no effect of study quality, attendance or duration. This could be viewed as evidence of a general interoceptive appreciation or attentional effect, instead of an effect specific to the involved meditation techniques. Prior studies have found inconsistent relationships between the ‘dosage’ of formal practice (usually measured in terms of hours or practice) and effects on distress [ 74 ]. Thus it is possible that the quantity of practice hours is less informative than the depth of learning from the intervention, for which phenomenological interviewing may be more informative [ 75 ]. Another noteworthy finding was that MBPs led to significantly greater improvements than body-based studies, although both were significant. Body-based MBI studies included here involved components like massage in the therapeutic process, where touch supports a non-judgemental awareness of the body. Many of these studies used the Mindful Awareness in Body-Oriented Therapy (MABT) protocol, an individual therapy that integrates touch, mindfulness, and psychoeducation to foster interoceptive awareness for self-care by increasing awareness of sensations and emotions and improving somatic appraisal [ 19 ]. A nuance of these studies is that many of the control conditions also incorporated massage, which may have decreased the size of treatment effects on interoception due to the common anchoring in modulation of body states [ 76 ]. However, when we coded control conditions based on mind-body components, this did not moderate overall treatment effects. More insight into this nuanced finding is necessary. Future studies should conduct dismantling approaches (e.g. mindfulness + massage, mindfulness, massage) or administer state measures after sessions to identify active components. A primary motivation for our study was examining differential effects on distinct interoception self-report measures. This potential was limited by the preponderance of studies employing the MAIA. The MAIA involves 8 subscales, which were designed to measure positive aspects of mind-body interventions on interoception [ 35 ]. Our construct-forward approach was to decompose the MAIA and other scales into adaptive and maladadaptive interoception, with sensing, attention, and interpretation components [ 37 , 50 ]. Many studies just report the total MAIA scores, but we contacted study authors and generated sufficient studies to measure effects in all positive categories (e.g. k = 16 for adaptive interpretation), and also in maladaptive attention ( k = 6). However, we did not find any statistically significant evidence of differences across categories. An exploratory analysis revealed smaller effects on ‘not-distracting’ and ‘not-worrying’. However, this could simply reflect limited construct validity in the original MAIA subscales [ 36 ]. In contrast, moderation effects by objective body awareness measures have been identified (more distal, emotionally targeted measures show larger effects than interoceptive accuracy measures; [ 32 ]). Objective measures may provide discriminability lacking in self-report measures. One may still question whether interoceptive benefits of mindfulness are epiphenomenal to improvements in distress. A formal test of this possibility would require mediation analyses, and would thus be reliant on individual participant data. In the current meta-analysis, we primarily had access to study-level data and thus instead attempted to assess whether changes in interoception were associated with changes in distress. Our findings suggest the possibility of a positive relation, where larger changes in interoception led to larger decreases in distress. The relationship between mindfulness and distress appeared stronger, but baseline relationships are also stronger in mindfulness [ 77 ]. Indeed, both apparent relationships could be due in whole or part to the associations between the measures (i.e., sampling errors) rather than due to relation between the latent impacts, and our sample did not include a sufficient number of studies effectively isolate the relation between latent impacts (50 or more may be required [ 78 ]). One future question is whether changes in objective measures in interoception show a similar relationship to distress. Limitations One limitation of the current literature is that it may not be diverse enough to meta-analytically identify differential effects of specific aspects of self-reported interoceptive awareness. As mentioned, the vast majority of studies used the MAIA. While the MAIA has different dimensions of interest, some of these reflect overlapping latent constructs, are moderately to highly correlated, and share similar language. This may have limited our ability to disentangle constructs of interoception like sensing, attention, and interpretation. Another limitation was that we were unable to meta-analytically examine mediation effects or other causal modelling findings – too few studies conducted mediation. Studies with larger sample sizes examining interoception as a mediator tended to find larger effects (contributing to the ‘reverse selection bias’ finding), suggesting that this effect is not incidental. Finally, we were unable to statistically examine relations between interoception, distress and mindfulness due to limited numbers of studies. Future examinations of this question would ideally draw on individual participant-level data from primary studies. Future Directions Very few of the selected studies examined both objective and subjective measures of interoception in parallel (we identified only one [ 70 ]). Assessing both dimensions concurrently is crucial to understanding whether and how mindfulness training alters the processing of interoceptive signals. The effects observed here on self-reported interoception appear to be more robust—i.e., larger—than those reported for objective measures [ 30 , 32 ]. This discrepancy may suggest that mindfulness primarily influences attitudes toward bodily sensations and regulatory aspects of interoception, rather than perceptual accuracy or acuity per se. Future studies should incorporate direct comparisons of objective and subjective interoceptive measures within the same samples to more clearly elucidate these mechanisms. Such work would likely need to focus on specific interoceptive channels, such as respiratory signals, which are particularly emphasized in many MBPs. We also did not observe moderation effects based on mental or physical health conditions. This is consistent with prior individual participant data meta-analyses of mindfulness interventions that similarly failed to identify moderation by distress levels [ 79 ]. One possible explanation is the heterogeneity of clinical presentations across trials. Still, emerging small-sample studies suggest that mindfulness may differentially affect interoceptive processing in depression versus anxiety [ 80 ], although our analysis did not identify enough studies to formally test this possibility. A striking gap in the literature is the absence of studies examining the effects of mindfulness on interoception in youth and adolescent populations. Adolescence is a particularly sensitive developmental period marked by rapid changes in both interoception and the emergence of many mental health conditions[ 79 – 82 ]. Investigating how mindfulness training influences subjective and objective interoception in adolescents could clarify mechanisms of resilience and inform early intervention strategies. Conclusion This study represents the first meta-analysis of the effects of mindfulness-based interventions on self-reported interoception. We observed robust improvements across the 29 studies included, providing evidence supporting the idea that changes in interoception—or at least the self-reported aspects of it—may underpin the therapeutic effects of mindfulness training. Nevertheless, the lack of sensitivity to many qualities of the included studies like dosage or self-report measure require further investigation. Declarations Author contributions statement INT contributed to conceptualization, methodology, investigation, writing-original draft, writing- review & editing, visualization, and project administration. YY, CV, CW managed investigation, visualization and writing- review & editing. JQ contributed to investigation and writing-review & editing. EW handled investigation. JP managed methodology, investigation, and writing- review & editing. SBG, ZSO, WM, contributed to conceptualization and review & editing. SK contributed to supervision, review & editing, and funding acquisition. Data availability Thedatasets and code generated during the current study are available at: https://osf.io/qzyh5/?view_only=c537e7d6de084f32a90eb12792175a2e. Additional Information Competing interests: The authors declare no competing interests. Ethics Approval: No original data collection was performed. AI Statement: No AI was used in the preparation of the language of this manuscript. An AI search was used to supplement the systematic search, and AI was used to generate Figure 2. Funding Statement: SBG was supported by NCCIH R24AT012845 and NCCIH K23AT010879. References Khalsa, S. S. et al. Interoception and Mental Health: A Roadmap. Biol. Psychiatry Cogn. Neurosci. Neuroimaging (2018) doi:10.1016/j.bpsc.2017.12.004. Greenwood, B. M. & Garfinkel, S. N. Interoceptive Mechanisms and Emotional Processing. Annu. Rev. Psychol. 76 , 59–86 (2025). Herbert, B. M., Herbert, C. & Pollatos, O. On the relationship between interoceptive awareness and alexithymia: Is interoceptive awareness related to emotional awareness? J. Pers. 79 , 1149–1175 (2011). Mehling, W. Differentiating attention styles and regulatory aspects of self-reported interoceptive sensibility. Philos. Trans. R. Soc. B Biol. Sci. 371 , (2016). Brener, J. & Ring, C. Towards a psychophysics of interoceptive processes: The measurement of heartbeat detection. Philos. Trans. R. Soc. B Biol. Sci. (2016) doi:10.1098/rstb.2016.0015. Schandry, R. Heart Beat Perception and Emotional Experience. Psychophysiology (1981) doi:10.1111/j.1469-8986.1981.tb02486.x. Khalsa, S. S. & Lapidus, R. C. Can interoception improve the pragmatic search for biomarkers in psychiatry? Front. Psychiatry 7 , (2016). Loureiro, F., Ringold, S. & Aziz-Zadeh, L. Interoception in Autism: A Narrative Review of Behavioral and Neurobiological Data. Psychol. Res. Behav. Manag. Volume 17 , 1841–1853 (2024). Eggart, M., Lange, A., Binser, M. J., Queri, S. & Müller-Oerlinghausen, B. Major depressive disorder is associated with impaired interoceptive accuracy: A systematic review. Brain Sci. 9 , 131 (2019). Paulus, M. P., Feinstein, J. S. & Khalsa, S. S. An Active Inference Approach to Interoceptive Psychopathology. Annu. Rev. Clin. Psychol. 15 , 97–122 (2019). Paulus, M. P. & Stein, M. B. Interoception in anxiety and depression. Brain Struct. Funct. 214 , 451–463 (2010). Trevisan, D. A., Mehling, W. E. & McPartland, J. C. Adaptive and Maladaptive Bodily Awareness: Distinguishing Interoceptive Sensibility and Interoceptive Attention from Anxiety-Induced Somatization in Autism and Alexithymia. Autism Res. 14 , 240–247 (2021). Van Bael, K. et al. A systematic review and meta-analysis of the relationship between subjective interoception and alexithymia: Implications for construct definitions and measurement. PLOS ONE 19 , e0310411 (2024). Clemente, R., Murphy, A. & Murphy, J. The Relationship Between Self-Reported Interoception and Anxiety: A Systematic Review and Meta-Analysis. Neurosci. Biobehav. Rev. 105923 (2024). Heim, N. et al. Psychological interventions for interoception in mental health disorders: A systematic review of randomized-controlled trials. Psychiatry Clin. Neurosci. 77 , 530–540 (2023). Cheng, S. C., Thompson, E. A. & Price, C. J. The Scale of Body Connection: A Multisample Study to Examine Sensitivity to Change Among Mind-Body and Bodywork Interventions. J. Integr. Complement. Med. 28 , 600–606 (2022). Farb, N. et al. Interoception, contemplative practice, and health. Front. Psychol. (2015) doi:10.3389/fpsyg.2015.00763. Khoury, N. M., Lutz, J. & Schuman-Olivier, Z. Interoception in Psychiatric Disorders: A Review of Randomized, Controlled Trials with Interoception-Based Interventions. Harv. Rev. Psychiatry 26 , 250–263 (2018). Price, C. J. & Hooven, C. Interoceptive awareness skills for emotion regulation: Theory and approach of mindful awareness in body-oriented therapy (MABT). Front. Psychol. 9 , 798 (2018). Creswell, J. D. Mindfulness Interventions. Annu. Rev. Psychol. 68 , 491–516 (2017). Kabat-Zinn, J. Full Catastrophe Living (Revised Edition): Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness . (2013). Bishop, S. R. et al. Mindfulness: A proposed operational definition. Clin. Psychol. Sci. Pract. 11 , (2004). Kabat-Zinn, J. An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: Theoretical considerations and preliminary results. Gen. Hosp. Psychiatry 4 , 33–47 (1982). Crane, R. S. et al. What defines mindfulness-based programs? The warp and the weft. Psychol. Med. 47 , 990–999 (2017). Cullen, M. Mindfulness-Based Interventions: An Emerging Phenomenon. Mindfulness 2 , 186–193 (2011). Moore, A. & Malinowski, P. Meditation, mindfulness and cognitive flexibility. Conscious. Cogn. 18 , 176–186 (2009). Kabat-Zinn, J., Lipworth, L. & Burney, R. The clinical use of mindfulness meditation for the self-regulation of chronic pain. J. Behav. Med. 8 , 163–190 (1985). Mehling, W. E., Todd, J. & Schuman-Olivier, Z. Multidisciplinary Assessment of Interoceptive Awareness, Version 2 (MAIA-2). in Handbook of Assessment in Mindfulness Research (eds. Medvedev, O. N., Krägeloh, C. U., Siegert, R. J. & Singh, N. N.) 1–23 (Springer International Publishing, Cham, 2022). doi:10.1007/978-3-030-77644-2_40-1. Santorelli, S. F., Meleo-Meyer, F., Koerbel, L. & Kabat-Zinn, J. Mindfulness-Based Stress Reduction (MBSR) Authorized Curriculum Guide © 2017. (2017). Treves, I. N., Tello, L. Y., Davidson, R. J. & Goldberg, S. B. The relationship between mindfulness and objective measures of body awareness: A meta-analysis. Sci. Rep. 9 , 1–12 (2019). Sze, J. A., Gyurak, A., Yuan, J. W. & Levenson, R. W. Coherence between emotional experience and physiology: Does body awareness training have an impact? Emotion 10 , 803–814 (2010). Schwartz, K., Ganster, F. M., Voracek, M. & Tran, U. S. Mindfulness and Objective Measures of Body Awareness: A Preregistered Systematic Review and Multilevel Meta-Analysis. Biopsychosoc. Sci. Med. 10.1097/PSY.0000000000001381 doi:10.1097/PSY.0000000000001381. Khalsa, S. S., Rudrauf, D., Hassanpour, M. S., Davidson, R. J. & Tranel, D. The practice of meditation is not associated with improved interoceptive awareness of the heartbeat. Psychophysiology 57 , 1–16 (2020). Price, C. J. & Thompson, E. A. Measuring Dimensions of Body Connection: Body Awareness and Bodily Dissociation. J. Altern. Complement. Med. (2007) doi:10.1089/acm.2007.0537. Mehling, W. E. et al. The Multidimensional Assessment of Interoceptive Awareness (MAIA). PLoS ONE (2012) doi:10.1371/journal.pone.0048230. Mehling, W. E., Acree, M., Stewart, A., Silas, J. & Jones, A. The multidimensional assessment of interoceptive awareness, version 2 (MAIA-2). PloS One 13 , e0208034 (2018). Trevisan, D. A., Tsheringla, S. & McPartland, J. C. On the relation between interoceptive attention and health anxiety: Distinguishing adaptive and maladaptive bodily awareness. Cogent Psychol. 10 , 2262855 (2023). Schuman-Olivier, Z. et al. Change starts with the body: Interoceptive appreciation mediates the effect of mindfulness training on behavior change – an effect moderated by depression severity. Psychiatry Res. 342 , 116230 (2024). Desbordes, G. et al. Moving Beyond Mindfulness: Defining Equanimity as an Outcome Measure in Meditation and Contemplative Research. Mindfulness 6 , 356–372 (2015). Farb, N. & Segal, Z. Better in Every Sense: How the New Science of Sensation Can Help You Reclaim Your Life . (Little, Brown, 2024). Desmedt, O., Heeren, A., Corneille, O. & Luminet, O. What do measures of self-report interoception measure? Insights from a systematic review, latent factor analysis, and network approach. Biol. Psychol. 169 , 108289 (2022). Pustejovsky, J. E. & Tipton, E. Meta-analysis with Robust Variance Estimation: Expanding the Range of Working Models. Prev. Sci. 23 , 425–438 (2022). Page, M. J. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372 , n71 (2021). Dahl, C. J., Lutz, A. & Davidson, R. J. Reconstructing and deconstructing the self: Cognitive mechanisms in meditation practice. Trends Cogn. Sci. 19 , 515–523 (2015). Sparby, T. & Sacchet, M. D. Defining Meditation: Foundations for an Activity-Based Phenomenological Classification System. Front. Psychol. 12 , (2022). Van Dam, N. T. et al. Mind the Hype: A Critical Evaluation and Prescriptive Agenda for Research on Mindfulness and Meditation. Perspect. Psychol. Sci. 13 , 36–61 (2018). Quaglia, J. T., Braun, S. E., Freeman, S. P., McDaniel, M. A. & Brown, K. W. Meta-Analytic Evidence for Effects of Mindfulness Training on Dimensions of Self-Reported Dispositional Mindfulness. Psychol. Assess. 28 , 803–818 (2016). Goldberg, S. B. et al. Mindfulness-based interventions for psychiatric disorders: A systematic review and meta-analysis. Clin. Psychol. Rev. (2018) doi:10.1016/j.cpr.2017.10.011. Eifert, G. H. et al. The cardiac anxiety questionnaire: development and preliminary validity. Behav. Res. Ther. 38 , 1039–1053 (2000). Desmedt, O., Luminet, O., Maurage, P. & Corneille, O. Discrepancies in the Definition and Measurement of Human Interoception: A Comprehensive Discussion and Suggested Ways Forward. Perspect. Psychol. Sci. 20 , 76–98 (2025). Price, C. J., Thompson, E. A., Crowell, S. & Pike, K. Longitudinal effects of interoceptive awareness training through mindful awareness in body-oriented therapy (MABT) as an adjunct to women’s substance use disorder treatment: A randomized controlled trial. Drug Alcohol Depend. 198 , 140–149 (2019). Hedges, L. V. Distribution Theory for Glass’s Estimator of Effect size and Related Estimators. J. Educ. Stat. 6 , 107–128 (1981). Borenstein, M. & Hedges, L. V. Effect sizes for meta-analysis. Handb. Res. Synth. Meta-Anal. 3 , 207–243 (2019). Cooper, H., Hedges, L. V. & Valentine, J. C. The Handbook of Research Synthesis and Meta-Analysis . (Russell Sage Foundation, 2019). Sterne, J. A. et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. bmj 366 , (2019). Del Re, A. C., Hoyt, W. T. & Del Re, M. A. Package ‘MAd’. (2022). Viechtbauer, W. Conducting meta-analyses in R with the metafor package. J. Stat. Softw. 36 , 1–48 (2010). Joshi, M., Pustejovsky, J. E. & Beretvas, S. N. Cluster wild bootstrapping to handle dependent effect sizes in meta‐analysis with a small number of studies. Res. Synth. Methods 13 , 457–477 (2022). Rosenthal, R. The file drawer problem and tolerance for null results. Psychol. Bull. 86 , 638–641 (1979). Gelman, A. & Loken, E. The garden of forking paths: Why multiple comparisons can be a problem, even when there is no “fishing expedition” or “p-hacking” and the research hypothesis was posited ahead of time. Dep. Stat. Columbia Univ. 348 , 3 (2013). Duncan, L. G. et al. Benefits of preparing for childbirth with mindfulness training: a randomized controlled trial with active comparison. BMC Pregnancy Childbirth 17 , 140 (2017). Loucks, E. B. et al. Mindfulness-Based College: A Stage 1 Randomized Controlled Trial for University Student Well-Being. Psychosom. Med. 83 , 602–614 (2021). Fischer, J. M. et al. Stress Reduction by Yoga versus Mindfulness Training in Adults Suffering from Distress: A Three-Armed Randomized Controlled Trial including Qualitative Interviews (RELAX Study). J. Clin. Med. 11 , 5680 (2022). Gawande, R. et al. Impact of warm mindfulness on emotion regulation: A randomized controlled effectiveness trial. Health Psychol. (2023) doi:10.1037/hea0001303. Gawande, R. et al. Insurance-reimbursable mindfulness for safety-net primary care patients: a pilot randomized controlled trial. Mindfulness 10 , 1744–1759 (2019). Gawande, R. et al. Mindfulness Training Enhances Self-Regulation and Facilitates Health Behavior Change for Primary Care Patients: a Randomized Controlled Trial. J. Gen. Intern. Med. 34 , 293–302 (2019). Price, C. J., Merrill, J. O., McCarty, R. L., Pike, K. C. & Tsui, J. I. A pilot study of mindful body awareness training as an adjunct to office-based medication treatment of opioid use disorder. J. Subst. Abuse Treat. 108 , 123–128 (2020). Bornemann, B., Herbert, B. M., Mehling, W. E. & Singer, T. Differential changes in self-reported aspects of interoceptive awareness through 3 months of contemplative training. Front. Psychol. 5 , (2015). Classen, C. C. et al. A Pilot RCT of A Body-Oriented Group Therapy For Complex Trauma Survivors: An Adaptation of Sensorimotor Psychotherapy. J. Trauma Dissociation 22 , 52–68 (2021). Lima-Araujo, G. L. D. et al. The impact of a brief mindfulness training on interoception: A randomized controlled trial. PLOS ONE 17 , e0273864 (2022). Goldberg, S. B., Riordan, K. M., Sun, S. & Davidson, R. J. The Empirical Status of Mindfulness-Based Interventions: A Systematic Review of 44 Meta-Analyses of Randomized Controlled Trials. Perspect. Psychol. Sci. 17 , 108–130 (2022). Fissler, M. et al. An Investigation of the Effects of Brief Mindfulness Training on Self-Reported Interoceptive Awareness, the Ability to Decenter, and Their Role in the Reduction of Depressive Symptoms. Mindfulness 7 , 1170–1181 (2016). de Jong, M. et al. Effects of Mindfulness-Based Cognitive Therapy on Body Awareness in Patients with Chronic Pain and Comorbid Depression. Front. Psychol. 7 , 967 (2016). Goldberg, S. B. et al. Is Dosage of a Meditation App Associated With Changes in Psychological Distress? It Depends on How You Ask. Clin. Psychol. Sci. 21677026241266567 (2024) doi:10.1177/21677026241266567. Poletti, S., Abdoun, O., Zorn, J. & Lutz, A. Pain regulation during mindfulness meditation: Phenomenological fingerprints in novices and experts practitioners. Eur. J. Pain 25 , 1583–1602 (2021). Binstock, M., Morinis, L., Adler, S. & Mehling, W. E. Students’ response to a Massage & Meditation medical school course elective. MedEdPublish 9 , 28 (2020). Carpenter, J. K., Conroy, K., Gomez, A. F., Curren, L. C. & Hofmann, S. G. The relationship between trait mindfulness and affective symptoms: A meta-analysis of the Five Facet Mindfulness Questionnaire (FFMQ). Clin. Psychol. Rev. 74 , 101785 (2019). McShane, B. B. & Böckenholt, U. Multilevel Multivariate Meta-analysis with Application to Choice Overload. Psychometrika 83 , 255–271 (2018). Mayer-Benarous, H., Benarous, X. & Robin, M. Disrupted profiles of interoception and mental health in youths: a systematic review. Eur. Child Adolesc. Psychiatry (2025) doi:10.1007/s00787-025-02705-w. Opdensteinen, K. D. et al. Interoception in preschoolers: New insights into its assessment and relations to emotion regulation and stress. Biol. Psychol. 165 , 108166 (2021). Koch, A. & Pollatos, O. Interoceptive sensitivity, body weight and eating behavior in children: a prospective study. Front. Psychol. 5 , (2014). Addabbo, M. & Milani, L. Measuring interoception from infancy to childhood: A scoping review. Neurosci. Biobehav. Rev. 173 , 106161 (2025). Brotto, L. et al. Mindfulness and Sex Education for Sexual Interest/Arousal Disorder: Mediators and Moderators of Treatment Outcome. J. Sex Res. 60 , 1–14 (2022). Francis, S. E. B., Shawyer, F., Cayoun, B., Enticott, J. & Meadows, G. N. Group Mindfulness-Integrated Cognitive Behavior Therapy (MiCBT) Reduces Depression and Anxiety and Improves Flourishing in a Transdiagnostic Primary Care Sample Compared to Treatment-as-Usual: A Randomized Controlled Trial. Front. Psychiatry Volume 13-2022 , (2022). Gaylord, S. et al. Mindfulness Training Reduces the Severity of Irritable Bowel Syndrome in Women: Results of a Randomized Controlled Trial. Am. J. Gastroenterol. 106 , 1678–88 (2011). Henrich, J., Gjelsvik, B., Surawy, C., Evans, E. & Martin, M. A Randomized Clinical Trial of Mindfulness-Based Cognitive Therapy for Women With Irritable Bowel Syndrome—Effects and Mechanisms. J. Consult. Clin. Psychol. 88 , (2020). Karing, C. & Beelmann, A. Evaluating the Implementation and Effectiveness of a Low-Dose Mindfulness-Based Intervention in a Student Sample: a Randomized Controlled Trial. Mindfulness 12 , (2021). Mittal, T. K. et al. Mindfulness-based intervention in patients with persistent pain in chest (MIPIC) of non-cardiac cause: a feasibility randomised control study. Open Heart 9 , e001970 (2022). Ugarte Pérez, C. et al. Comparative efficacy of remotely delivered mindfulness-based eating awareness training versus behavioral-weight loss counseling during COVID-19. Front Psychol 14 , 1101120 (2023). Price, C. Body-oriented therapy in recovery from child sexual abuse: an efficacy study. Altern. Ther. Health Med. 11 , 46–57 (2005). Price, C. J., Wells, E. A., Donovan, D. M. & Rue, T. Mindful awareness in body-oriented therapy as an adjunct to women’s substance use disorder treatment: a pilot feasibility study. J. Subst. Abuse Treat. 43 , 94–107 (2012). Price, C. J., Sevinc, G. & Farb, N. A. S. Within-Person Modulation of Neural Networks following Interoceptive Awareness Training through Mindful Awareness in Body-Oriented Therapy (MABT): A Pilot Study. Brain Sci. 13 , 1396 (2023). Roberts, R. L., Ledermann, K. & Garland, E. L. Mindfulness-oriented recovery enhancement improves negative emotion regulation among opioid-treated chronic pain patients by increasing interoceptive awareness. J. Psychosom. Res. 152 , 110677 (2021). Segal, Z. V. et al. Practice of therapy acquired regulatory skills and depressive relapse/recurrence prophylaxis following cognitive therapy or mindfulness based cognitive therapy. J. Consult. Clin. Psychol. 87 , 161–170 (2019). Sharp, M. et al. Prenatal Mindfulness Training and Interoceptive Awareness in Pregnant People at Risk for Hypertensive Disorders. J. Integr. Complement. Med. 30 , 1200–1208 (2024). Thomas, E. A. et al. Mindfulness-Oriented Recovery Enhancement Restructures Reward Processing and Promotes Interoceptive Awareness in Overweight Cancer Survivors: Mechanistic Results From a Stage 1 Randomized Controlled Trial. Integr. Cancer Ther. 18 , 1534735419855138 (2019). van der Velden, A. M. et al. Mindfulness Training Changes Brain Dynamics During Depressive Rumination: A Randomized Controlled Trial. Biol. Psychiatry 93 , 233–242 (2023). Vollbehr, N. K. et al. Mindful yoga intervention as add-on to treatment as usual for young women with major depressive disorder: Results from a randomized controlled trial. J. Consult. Clin. Psychol. 90 , 925–941 (2022). Additional Declarations No competing interests reported. Supplementary Files Supplement1D4.docx Supplement2Checklist.docx Cite Share Download PDF Status: Published Journal Publication published 06 Nov, 2025 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 21 Aug, 2025 Reviewers agreed at journal 19 Aug, 2025 Reviews received at journal 19 Aug, 2025 Reviewers agreed at journal 19 Aug, 2025 Reviewers agreed at journal 18 Aug, 2025 Reviewers agreed at journal 18 Aug, 2025 Reviewers agreed at journal 14 Aug, 2025 Reviewers agreed at journal 14 Aug, 2025 Reviews received at journal 13 Aug, 2025 Reviewers agreed at journal 13 Aug, 2025 Reviewers agreed at journal 13 Aug, 2025 Reviewers agreed at journal 11 Aug, 2025 Reviewers agreed at journal 11 Aug, 2025 Reviewers agreed at journal 11 Aug, 2025 Reviewers agreed at journal 11 Aug, 2025 Reviewers agreed at journal 27 Jul, 2025 Reviewers invited by journal 25 Jul, 2025 Editor invited by journal 04 Jun, 2025 Editor assigned by journal 03 Jun, 2025 Submission checks completed at journal 02 Jun, 2025 First submitted to journal 31 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6792067","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":465215628,"identity":"0edc0817-9423-4834-9001-7b0463483d18","order_by":0,"name":"Isaac N. Treves","email":"data:image/png;base64,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","orcid":"","institution":"Columbia University Irving Medical Center","correspondingAuthor":true,"prefix":"","firstName":"Isaac","middleName":"N.","lastName":"Treves","suffix":""},{"id":465215633,"identity":"0191579a-085a-497b-af5d-918b607c7b78","order_by":1,"name":"Ya-Yun Chen","email":"","orcid":"","institution":"Virginia Tech","correspondingAuthor":false,"prefix":"","firstName":"Ya-Yun","middleName":"","lastName":"Chen","suffix":""},{"id":465215634,"identity":"7d0700e2-cf80-4389-bcbb-a950183a09c9","order_by":2,"name":"Caitlyn L. Wilson","email":"","orcid":"","institution":"University of Colorado Denver","correspondingAuthor":false,"prefix":"","firstName":"Caitlyn","middleName":"L.","lastName":"Wilson","suffix":""},{"id":465215635,"identity":"66053c2b-d9eb-4dc9-8da1-0e91ab22fc0d","order_by":3,"name":"Charles Verdonk","email":"","orcid":"","institution":"UMR VIFASOM, Université de Paris","correspondingAuthor":false,"prefix":"","firstName":"Charles","middleName":"","lastName":"Verdonk","suffix":""},{"id":465215636,"identity":"c34a147f-7fb2-4001-b74b-86da96bd98d1","order_by":4,"name":"Joanne Qina`au","email":"","orcid":"","institution":"University of California, San Francisco","correspondingAuthor":false,"prefix":"","firstName":"Joanne","middleName":"","lastName":"Qina`au","suffix":""},{"id":465215637,"identity":"4e8542d4-0de2-4d0d-a695-86b25a335387","order_by":5,"name":"James E. Pustejovsky","email":"","orcid":"","institution":"University of Wisconsin-Madison","correspondingAuthor":false,"prefix":"","firstName":"James","middleName":"E.","lastName":"Pustejovsky","suffix":""},{"id":465215638,"identity":"e5282b38-e148-409f-91d1-f72c7ca74369","order_by":6,"name":"Simon B. Goldberg","email":"","orcid":"","institution":"University of Wisconsin-Madison","correspondingAuthor":false,"prefix":"","firstName":"Simon","middleName":"B.","lastName":"Goldberg","suffix":""},{"id":465215639,"identity":"23a49dc0-9abd-410b-a338-bbf1f2778059","order_by":7,"name":"Wolf Mehling","email":"","orcid":"","institution":"University of California, San Francisco","correspondingAuthor":false,"prefix":"","firstName":"Wolf","middleName":"","lastName":"Mehling","suffix":""},{"id":465215640,"identity":"c345b2b8-1454-48fe-b5c3-5707fad12564","order_by":8,"name":"Zev Schuman-Olivier","email":"","orcid":"","institution":"Cambridge Health Alliance","correspondingAuthor":false,"prefix":"","firstName":"Zev","middleName":"","lastName":"Schuman-Olivier","suffix":""},{"id":465215641,"identity":"999a240a-d6ca-4a90-b946-9f5858a54bc3","order_by":9,"name":"Sahib S. Khalsa","email":"","orcid":"","institution":"University of California at Los Angeles","correspondingAuthor":false,"prefix":"","firstName":"Sahib","middleName":"S.","lastName":"Khalsa","suffix":""}],"badges":[],"createdAt":"2025-05-31 16:23:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6792067/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6792067/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-025-22661-4","type":"published","date":"2025-11-06T15:57:25+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":83917391,"identity":"1d26c9bd-6686-4541-9de4-34f865b307cb","added_by":"auto","created_at":"2025-06-04 12:59:29","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":391138,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePRISMA[43] flow diagram depicting number of identified and evaluated articles.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6792067/v1/7ec647933971f62284968fe7.png"},{"id":83916536,"identity":"db4993b0-24ad-40db-8e5f-1411b754e2ac","added_by":"auto","created_at":"2025-06-04 12:51:29","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":562386,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSummary of study characteristics included in the meta-analysis. (A)\u003c/strong\u003e Types of mindfulness interventions categorized as mindfulness-based programs (MBP), body-based interventions, and other mindfulness interventions. Stacked bars indicate specific intervention subtypes. \u003cstrong\u003e(B)\u003c/strong\u003e Self-report measures of interoception used across studies, with the number of studies (\u003cem\u003ek\u003c/em\u003e) per measure. \u003cem\u003eNote: Some studies included multiple self-report measures.\u003c/em\u003e \u003cstrong\u003e(C)\u003c/strong\u003eParticipant populations classified as having psychopathology, physical health conditions, normative status, or other. Percentages reflect the proportion of studies in each category relative to the total number of included studies, with the number of studies (\u003cem\u003ek\u003c/em\u003e) shown for each group. \u003cstrong\u003e(D)\u003c/strong\u003e Characteristics of the overall sample included in the meta-analysis. MBSR: Mindfulness-based stress reduction; MBCT: Mindfulness-based cognitive therapy; MTPC: Mindfulness training for primary care (now called Mindful Behavior Change); MABT: Mindful awareness in body-oriented therapy; MORE: Mindfulness-oriented recovery enhancement; MAIA: Multidimensional Assessment of Interoceptive Awareness; BAQ: Body Awareness Questionnaire; SBC: Scale of Body Connection; CAQ: Cardiac Anxiety Questionnaire; VSI: Visceral Sensitivity Index.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6792067/v1/80db5a34ee71f8b70f5dd439.png"},{"id":83916534,"identity":"171acc31-00ae-43f1-86ea-802f3e82ae8c","added_by":"auto","created_at":"2025-06-04 12:51:29","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":75680,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eStudy risk of bias by domain (ROB-2).\u003c/strong\u003e “Low risk” categorization occurred when a study was judged to be free from bias in that domain; all criteria were met and deviations were unlikely to affect the outcome. “Some concerns” categorization occurred when a study was judged to have potential for bias in that domain; one or more criteria were not clearly met, raising uncertainty about the risk of bias. “High risk” categorization occurred when a study had clear evidence of bias or contained multiple issues that substantially lowered confidence in the results for that domain..\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6792067/v1/6334134d248411d9ad401856.png"},{"id":83916540,"identity":"9e1cd159-e502-43ce-9bea-431d85892d8c","added_by":"auto","created_at":"2025-06-04 12:51:29","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":476778,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eForest plot showing change in self-reported interoception across all mindfulness-based interventions.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-6792067/v1/2f017ff802470ee2aa30218b.png"},{"id":83916542,"identity":"ec42bb38-983f-49d7-afae-bde426a3b155","added_by":"auto","created_at":"2025-06-04 12:51:29","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":465802,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eForest plot depicting the effect of mindfulness intervention by intervention type and SIM dimension.\u003c/strong\u003e Measures reported in more than four independent studies are shown. MAIA: Multidimensional Assessment of Interoceptive Awareness. \u003csup\u003e1\u003c/sup\u003eMAIA total score, refers to reporting of effects on total score only (no aggregation of subscales); MAIA8: includes total score and aggregation of all eight MAIA subscales; MAIA6: does not include total score, but is aggregation of all MAIA subscales but noticing and not-worrying. SBC: Scale of Body Connection; * \u003cem\u003ep \u003c/em\u003e\u0026lt; 0.05\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-6792067/v1/397f936caf0112d520b18eae.png"},{"id":83916539,"identity":"0d4ced25-ee6d-4a4e-b36e-dc04e32f1de2","added_by":"auto","created_at":"2025-06-04 12:51:29","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":192240,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eChanges in interoception vs changes in distress\u003c/strong\u003e. Each dot represents a study level effect, where positives represent improvements in interoception and decreases in distress.\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-6792067/v1/ca062b57d701c56329107a32.png"},{"id":95563991,"identity":"ac3344bb-7814-4b8f-a34c-4bda6f5339c3","added_by":"auto","created_at":"2025-11-10 16:06:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3639004,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6792067/v1/67a8662e-68f4-49d0-98ef-4be38769ef31.pdf"},{"id":83916538,"identity":"b5e4151d-4df7-47fb-a906-d69eb954c0e7","added_by":"auto","created_at":"2025-06-04 12:51:29","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":341709,"visible":true,"origin":"","legend":"","description":"","filename":"Supplement1D4.docx","url":"https://assets-eu.researchsquare.com/files/rs-6792067/v1/4b734f37e8b3d956461aec0c.docx"},{"id":83917392,"identity":"eb793690-d46a-4718-af78-ffc7206eeba1","added_by":"auto","created_at":"2025-06-04 12:59:29","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":275447,"visible":true,"origin":"","legend":"","description":"","filename":"Supplement2Checklist.docx","url":"https://assets-eu.researchsquare.com/files/rs-6792067/v1/b514018c947007ee3d8a0d31.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Minding the Body: A Meta-analysis of the Effects of Mindfulness Meditation Training on Self-reported Interoception","fulltext":[{"header":"Introduction","content":"\u003cp\u003eInteroception refers broadly to the processing of internal bodily signals by the nervous system [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], and is related to emotional awareness, self-regulation, mental health, and cognition [\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Interoception can be measured objectively, e.g. by testing how accurately one can sense one\u0026rsquo;s resting heartbeat [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], or via homeostatic perturbations of physiological states [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Reduced interoceptive accuracy has been suggested to underly behavioral health difficulties in autism and other neurodevelopmental populations [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], and is implicated in anxiety and depression [\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Interoception also involves subjective components, including interoceptive sensibility, attention, interpretation, and regulation of bodily signals \u0026ndash; which may be measured through self-report using questionnaires. Self-reported interoception is especially relevant in clinical contexts, and the use of questionnaires reflects a standardized effort to delineate symptoms and track changes in symptoms following treatment. Decreased levels of self-reported interoceptive attention and regulation are found in individuals with abnormalities of emotional experience, such as alexithymia [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Interoceptive catastrophizing (i.e., exaggerated symptom reporting) is common in individuals with somatic, generalized, and panic disorders [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], and similar reports are found in other conditions including post-traumatic stress disorder, irritable bowel syndrome, fibromyalgia, eating disorders, and substance use disorders [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Given the evidence that difficulties with interoception are related to psychopathology, there is substantial interest in cultivating interoceptive awareness through mind-body interventions [\u003cspan additionalcitationids=\"CR16 CR17 CR18\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], including those utilizing mindfulness meditation [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMindfulness is often defined as a non-judgmental awareness of the present moment [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], although this reflects a secular distillation from a broader historical Buddhist tradition. Mindfulness-Based Stress Reduction (MBSR) [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] emerged as a paradigmatic program for training mindfulness in the context of efforts to achieve symptom reduction in various physical and mental conditions. Following standard recommendations [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] we distinguish trainings based in theory and curricula of MBSR as mindfulness-based programs (MBP) from the more general health-based approaches, which we refer to as mindfulness-based interventions (MBI) [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. MBSR consists of 8 weeks of mindfulness training through focused attention meditation, body scan meditation, mindful movement (e.g., yoga asana), dialogue and inquiry, and didactic instruction. While cognitive explanations of mindfulness emphasizing attention and emotion regulation predominate in the literature (e.g., [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]), MBSR was initially conceived for individuals with chronic pain [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], and transforming the process of sensing and interpreting body signals was always a central part of the therapeutic approach [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Many elements of MBSR involve body-focused awareness and a sustained top-down attentional focus on interoceptive signals [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. For example, the most commonly taught focused attention meditation includes the practice of continuously attending to signals of the breath and discerning its movements throughout the nasal cavities, chest, diaphragm, and abdomen. Body scans involve shifting attention throughout the body and observing spontaneously arising signals. Mindful movement involves proprioceptive attention as the body changes position and orientation as well as breath awareness. All of these practices are taught with an emphasis on acceptance, present-moment sensory awareness, non-judgement and self-compassion, and formal and informal practice of these qualities are emphasized in didactics.\u003c/p\u003e \u003cp\u003eThere is systematic meta-analytic evidence that mindfulness-based interventions involve improvements in certain objective measures of body awareness [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. In that initial meta-analysis, we advanced the framework of \u0026lsquo;accurate and correct monitoring\u0026rsquo; to identify and categorized body awareness tasks, to include both \u0026lsquo;proximal\u0026rsquo; tasks (e.g., heartbeat perception) and \u0026lsquo;distal\u0026rsquo; tasks (e.g., monitoring emotional arousal in the body during a movie [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]). A updated meta-analysis using this framework confirmed a small, heterogeneous effect of mindfulness on objective accuracy, that was most prominent for distal measures [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. There was no evidence of differences in proximal tasks, such as heartbeat perception, as we have found previously [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. These dissociations between proximal and distal measures may, in part, reflect process-specific practice effects, as most MBPs do not specifically target heartbeat perception. To date there are few MBPs evaluating a training effect on respiratory interoception.\u003c/p\u003e \u003cp\u003eWhile there are many studies examining the subjective aspects of interoception, there is no meta-analytic clarity about the effects of mindfulness or MBPs on self-reported interoception broadly. Several well-established self-reported interoception measures (SIM) exist, e.g., the Scale of Body Connection [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], and the Multidimensional Assessment of Interoceptive Awareness [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], but they have yet to be meta-analytically examined in the context of mindfulness. One question is whether all measures are equally sensitive to mindfulness meditation training. Distinctions between scales, including the distinction between maladaptive and adaptive subjective interoception [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], may inform the understanding of processes involved in MBIs. Statistical differences between scales may be assessed in a meta-analytic framework. Other questions concern the relationships between improvements in interoception and improvements in distress and mindfulness. A recent study found that interoceptive appreciation (measured by the MAIA Body Listen\u0026thinsp;+\u0026thinsp;Trusting subscales) partially mediated the effects of a mindfulness-based program on enhancing the capacity for health behavior change [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. If relationships between changes in clinical outcomes and interoception are consistent across studies, this could support measurement of interoception as a process in MBIs, as well as mindfulness didactics focusing on interoceptive awareness [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePrevious studies have examined the effects of mind-body interventions on interoception in psychiatric disorders [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], but a systematic interrogation of effects on self-reported interoception measures is lacking. In the current study, we meta-analytically examined evidence from randomized control trials evaluating the effects of mindfulness interventions on self-reported interoception, including both MBP interventions structured similarly to MBSR, but also incorporating any interventions with teacher-led mindfulness meditation. Given some uncertainty about the scope of SIMs, we use measures incorporated previously in a construct review[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e], and we use cutting-edge meta-analytic techniques to account for correlated measures within studies [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. We analyzed moderators including study adherence, study populations and practice quantities to inform theories of interoceptive skill acquisition. Our preregistered questions were:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e(RQ1): Do mindfulness interventions improve self-reported interoception? If so, which constructs of interoception (e.g. adaptive or maladaptive) are influenced by mindfulness interventions?\u003c/p\u003e\u003cp\u003e(RQ2) What characteristics of mindfulness interventions and participant samples moderate effects on self-reported interoception?\u003c/p\u003e\u003cp\u003e(RQ3) Do changes in interoception relate to changes in psychological symptoms?\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eThe objective of this meta-analysis was to (RQ1) analyze the effects of mindfulness training on self-reported interoception, as well as test (RQ2) moderation effects, and finally (RQ3) to assess the relationship between changes in interoception, changes in psychological distress, and changes in mindfulness.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eProtocol and Registration\u003c/h3\u003e\n\u003cp\u003eThe meta-analysis was preregistered at \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://osf.io/yr439\u003c/span\u003e\u003cspan address=\"https://osf.io/yr439\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Several deviations were made. Namely, we used expert input for dimensions of interoception instead of empirical factor analyses, given incomplete coverage of the present measures in empirical factor analyses [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. In addition, we renamed \u0026lsquo;interoception\u0026rsquo; interventions to \u0026lsquo;body-based\u0026rsquo; interventions given that they included interoceptive, proprioceptive and body awareness practices generally. Most importantly, we found inadequate performance of the bivariate meta-analytic models for assessing relationships between changes in distress, mindfulness, and interoception. The models uniformly produced high correlation values, but also extremely large confidence intervals that varied based on model assumptions. For instance, the relationship between mindfulness and distress was significant assuming no sampling covariance, but when positing a moderate sampling covariance it was not significant. For this reason, we characterized the relationships using correlation coefficients and scatterplots, but did not test statistical significance. We followed PRISMA guidelines [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e](Supplement 2: CHECKLIST\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e\n\u003ch3\u003eEligibility Criteria\u003c/h3\u003e\n\u003cp\u003eWe included only randomized controlled trials of MBIs that involved sustained (\u0026gt;\u0026thinsp;4 formal hours) practice of mindfulness meditation, defined as practices including: open awareness, breath meditation and body scans, with the focus of present-moment awareness and acceptance [\u003cspan additionalcitationids=\"CR45\" citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Interventions could also include other components such as yoga, walking and massage, as long as they were paired with mindfulness meditation. This decision was made to maintain a pluralistic and inclusive focus of MBIs [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]; however, we coded the relevant distinctions between interventions so as to isolate differential effects. Specifically, we categorized interventions as (1) MBPs (i.e., MBSR, MBCT, and other programs with the same training standards and curricular elements [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]), (2) body-based MBIs that included massage, and (3) other MBIs. We excluded app-based interventions given heterogeneous training durations, more limited adherence, and lack of teacher involvement [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. See Supplemental Table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e for a full list of included studies.\u003c/p\u003e \u003cp\u003eFor the present meta-analysis, we refer broadly to interoception as the processing of internal bodily signals by the nervous system, and to interoceptive self-report as measuring interoceptive beliefs, attitudes, and thoughts. Studies in the current review must have included data from a questionnaire primarily developed for studying the construct of interoception. We specifically included any questionnaires that were present in a systematic review of self-report interoception constructs [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e] (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). We additionally added two questionnaires \u0026ndash; the Scale of Body Connection (SBC) [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] and the Cardiac Anxiety Questionnaire (CAQ) [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e], because examination of their item-level responses revealed compatibility with the measurement of self-reported interoception. It should be noted that the Five-Facet Mindfulness Questionnaire and its \u0026lsquo;Observing\u0026rsquo; subscale was not considered a self-report measure of interoception, as the item-level responses primarily assess awareness of external sensory experiences (e.g. sun on face, wind in hair) and general emotional awareness, rather than direct perception of internal bodily signals such as respiration, heartbeat or visceral sensations, which are central to self-reported interoception. We only included empirical studies, allowing for preprints, theses, or book chapters, regardless of peer-review publication status. We allowed for all ages and populations of participants.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSelf-reported measures, along with their corresponding interoceptive dimensions and adaptive/maladaptive categorization.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-reported Measures\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInteroceptive Dimension\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMAIA-NO, BAQ, SBC-A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSensing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eAdaptive\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMAIA-ND, MAIA-SR, MAIA-AR,\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAttention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eAdaptive\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMAIA-NW, MAIA-BL, MAIA-EA, MAIA-TR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInterpretation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eAdaptive\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVSI, CAQ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSensing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eMaladaptive\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVSI, CAQ, SBC-D\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAttention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eMaladaptive\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVSI, CAQ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInterpretation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eMaladaptive\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003cem\u003eNote.\u003c/em\u003e All SIMS reported are included. MAIA: Multidimensional Assessment of Interoceptive Awareness; MAIA-NO: Noticing subscale of the MAIA; BAQ: Body Awareness Questionnaire; SBC: Scale of Body Connection; SBC-A: Awareness subscale of the SBC; MAIA-ND: Not Distracting subscale of the MAIA; MAIA-SR: Self-Regulation subscale of the MAIA; MAIA-AR: Attention Regulation subscale of the MAIA; MAIA-NW: Not Worrying subscale of the MAIA; MAIA-BL: Body Listening subscale of the MAIA; MAIA-EA: Emotional Awareness subscale of the MAIA; MAIA-Trusting: Trusting subscale of the MAIA; VSI: Visceral Sensitivity Index; CAQ: Cardiac Anxiety Questionnaire; SBC-D: Dissociation subscale of the SBC.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eOutcomes of Interest\u003c/h3\u003e\n\u003cp\u003eSelf-reported interoception measures (SIMs) were extracted from the studies, including each dimensional subscale when possible (e.g., the eight MAIA subscales). We also extracted psychological distress measures, encompassing stress, anxiety, depression, and PTSD symptoms (Supplementary Table \u003cspan refid=\"MOESM2\" class=\"InternalRef\"\u003eS2\u003c/span\u003e) and mindfulness measures, encompassing total Five Facet Mindfulness Questionnaire (FFMQ) scores, Freiburg Mindfulness Inventory, etc. (Supplementary Table S3). We contacted authors to provide data for SIMs where necessary; for example, when manuscripts did not report scores for individual MAIA subscales. Come Studies were eligible for inclusion in main analysis if they reported outcomes on SIMs, even if they did not report mindfulness or distress measures.\u003c/p\u003e\n\u003ch3\u003eSystematic Search\u003c/h3\u003e\n\u003cp\u003eWe conducted two searches on July 7th of 2024 of PubMed, ProQuest, PsycArticles, and WebOfScience. Search One: (mindfulness OR meditation) AND (interocept* OR \u0026ldquo;bodily awareness\u0026rdquo; OR \u0026ldquo;body awareness\u0026rdquo; OR \u0026ldquo;somatic awareness\u0026rdquo; OR somatosensory OR visceral OR proprioception) AND (\"questionnaire\" or \"inventory\" or \"scale\" or \"rating\" or \"instrument\"). Search two: (mindfulness OR meditation) AND (BAQ OR MAIA OR SAQ OR PBCS OR BPQ OR VSI OR \u0026ldquo;Body Perception Questionnaire\" OR \"Body Awareness Questionnaire\" OR \"Self-Awareness Questionnaire\" OR \"Multidimensional Assessment of Interoceptive Awareness\" OR \u0026ldquo;Visceral Sensitivity Index\u0026rdquo;). We additionally searched reference lists of identified studies and conducted an AI-assisted search on Undermind which supplied articles matching a natural language query (Supplementary Text S1). Only studies published before July of 2024 were included.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStudy Selection\u003c/h2\u003e \u003cp\u003eSearch results consisting of citation data and abstracts were first screened for duplicate publications. Next, all abstracts were evaluated based on two main criteria: an empirical study (examples of excluded articles were review papers and protocol papers) and content relevance (based on mindfulness and interoception or body awareness). Remaining studies were screened by reviewing the methods section and full paper to further evaluate whether the study met all inclusion criteria. All inclusion/exclusion coding was conducted in duplicate, once by IT, and then independently by CV or YY.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData Collection Process\u003c/h3\u003e\n\u003cp\u003eA coding manual was developed by the first author to guide the extraction of study descriptive and effect size data. Extraction of these data were conducted by IT and confirmed independently by CV, CW, YY, or JQ. Coding disagreements were discussed by the team.\u003c/p\u003e\n\u003ch3\u003eData Items\u003c/h3\u003e\n\u003cp\u003eWe extracted the following descriptive variables: duration of intervention in training weeks, subjects in mindfulness and control conditions (after dropout), mindfulness condition type, control condition type, age, percentage female (using reported gender), population type (normative, physical health condition, psychopathology, and other), and interoception measure/dimension. Intervention type was determined as following: (1) \u0026lsquo;mindfulness-based programs\u0026rsquo; (MBPs) involved manualized interventions of at least 8 weeks that closely followed MBSR or MBCT, (2) \u0026lsquo;body-based interventions\u0026rsquo; involved meditation but also extensive body-focused practices e.g. massage, sexual awareness, eating awareness and hunger monitoring, and (3) \u0026lsquo;other MBIs\u0026rsquo; interventions included the small set of heterogeneous studies remaining. Interoceptive awareness dimensions were defined and categorized by expert input from SK and WM in the context of a maladaptive/adaptive framework from [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e] where interoception consists of sensing, attending, interpreting, and may be maladaptive or adaptive (maladaptive is not continuous with adaptive). The categorizations of study measures are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eIn the case of one study with two similar control groups (both active), we combined the groups (and pooled their means and standard deviations) [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. Intervention impacts on interoception were measured as standardized mean differences, corrected using Hedges\u0026rsquo; g adjustment for small samples [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e], with positive effect sizes favoring the mindfulness group over the control group. For calculating standardized treatment effects, we applied the following approaches (in decreasing preference): (1) Group differences adjusted for baseline measures (using analysis of covariance or regression adjustment) (2) Group differences in mean change scores (post-intervention minus pre-intervention scores). Other reported statistics (e.g., mixed effect model estimates) were used when appropriate based on standard meta-analytic methods [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eRisk of Bias\u003c/h2\u003e \u003cp\u003eBias assessment was adapted from the ROB-2 [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e], with modifications to fit the focus of the current study. As the study exclusively involved self-report measures, evaluation of bias related to objective outcome measurement was deemed not applicable. The bias evaluation process was as follows: At least two authors of IT, YY, CW, JQ and CV independently rated the risk across several domains, including 1) randomization bias, 2) bias due to deviations from intended interventions (e.g., issues related to blinding in the present study), 3) bias due to missing outcome (i.e., objective measurements of attrition) 4) outcome bias (i.e., attrition differences between groups) and 5) reporting bias. This estimated risk in each domain was then compared between raters. Any disagreements were discussed and resolved by a third author, YY. After inter-rater agreement was reached, studies were classified as having low, some concerns, or high risk of bias. Methods for quantifying study quality are detailed in supplement \u003cb\u003e(\u003c/b\u003eSupplementary Text S2).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eAnalysis\u003c/h2\u003e \u003cp\u003eAnalysis was conducted in R 4.3.1 using the \u003cem\u003emetafor\u003c/em\u003e and \u003cem\u003eMAd\u003c/em\u003e packages [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]. For RQ1, to assess overall mindfulness intervention effects on interoception, we conducted a correlated-and-hierarchical effects (CHE) meta-analysis with robust variance estimation [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. This model allows for inclusion of effect size estimates for multiple outcomes from the same study (e.g., subscale of a single interoception measure or multiple measures of interoception) and makes tentative assumptions about the intercorrelation between such estimates. We developed these assumptions using correlations between the outcomes reported in the literature in order to specify an assumed sampling variance-covariance matrix (Supplementary Table S4\u003cb\u003e)\u003c/b\u003e. We used robust variance estimation methods to allow for the possibility that these and other model assumptions about the variability of the effect size estimates might not be correct. We reported the overall average effect size estimate, heterogeneity estimates (tau) at the study level and effect size level, and a 67% prediction interval describing the distribution of effects that would be observed in new studies. We conducted sensitivity analysis by repeating the summary meta-analysis while omitting one primary study at a time, and by winsorizing outlier effect sizes.\u003c/p\u003e \u003cp\u003eWe then (RQ2) examined for whom and under what circumstances mindfulness interventions produce effects on interoception measures i.e. testing meta-analytic moderators. Using separate meta-regression analyses for each moderator, we examined sex, age, mental health condition vs normative, physical health condition vs normative, sample size, duration of intervention (weeks and minutes, with and without home practice), preregistration status, control type (passive vs active), control type (includes mind-body characteristics or not), adherence (session attendance) and quality of study (ROB-2). Meta-regression models were estimated using the same working model as in RQ1. To compare meta-analytic effects across intervention types with two levels, we used the clubSandwich package to conduct cluster-robust \u003cem\u003et\u003c/em\u003e tests with Satterthwaite degrees of freedom. To compare meta-analytic effects across intervention types or self-report measures with more than two categories, we used the \u003cem\u003ewildmeta\u003c/em\u003e package [\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e] to conduct Wald tests of the null hypothesis that average effects are equal across categories, with clustered wild bootstrapping to determine significance levels of the tests. While we calculated meta-analytic effects for all measures, we did not test for differences among all self-report measures statistically, given the large number of measures. Instead, we tested for differential effects between adaptive and maladaptive dimensions of interoception, provided that at least four studies included measures for a given dimension. We also statistically compared MAIA vs other self-report measures, given the preponderance of studies using the MAIA.\u003c/p\u003e \u003cp\u003eTo examine (RQ3) the relationships between interoception, distress and mindfulness, we assessed relationships between the pre-post effects in each domain. We provide scatterplots as well as Pearson\u0026rsquo;s and Spearman\u0026rsquo;s correlation coefficients where appropriate so as to provide information about the size of relationships. The observed correlation coefficients imply both baseline and latent change contributions to the effect and thus were not assessed for statistical significance. We were unable to disentangle the contributions using bivariate meta-analytic models due to a limited number of studies (see Deviations). On an exploratory basis we examined whether effects on mindfulness were significantly different from effects on interoception.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eSelective Reporting and Publication Bias\u003c/h2\u003e \u003cp\u003ePsychological research is affected by selective reporting bias (occurring when affirmative and statistically significant results have a higher probability of getting published [\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e]) and so-called \u0026lsquo;data contingent\u0026rsquo; analyses [\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e]. We used two different approaches to evaluate potential bias due to preferential reporting of statistically significant results: funnel plots to detect if small samples disproportionately report larger effects, and three-parameter selection models (using the \u003cem\u003emetaselection\u003c/em\u003e package) which explicitly model the probability that a finding is reported based on the sign and statistical significance level of the effect estimate. To account for correlations between effect sizes, we used cluster-wise bootstrapping to calculate percentile confidence intervals for the selection model parameters.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eSelected Studies\u003c/h2\u003e \u003cp\u003eA PRISMA flow diagram is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eStudy characteristics\u003c/h2\u003e \u003cp\u003eTwenty-nine randomized controlled mindfulness interventions with self-report interoception measures were identified. For an overview of study characteristics, see Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The studies involved 2,191 participants (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;32.78 yrs, SD\u0026thinsp;=\u0026thinsp;10.33 yrs), the majority of whom were female (77.82%). No studies involved children or adolescents, indicating a possible lack of investigation of mindfulness-based interoception changes in developmental populations. Sixteen studies involved participants with mental health conditions (trauma, depression, substance use, chronic pain of non-physical origin), six involved normative samples, four involved physical health conditions, and the remaining three had other characteristics (e.g. pregnancy; 61]. The average sample size for the mindfulness interventions was 44.4 participants, and 36.8 participants for the control interventions.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe majority of mindfulness-based interventions were mindfulness-based programs (e.g., MBSR), encompassing 15 studies (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;1,255 participants). Thirteen of these studies were of the standard length (8 weeks) with one of 9 weeks [\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e] and one of 12 weeks [\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e]. Three of the studies used identical programs, control conditions, and measures with different samples, and the authors provided data in aggregate [\u003cspan additionalcitationids=\"CR65\" citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e]. These studies were collapsed for synthesis. The second most common category was body-based mindfulness (\u003cem\u003ek\u003c/em\u003e\u0026thinsp;=\u0026thinsp;8, \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;581), including studies that involved mindfulness meditation supplemented with massage (\u003cem\u003ek\u003c/em\u003e\u0026thinsp;=\u0026thinsp;5, e.g., [\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e]).The majority of these studies were 8 weeks, with two more extended training programs [\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e]. Finally, six remaining studies (\u0026lsquo;other\u0026rsquo;) (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;426) involved mindfulness practices but did not follow a standardized program; these were variable in length (1\u0026ndash;9 weeks).\u003c/p\u003e \u003cp\u003eEighteen of the twenty-nine studies had active controls (e.g. relaxation, low-dose comparators, therapy, massage without meditation). Sixteen studies were preregistered, although interoception was only a primary outcome in three studies [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e] (psychological distress was more typical). Measures of interoception mainly consisted of the MAIA (21/29) followed by the SBC-Awareness (5/29), SBC-Dissociation (3/29), CAQ (1/29), BAQ (1/29) (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e for further categorizations).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eRisk of Bias\u003c/h2\u003e \u003cp\u003eRisk of bias is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and Supplementary Figure \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e. The primary source of bias across studies was related to blinding (\u003cem\u003ek\u003c/em\u003e\u0026thinsp;=\u0026thinsp;17), as the majority of studies did not have instructors blinded to the intervention aims. Many studies were rated as \u0026lsquo;some concerns of bias\u0026rsquo; for randomization, as many studies did not perform allocation concealment, and a few contained meaningful baseline differences between treatment and control groups. Most studies showed adequate reporting, and differential attrition between group was not a major area of potential bias. A full summary of study risk of bias is found in Supplementary Table S5.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eStudy Synthesis (RQ1)\u003c/h2\u003e \u003cp\u003eAcross all studies, there was a positive, small-to-medium average effect on self-reported interoception (\u003cem\u003ek\u003c/em\u003e\u0026thinsp;=\u0026thinsp;29, 89 correlated effects, \u003cem\u003eg\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.31, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001, 95% CI = [0.21, 0.42]) (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Heterogeneity was low-to-moderate, with a total heterogeneity \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\widehat{\\tau\\:}\\)\u003c/span\u003e\u003c/span\u003e of 0.16 (between-study \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\widehat{\\tau\\:}\\)\u003c/span\u003e\u003c/span\u003e = 0.14, within-study \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\widehat{\\tau\\:}\\)\u003c/span\u003e\u003c/span\u003e = 0.09) and a 67% prediction interval of [0.15, 0.48]. We found no evidence of publication bias either through funnel plots (Supplementary Figure \u003cspan refid=\"MOESM2\" class=\"InternalRef\"\u003eS2\u003c/span\u003e) or three-parameter selection models. Counter to typically expected selective reporting processes, the three-parameter selection model estimates indicated selection \u003cem\u003ein favor\u003c/em\u003e of non-affirmative findings (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\lambda\\:}_{1}\\)\u003c/span\u003e\u003c/span\u003e = 1.19, 95% CI = [0.46, 2.99]), leading to a slightly larger adjusted average effect size estimate of \u003cem\u003eg\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.35, 95% CI = [0.23, 0.51].\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe omnibus effect was robust to outliers; the maximum change in average effect based on leave-one-study-out sensitivity was +/-15%, and winsorizing did not change the average effect size estimate.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eModeration Analyses (RQ2)\u003c/h2\u003e \u003cp\u003eAll effects are shown for intervention type (design) and measures that include more than four independent studies in Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. We statistically examined design and interoception measures independently to maintain adequate power for moderation comparisons. Effects for all designs were significant: MBPs (\u003cem\u003ek\u003c/em\u003e\u0026thinsp;=\u0026thinsp;15, \u003cem\u003eg\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.41, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), body-based interventions (\u003cem\u003ek\u003c/em\u003e\u0026thinsp;=\u0026thinsp;8, \u003cem\u003eg\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.19, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and other mindfulness (\u003cem\u003ek\u003c/em\u003e\u0026thinsp;=\u0026thinsp;6, \u003cem\u003eg\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.23, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). There was no overall significant moderation by design (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.14), but pairwise contrasts revealed MBPs had larger effects than body-based interventions (B\u0026thinsp;=\u0026thinsp;0.22, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.048). For self-report measures, we compared the constructs of adaptive sensing (\u003cem\u003eg\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.29, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), adaptive interpretation (\u003cem\u003eg\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.28, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), adaptive attention (\u003cem\u003eg\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.31, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and maladaptive attention (\u003cem\u003eg\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.25, \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.1). The four-way contrast was not significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.83), and no pairwise contrasts were significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.4). Comparisons between SIMs were similar when examining MBP studies only. Of the SIMs, MAIA not-worrying (\u003cem\u003eg\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.15, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.11) and MAIA not-distracting (\u003cem\u003eg\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.12, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.11) showed the smallest effects of any measure (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eNo other moderators (e.g. active vs passive controls) were statistically significant (unadjusted \u003cem\u003ep\u003c/em\u003es\u0026thinsp;\u0026gt;\u0026thinsp;0.2) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). When examining only MBPs, likewise, no significant moderations were observed (Supplementary Table S6).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eModeration effects across all studies.\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eName\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBeta\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCI-Low\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCI-High\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePercent Female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.523\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean Age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.225\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMH Sample vs. Not\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.269\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.156\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.581\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMH Sample vs. Normative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.523\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.350\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.629\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePH Sample vs. Not\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.405\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.366\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.887\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePH Sample vs. Normative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.466\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.382\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.809\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSample Size\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.724\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeeks Intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.358\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.062\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.078\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.784\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePractice Min Excluding Home\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.249\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.378\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePractice Min Including Home\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.386\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.366\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.913\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSession Attendance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-2.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.377\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.545\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreregistered\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.198\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.244\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.826\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eActive Control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.346\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.355\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMind-Body Control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.446\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.724\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.525\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003eNote.\u003c/em\u003e Betas represent standardized effect for relationship between effect sizes and moderator. No FDR-correction was applied as no \u003cem\u003ep\u003c/em\u003e-values met significance. CI: confidence interval; MH Sample: mental health condition sample; PH Sample physical health condition sample.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eBivariate Analyses (RQ3)\u003c/h2\u003e \u003cp\u003eWe examined changes in distress and mindfulness for the studies that reported those outcomes. Effect sizes on distress were small-to-moderate (\u003cem\u003ek\u003c/em\u003e\u0026thinsp;=\u0026thinsp;24, \u003cem\u003eg\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.28, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001, \u003cem\u003eCI\u003c/em\u003e = [0.16, 0.39]). Effect sizes on mindfulness were small-to-moderate (\u003cem\u003ek\u003c/em\u003e\u0026thinsp;=\u0026thinsp;17, \u003cem\u003eg\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.27, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001, \u003cem\u003eCI\u003c/em\u003e = [0.16,0.38]). In the sample of 17 studies reporting mindfulness, the effect on self-reported interoception was slightly larger (\u003cem\u003eg\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.34), although the difference was not statistically significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.1). The relationship between increases in self-reported interoception and decreases in distress was positive (\u003cem\u003er\u003c/em\u003e(22)\u0026thinsp;=\u0026thinsp;0.25, \u003cem\u003erho\u003c/em\u003e(22)\u0026thinsp;=\u0026thinsp;0.36) (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). The relationship between distress and mindfulness (\u003cem\u003er\u003c/em\u003e(14)\u0026thinsp;=\u0026thinsp;0.77) was strong, and the relationship between mindfulness and self-reported interoception (\u003cem\u003er\u003c/em\u003e(13)\u0026thinsp;=\u0026thinsp;0.36) was positive(Supplementary Figure S3 and S4). Bivariate model estimates were unstable and highly sensitive to sampling covariance assumptions, likely because the quantity of studies reporting multiple types of outcomes was too small (e.g., \u003cem\u003ek\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;50) to estimate correlations between the latent variables of impacts on distress and impacts on mindfulness. Consequently, we did not interpret the parameter estimates from the bivariate model.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn the current meta-analysis, we conducted the first systematic evaluation of self-reported interoception in studies employing mindfulness-based interventions. Across 29 studies with over 2,000 participants, we identified a small-to-moderate positive effect (g\u0026thinsp;=\u0026thinsp;0.31) across all designs and measures. Prediction intervals did not cross zero, suggesting that future mindfulness interventions are likely to yield beneficial self-reported interoception outcomes with reasonable certainty. Heterogeneity was low-to-moderate, and publication bias based on statistical significance was not evident. In terms of moderation, Mindfulness Based Programs, based on MBSR, had larger effects than the body-based approaches included in our analysis. Lastly, we identified positive relationships between interoception improvements and decreases in distress, although we were unable to assess statistical significance based on the limited number of studies.\u003c/p\u003e \u003cp\u003eFirst, we discuss the size and implications of the omnibus effect. Prior studies on objective body awareness measures found small effects with wide confidence intervals (e.g., \u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.13, CI = [-0.36 to 0.62] [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]), which were limited to certain types of study designs and measures. The current result on self-reported interoception measures (SIMs) was larger, more precise, and consistent across study designs and measures. Researchers have acknowledged that mindfulness and other behavioral interventions may move self-report more than objective measures [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e], but until the current study there was little meta-analytic evidence. The observed effect on SIMs was in the range of effects observed on trait mindfulness (\u003cem\u003eg\u003c/em\u003es\u0026thinsp;=\u0026thinsp;0.28\u0026ndash;0.49, [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]), which is often used as a primary measure of treatment efficacy in mindfulness interventions. Notably, in studies from our sample that included both mindfulness and interoception outcome measures, the effects on interoception tended to be larger. Given that the therapeutic approach of programs like MBSR emphasizes the process of sensing and interpretation of body signals [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], our findings support the use of SIMs as primary measures in mindfulness studies.\u003c/p\u003e \u003cp\u003eSeveral studies included here have reported the role of interoceptive awareness measures or dimensions as mediators or partial mediators of clinical outcomes in MBIs, especially in populations with depression. Fissler et al. [\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e] reported that the effects of a brief mindfulness intervention on depression symptoms were mediated by changes in a path where score increases on multiple MAIA subscales were serially related to decentering, which reduced depressive symptoms. DeJong et al. [\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e] reported that among a population of patients with depression and chronic pain, the positive effect of MBCT on depression severity was mediated by MAIA, specifically \u0026lsquo;Not Distracting\u0026rsquo;. Finally, Schuman-Olivier et al. [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e] demonstrated that the effect on health behavior change initiation from a MBP among primary care patients with depression was partially mediated by MAIA \u0026lsquo;Body Trusting\u0026rsquo;, while health behavior change was mediated by \u0026lsquo;Body Listening\u0026rsquo; among those without depression. These studies suggest that self-report measures of interoceptive awareness may be clinically relevant mediators. However, the most optimal shifts in interoceptive processing may differentially depend on disorder and outcome measured. As we only compared general categories of psychopathology, physical health conditions, and normative populations in the current meta-analysis, these differences need further study.\u003c/p\u003e \u003cp\u003eOur findings support the possibility that interoception, and particularly the self-reported aspect of interoception, is a key process targeted in mindfulness training. However, numerous questions remain about the potential underlying mechanism(s) of action. For one, there was no effect of study quality, attendance or duration. This could be viewed as evidence of a general interoceptive appreciation or attentional effect, instead of an effect specific to the involved meditation techniques. Prior studies have found inconsistent relationships between\u003c/p\u003e \u003cp\u003ethe \u0026lsquo;dosage\u0026rsquo; of formal practice (usually measured in terms of hours or practice) and effects on distress [\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e]. Thus it is possible that the quantity of practice hours is less informative than the depth of learning from the intervention, for which phenomenological interviewing may be more informative [\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAnother noteworthy finding was that MBPs led to significantly greater improvements than body-based studies, although both were significant. Body-based MBI studies included here involved components like massage in the therapeutic process, where touch supports a non-judgemental awareness of the body. Many of these studies used the Mindful Awareness in Body-Oriented Therapy (MABT) protocol, an individual therapy that integrates touch, mindfulness, and psychoeducation to foster interoceptive awareness for self-care by increasing awareness of sensations and emotions and improving somatic appraisal [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. A nuance of these studies is that many of the control conditions also incorporated massage, which may have decreased the size of treatment effects on interoception due to the common anchoring in modulation of body states [\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e]. However, when we coded control conditions based on mind-body components, this did not moderate overall treatment effects. More insight into this nuanced finding is necessary. Future studies should conduct dismantling approaches (e.g. mindfulness\u0026thinsp;+\u0026thinsp;massage, mindfulness, massage) or administer state measures after sessions to identify active components.\u003c/p\u003e \u003cp\u003eA primary motivation for our study was examining differential effects on distinct interoception self-report measures. This potential was limited by the preponderance of studies employing the MAIA. The MAIA involves 8 subscales, which were designed to measure positive aspects of mind-body interventions on interoception [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Our construct-forward approach was to decompose the MAIA and other scales into adaptive and maladadaptive interoception, with sensing, attention, and interpretation components [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. Many studies just report the total MAIA scores, but we contacted study authors and generated sufficient studies to measure effects in all positive categories (e.g. \u003cem\u003ek\u003c/em\u003e\u0026thinsp;=\u0026thinsp;16 for adaptive interpretation), and also in maladaptive attention (\u003cem\u003ek\u003c/em\u003e\u0026thinsp;=\u0026thinsp;6). However, we did not find any statistically significant evidence of differences across categories. An exploratory analysis revealed smaller effects on \u0026lsquo;not-distracting\u0026rsquo; and \u0026lsquo;not-worrying\u0026rsquo;. However, this could simply reflect limited construct validity in the original MAIA subscales [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. In contrast, moderation effects by objective body awareness measures have been identified (more distal, emotionally targeted measures show larger effects than interoceptive accuracy measures; [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]). Objective measures may provide discriminability lacking in self-report measures.\u003c/p\u003e \u003cp\u003eOne may still question whether interoceptive benefits of mindfulness are epiphenomenal to improvements in distress. A formal test of this possibility would require mediation analyses, and would thus be reliant on individual participant data. In the current meta-analysis, we primarily had access to study-level data and thus instead attempted to assess whether changes in interoception were associated with changes in distress. Our findings suggest the possibility of a positive relation, where larger changes in interoception led to larger decreases in distress. The relationship between mindfulness and distress appeared stronger, but baseline relationships are also stronger in mindfulness [\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e]. Indeed, both apparent relationships could be due in whole or part to the associations between the measures (i.e., sampling errors) rather than due to relation between the latent impacts, and our sample did not include a sufficient number of studies effectively isolate the relation between latent impacts (50 or more may be required [\u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e]). One future question is whether changes in objective measures in interoception show a similar relationship to distress.\u003c/p\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eOne limitation of the current literature is that it may not be diverse enough to meta-analytically identify differential effects of specific aspects of self-reported interoceptive awareness. As mentioned, the vast majority of studies used the MAIA. While the MAIA has different dimensions of interest, some of these reflect overlapping latent constructs, are moderately to highly correlated, and share similar language. This may have limited our ability to disentangle constructs of interoception like sensing, attention, and interpretation. Another limitation was that we were unable to meta-analytically examine mediation effects or other causal modelling findings \u0026ndash; too few studies conducted mediation. Studies with larger sample sizes examining interoception as a mediator tended to find larger effects (contributing to the \u0026lsquo;reverse selection bias\u0026rsquo; finding), suggesting that this effect is not incidental. Finally, we were unable to statistically examine relations between interoception, distress and mindfulness due to limited numbers of studies. Future examinations of this question would ideally draw on individual participant-level data from primary studies.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eFuture Directions\u003c/h2\u003e \u003cp\u003eVery few of the selected studies examined both objective and subjective measures of interoception in parallel (we identified only one [\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e]). Assessing both dimensions concurrently is crucial to understanding whether and how mindfulness training alters the processing of interoceptive signals. The effects observed here on self-reported interoception appear to be more robust\u0026mdash;i.e., larger\u0026mdash;than those reported for objective measures [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. This discrepancy may suggest that mindfulness primarily influences attitudes toward bodily sensations and regulatory aspects of interoception, rather than perceptual accuracy or acuity per se. Future studies should incorporate direct comparisons of objective and subjective interoceptive measures within the same samples to more clearly elucidate these mechanisms. Such work would likely need to focus on specific interoceptive channels, such as respiratory signals, which are particularly emphasized in many MBPs.\u003c/p\u003e \u003cp\u003eWe also did not observe moderation effects based on mental or physical health conditions. This is consistent with prior individual participant data meta-analyses of mindfulness interventions that similarly failed to identify moderation by distress levels [\u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e]. One possible explanation is the heterogeneity of clinical presentations across trials. Still, emerging small-sample studies suggest that mindfulness may differentially affect interoceptive processing in depression versus anxiety [\u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e], although our analysis did not identify enough studies to formally test this possibility.\u003c/p\u003e \u003cp\u003eA striking gap in the literature is the absence of studies examining the effects of mindfulness on interoception in youth and adolescent populations. Adolescence is a particularly sensitive developmental period marked by rapid changes in both interoception and the emergence of many mental health conditions[\u003cspan additionalcitationids=\"CR80 CR81\" citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e]. Investigating how mindfulness training influences subjective and objective interoception in adolescents could clarify mechanisms of resilience and inform early intervention strategies.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study represents the first meta-analysis of the effects of mindfulness-based interventions on self-reported interoception. We observed robust improvements across the 29 studies included, providing evidence supporting the idea that changes in interoception\u0026mdash;or at least the self-reported aspects of it\u0026mdash;may underpin the therapeutic effects of mindfulness training. Nevertheless, the lack of sensitivity to many qualities of the included studies like dosage or self-report measure require further investigation.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eINT contributed to conceptualization, methodology, investigation, writing-original draft, writing- review \u0026amp; editing, visualization, and project administration. YY, CV, CW managed investigation, visualization and writing- review \u0026amp; editing. JQ contributed to investigation and writing-review \u0026amp; editing. EW handled investigation. JP managed methodology, investigation, and writing- review \u0026amp; editing. SBG, ZSO, WM, contributed to conceptualization and review \u0026amp; editing. SK contributed to supervision, review \u0026amp; editing, and funding acquisition.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThedatasets and code generated during the current study are available at: https://osf.io/qzyh5/?view_only=c537e7d6de084f32a90eb12792175a2e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eAdditional Information\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval:\u0026nbsp;\u003c/strong\u003eNo original data collection was performed.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAI Statement:\u0026nbsp;\u003c/strong\u003eNo AI was used in the preparation of the language of this manuscript. An AI search was used to supplement the systematic search, and AI was used to generate Figure 2.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Statement:\u0026nbsp;\u003c/strong\u003eSBG was supported by NCCIH R24AT012845 and NCCIH K23AT010879.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKhalsa, S. S. \u003cem\u003eet al.\u003c/em\u003e Interoception and Mental Health: A Roadmap. \u003cem\u003eBiol. Psychiatry Cogn. Neurosci. Neuroimaging\u003c/em\u003e (2018) doi:10.1016/j.bpsc.2017.12.004.\u003c/li\u003e\n\u003cli\u003eGreenwood, B. M. \u0026amp; Garfinkel, S. N. Interoceptive Mechanisms and Emotional Processing. \u003cem\u003eAnnu. Rev. Psychol.\u003c/em\u003e \u003cstrong\u003e76\u003c/strong\u003e, 59\u0026ndash;86 (2025).\u003c/li\u003e\n\u003cli\u003eHerbert, B. M., Herbert, C. \u0026amp; Pollatos, O. On the relationship between interoceptive awareness and alexithymia: Is interoceptive awareness related to emotional awareness? \u003cem\u003eJ. Pers.\u003c/em\u003e \u003cstrong\u003e79\u003c/strong\u003e, 1149\u0026ndash;1175 (2011).\u003c/li\u003e\n\u003cli\u003eMehling, W. Differentiating attention styles and regulatory aspects of self-reported interoceptive sensibility. \u003cem\u003ePhilos. Trans. R. Soc. B Biol. Sci.\u003c/em\u003e \u003cstrong\u003e371\u003c/strong\u003e, (2016).\u003c/li\u003e\n\u003cli\u003eBrener, J. \u0026amp; Ring, C. Towards a psychophysics of interoceptive processes: The measurement of heartbeat detection. \u003cem\u003ePhilos. Trans. R. Soc. B Biol. Sci.\u003c/em\u003e (2016) doi:10.1098/rstb.2016.0015.\u003c/li\u003e\n\u003cli\u003eSchandry, R. Heart Beat Perception and Emotional Experience. \u003cem\u003ePsychophysiology\u003c/em\u003e (1981) doi:10.1111/j.1469-8986.1981.tb02486.x.\u003c/li\u003e\n\u003cli\u003eKhalsa, S. S. \u0026amp; Lapidus, R. C. Can interoception improve the pragmatic search for biomarkers in psychiatry? \u003cem\u003eFront. Psychiatry\u003c/em\u003e \u003cstrong\u003e7\u003c/strong\u003e, (2016).\u003c/li\u003e\n\u003cli\u003eLoureiro, F., Ringold, S. \u0026amp; Aziz-Zadeh, L. Interoception in Autism: A Narrative Review of Behavioral and Neurobiological Data. \u003cem\u003ePsychol. Res. Behav. Manag.\u003c/em\u003e \u003cstrong\u003eVolume 17\u003c/strong\u003e, 1841\u0026ndash;1853 (2024).\u003c/li\u003e\n\u003cli\u003eEggart, M., Lange, A., Binser, M. J., Queri, S. \u0026amp; M\u0026uuml;ller-Oerlinghausen, B. Major depressive disorder is associated with impaired interoceptive accuracy: A systematic review. \u003cem\u003eBrain Sci.\u003c/em\u003e \u003cstrong\u003e9\u003c/strong\u003e, 131 (2019).\u003c/li\u003e\n\u003cli\u003ePaulus, M. P., Feinstein, J. S. \u0026amp; Khalsa, S. S. An Active Inference Approach to Interoceptive Psychopathology. \u003cem\u003eAnnu. Rev. Clin. Psychol.\u003c/em\u003e \u003cstrong\u003e15\u003c/strong\u003e, 97\u0026ndash;122 (2019).\u003c/li\u003e\n\u003cli\u003ePaulus, M. P. \u0026amp; Stein, M. B. Interoception in anxiety and depression. \u003cem\u003eBrain Struct. Funct.\u003c/em\u003e \u003cstrong\u003e214\u003c/strong\u003e, 451\u0026ndash;463 (2010).\u003c/li\u003e\n\u003cli\u003eTrevisan, D. A., Mehling, W. E. \u0026amp; McPartland, J. C. Adaptive and Maladaptive Bodily Awareness: Distinguishing Interoceptive Sensibility and Interoceptive Attention from Anxiety-Induced Somatization in Autism and Alexithymia. \u003cem\u003eAutism Res.\u003c/em\u003e \u003cstrong\u003e14\u003c/strong\u003e, 240\u0026ndash;247 (2021).\u003c/li\u003e\n\u003cli\u003eVan Bael, K. \u003cem\u003eet al.\u003c/em\u003e A systematic review and meta-analysis of the relationship between subjective interoception and alexithymia: Implications for construct definitions and measurement. \u003cem\u003ePLOS ONE\u003c/em\u003e \u003cstrong\u003e19\u003c/strong\u003e, e0310411 (2024).\u003c/li\u003e\n\u003cli\u003eClemente, R., Murphy, A. \u0026amp; Murphy, J. The Relationship Between Self-Reported Interoception and Anxiety: A Systematic Review and Meta-Analysis. \u003cem\u003eNeurosci. Biobehav. Rev.\u003c/em\u003e 105923 (2024).\u003c/li\u003e\n\u003cli\u003eHeim, N. \u003cem\u003eet al.\u003c/em\u003e Psychological interventions for interoception in mental health disorders: A systematic review of randomized-controlled trials. \u003cem\u003ePsychiatry Clin. Neurosci.\u003c/em\u003e \u003cstrong\u003e77\u003c/strong\u003e, 530\u0026ndash;540 (2023).\u003c/li\u003e\n\u003cli\u003eCheng, S. C., Thompson, E. A. \u0026amp; Price, C. J. The Scale of Body Connection: A Multisample Study to Examine Sensitivity to Change Among Mind-Body and Bodywork Interventions. \u003cem\u003eJ. Integr. Complement. Med.\u003c/em\u003e \u003cstrong\u003e28\u003c/strong\u003e, 600\u0026ndash;606 (2022).\u003c/li\u003e\n\u003cli\u003eFarb, N. \u003cem\u003eet al.\u003c/em\u003e Interoception, contemplative practice, and health. \u003cem\u003eFront. Psychol.\u003c/em\u003e (2015) doi:10.3389/fpsyg.2015.00763.\u003c/li\u003e\n\u003cli\u003eKhoury, N. M., Lutz, J. \u0026amp; Schuman-Olivier, Z. Interoception in Psychiatric Disorders: A Review of Randomized, Controlled Trials with Interoception-Based Interventions. \u003cem\u003eHarv. Rev. Psychiatry\u003c/em\u003e \u003cstrong\u003e26\u003c/strong\u003e, 250\u0026ndash;263 (2018).\u003c/li\u003e\n\u003cli\u003ePrice, C. J. \u0026amp; Hooven, C. Interoceptive awareness skills for emotion regulation: Theory and approach of mindful awareness in body-oriented therapy (MABT). \u003cem\u003eFront. Psychol.\u003c/em\u003e \u003cstrong\u003e9\u003c/strong\u003e, 798 (2018).\u003c/li\u003e\n\u003cli\u003eCreswell, J. D. Mindfulness Interventions. \u003cem\u003eAnnu. Rev. Psychol.\u003c/em\u003e \u003cstrong\u003e68\u003c/strong\u003e, 491\u0026ndash;516 (2017).\u003c/li\u003e\n\u003cli\u003eKabat-Zinn, J. \u003cem\u003eFull Catastrophe Living (Revised Edition): Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness\u003c/em\u003e. (2013).\u003c/li\u003e\n\u003cli\u003eBishop, S. R. \u003cem\u003eet al.\u003c/em\u003e Mindfulness: A proposed operational definition. \u003cem\u003eClin. Psychol. Sci. Pract.\u003c/em\u003e \u003cstrong\u003e11\u003c/strong\u003e, (2004).\u003c/li\u003e\n\u003cli\u003eKabat-Zinn, J. An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: Theoretical considerations and preliminary results. \u003cem\u003eGen. Hosp. Psychiatry\u003c/em\u003e \u003cstrong\u003e4\u003c/strong\u003e, 33\u0026ndash;47 (1982).\u003c/li\u003e\n\u003cli\u003eCrane, R. S. \u003cem\u003eet al.\u003c/em\u003e What defines mindfulness-based programs? The warp and the weft. \u003cem\u003ePsychol. Med.\u003c/em\u003e \u003cstrong\u003e47\u003c/strong\u003e, 990\u0026ndash;999 (2017).\u003c/li\u003e\n\u003cli\u003eCullen, M. Mindfulness-Based Interventions: An Emerging Phenomenon. \u003cem\u003eMindfulness\u003c/em\u003e \u003cstrong\u003e2\u003c/strong\u003e, 186\u0026ndash;193 (2011).\u003c/li\u003e\n\u003cli\u003eMoore, A. \u0026amp; Malinowski, P. Meditation, mindfulness and cognitive flexibility. \u003cem\u003eConscious. Cogn.\u003c/em\u003e \u003cstrong\u003e18\u003c/strong\u003e, 176\u0026ndash;186 (2009).\u003c/li\u003e\n\u003cli\u003eKabat-Zinn, J., Lipworth, L. \u0026amp; Burney, R. The clinical use of mindfulness meditation for the self-regulation of chronic pain. \u003cem\u003eJ. Behav. Med.\u003c/em\u003e \u003cstrong\u003e8\u003c/strong\u003e, 163\u0026ndash;190 (1985).\u003c/li\u003e\n\u003cli\u003eMehling, W. E., Todd, J. \u0026amp; Schuman-Olivier, Z. Multidisciplinary Assessment of Interoceptive Awareness, Version 2 (MAIA-2). in \u003cem\u003eHandbook of Assessment in Mindfulness Research\u003c/em\u003e (eds. Medvedev, O. N., Kr\u0026auml;geloh, C. U., Siegert, R. J. \u0026amp; Singh, N. N.) 1\u0026ndash;23 (Springer International Publishing, Cham, 2022). doi:10.1007/978-3-030-77644-2_40-1.\u003c/li\u003e\n\u003cli\u003eSantorelli, S. F., Meleo-Meyer, F., Koerbel, L. \u0026amp; Kabat-Zinn, J. Mindfulness-Based Stress Reduction (MBSR) Authorized Curriculum Guide \u0026copy; 2017. (2017).\u003c/li\u003e\n\u003cli\u003eTreves, I. N., Tello, L. Y., Davidson, R. J. \u0026amp; Goldberg, S. B. The relationship between mindfulness and objective measures of body awareness: A meta-analysis. \u003cem\u003eSci. Rep.\u003c/em\u003e \u003cstrong\u003e9\u003c/strong\u003e, 1\u0026ndash;12 (2019).\u003c/li\u003e\n\u003cli\u003eSze, J. A., Gyurak, A., Yuan, J. W. \u0026amp; Levenson, R. W. Coherence between emotional experience and physiology: Does body awareness training have an impact? \u003cem\u003eEmotion\u003c/em\u003e \u003cstrong\u003e10\u003c/strong\u003e, 803\u0026ndash;814 (2010).\u003c/li\u003e\n\u003cli\u003eSchwartz, K., Ganster, F. M., Voracek, M. \u0026amp; Tran, U. S. Mindfulness and Objective Measures of Body Awareness: A Preregistered Systematic Review and Multilevel Meta-Analysis. \u003cem\u003eBiopsychosoc. Sci. Med.\u003c/em\u003e 10.1097/PSY.0000000000001381 doi:10.1097/PSY.0000000000001381.\u003c/li\u003e\n\u003cli\u003eKhalsa, S. S., Rudrauf, D., Hassanpour, M. S., Davidson, R. J. \u0026amp; Tranel, D. The practice of meditation is not associated with improved interoceptive awareness of the heartbeat. \u003cem\u003ePsychophysiology\u003c/em\u003e \u003cstrong\u003e57\u003c/strong\u003e, 1\u0026ndash;16 (2020).\u003c/li\u003e\n\u003cli\u003ePrice, C. J. \u0026amp; Thompson, E. A. Measuring Dimensions of Body Connection: Body Awareness and Bodily Dissociation. \u003cem\u003eJ. Altern. Complement. Med.\u003c/em\u003e (2007) doi:10.1089/acm.2007.0537.\u003c/li\u003e\n\u003cli\u003eMehling, W. E. \u003cem\u003eet al.\u003c/em\u003e The Multidimensional Assessment of Interoceptive Awareness (MAIA). \u003cem\u003ePLoS ONE\u003c/em\u003e (2012) doi:10.1371/journal.pone.0048230.\u003c/li\u003e\n\u003cli\u003eMehling, W. E., Acree, M., Stewart, A., Silas, J. \u0026amp; Jones, A. The multidimensional assessment of interoceptive awareness, version 2 (MAIA-2). \u003cem\u003ePloS One\u003c/em\u003e \u003cstrong\u003e13\u003c/strong\u003e, e0208034 (2018).\u003c/li\u003e\n\u003cli\u003eTrevisan, D. A., Tsheringla, S. \u0026amp; McPartland, J. C. On the relation between interoceptive attention and health anxiety: Distinguishing adaptive and maladaptive bodily awareness. \u003cem\u003eCogent Psychol.\u003c/em\u003e \u003cstrong\u003e10\u003c/strong\u003e, 2262855 (2023).\u003c/li\u003e\n\u003cli\u003eSchuman-Olivier, Z. \u003cem\u003eet al.\u003c/em\u003e Change starts with the body: Interoceptive appreciation mediates the effect of mindfulness training on behavior change \u0026ndash; an effect moderated by depression severity. \u003cem\u003ePsychiatry Res.\u003c/em\u003e \u003cstrong\u003e342\u003c/strong\u003e, 116230 (2024).\u003c/li\u003e\n\u003cli\u003eDesbordes, G. \u003cem\u003eet al.\u003c/em\u003e Moving Beyond Mindfulness: Defining Equanimity as an Outcome Measure in Meditation and Contemplative Research. \u003cem\u003eMindfulness\u003c/em\u003e \u003cstrong\u003e6\u003c/strong\u003e, 356\u0026ndash;372 (2015).\u003c/li\u003e\n\u003cli\u003eFarb, N. \u0026amp; Segal, Z. \u003cem\u003eBetter in Every Sense: How the New Science of Sensation Can Help You Reclaim Your Life\u003c/em\u003e. (Little, Brown, 2024).\u003c/li\u003e\n\u003cli\u003eDesmedt, O., Heeren, A., Corneille, O. \u0026amp; Luminet, O. What do measures of self-report interoception measure? Insights from a systematic review, latent factor analysis, and network approach. \u003cem\u003eBiol. Psychol.\u003c/em\u003e \u003cstrong\u003e169\u003c/strong\u003e, 108289 (2022).\u003c/li\u003e\n\u003cli\u003ePustejovsky, J. E. \u0026amp; Tipton, E. Meta-analysis with Robust Variance Estimation: Expanding the Range of Working Models. \u003cem\u003ePrev. Sci.\u003c/em\u003e \u003cstrong\u003e23\u003c/strong\u003e, 425\u0026ndash;438 (2022).\u003c/li\u003e\n\u003cli\u003ePage, M. J. \u003cem\u003eet al.\u003c/em\u003e The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. \u003cem\u003eBMJ\u003c/em\u003e \u003cstrong\u003e372\u003c/strong\u003e, n71 (2021).\u003c/li\u003e\n\u003cli\u003eDahl, C. J., Lutz, A. \u0026amp; Davidson, R. J. Reconstructing and deconstructing the self: Cognitive mechanisms in meditation practice. \u003cem\u003eTrends Cogn. Sci.\u003c/em\u003e \u003cstrong\u003e19\u003c/strong\u003e, 515\u0026ndash;523 (2015).\u003c/li\u003e\n\u003cli\u003eSparby, T. \u0026amp; Sacchet, M. D. Defining Meditation: Foundations for an Activity-Based Phenomenological Classification System. \u003cem\u003eFront. Psychol.\u003c/em\u003e \u003cstrong\u003e12\u003c/strong\u003e, (2022).\u003c/li\u003e\n\u003cli\u003eVan Dam, N. T. \u003cem\u003eet al.\u003c/em\u003e Mind the Hype: A Critical Evaluation and Prescriptive Agenda for Research on Mindfulness and Meditation. \u003cem\u003ePerspect. Psychol. Sci.\u003c/em\u003e \u003cstrong\u003e13\u003c/strong\u003e, 36\u0026ndash;61 (2018).\u003c/li\u003e\n\u003cli\u003eQuaglia, J. T., Braun, S. E., Freeman, S. P., McDaniel, M. A. \u0026amp; Brown, K. W. Meta-Analytic Evidence for Effects of Mindfulness Training on Dimensions of Self-Reported Dispositional Mindfulness. \u003cem\u003ePsychol. Assess.\u003c/em\u003e \u003cstrong\u003e28\u003c/strong\u003e, 803\u0026ndash;818 (2016).\u003c/li\u003e\n\u003cli\u003eGoldberg, S. B. \u003cem\u003eet al.\u003c/em\u003e Mindfulness-based interventions for psychiatric disorders: A systematic review and meta-analysis. \u003cem\u003eClin. Psychol. Rev.\u003c/em\u003e (2018) doi:10.1016/j.cpr.2017.10.011.\u003c/li\u003e\n\u003cli\u003eEifert, G. H. \u003cem\u003eet al.\u003c/em\u003e The cardiac anxiety questionnaire: development and preliminary validity. \u003cem\u003eBehav. Res. Ther.\u003c/em\u003e \u003cstrong\u003e38\u003c/strong\u003e, 1039\u0026ndash;1053 (2000).\u003c/li\u003e\n\u003cli\u003eDesmedt, O., Luminet, O., Maurage, P. \u0026amp; Corneille, O. Discrepancies in the Definition and Measurement of Human Interoception: A Comprehensive Discussion and Suggested Ways Forward. \u003cem\u003ePerspect. Psychol. Sci.\u003c/em\u003e \u003cstrong\u003e20\u003c/strong\u003e, 76\u0026ndash;98 (2025).\u003c/li\u003e\n\u003cli\u003ePrice, C. J., Thompson, E. A., Crowell, S. \u0026amp; Pike, K. Longitudinal effects of interoceptive awareness training through mindful awareness in body-oriented therapy (MABT) as an adjunct to women\u0026rsquo;s substance use disorder treatment: A randomized controlled trial. \u003cem\u003eDrug Alcohol Depend.\u003c/em\u003e \u003cstrong\u003e198\u003c/strong\u003e, 140\u0026ndash;149 (2019).\u003c/li\u003e\n\u003cli\u003eHedges, L. V. Distribution Theory for Glass\u0026rsquo;s Estimator of Effect size and Related Estimators. \u003cem\u003eJ. Educ. Stat.\u003c/em\u003e \u003cstrong\u003e6\u003c/strong\u003e, 107\u0026ndash;128 (1981).\u003c/li\u003e\n\u003cli\u003eBorenstein, M. \u0026amp; Hedges, L. V. Effect sizes for meta-analysis. \u003cem\u003eHandb. Res. Synth. Meta-Anal.\u003c/em\u003e \u003cstrong\u003e3\u003c/strong\u003e, 207\u0026ndash;243 (2019).\u003c/li\u003e\n\u003cli\u003eCooper, H., Hedges, L. V. \u0026amp; Valentine, J. C. \u003cem\u003eThe Handbook of Research Synthesis and Meta-Analysis\u003c/em\u003e. (Russell Sage Foundation, 2019).\u003c/li\u003e\n\u003cli\u003eSterne, J. A. \u003cem\u003eet al.\u003c/em\u003e RoB 2: a revised tool for assessing risk of bias in randomised trials. \u003cem\u003ebmj\u003c/em\u003e \u003cstrong\u003e366\u003c/strong\u003e, (2019).\u003c/li\u003e\n\u003cli\u003eDel Re, A. C., Hoyt, W. T. \u0026amp; Del Re, M. A. Package \u0026lsquo;MAd\u0026rsquo;. (2022).\u003c/li\u003e\n\u003cli\u003eViechtbauer, W. Conducting meta-analyses in R with the metafor package. \u003cem\u003eJ. Stat. Softw.\u003c/em\u003e \u003cstrong\u003e36\u003c/strong\u003e, 1\u0026ndash;48 (2010).\u003c/li\u003e\n\u003cli\u003eJoshi, M., Pustejovsky, J. E. \u0026amp; Beretvas, S. N. Cluster wild bootstrapping to handle dependent effect sizes in meta‐analysis with a small number of studies. \u003cem\u003eRes. Synth. Methods\u003c/em\u003e \u003cstrong\u003e13\u003c/strong\u003e, 457\u0026ndash;477 (2022).\u003c/li\u003e\n\u003cli\u003eRosenthal, R. The file drawer problem and tolerance for null results. \u003cem\u003ePsychol. Bull.\u003c/em\u003e \u003cstrong\u003e86\u003c/strong\u003e, 638\u0026ndash;641 (1979).\u003c/li\u003e\n\u003cli\u003eGelman, A. \u0026amp; Loken, E. The garden of forking paths: Why multiple comparisons can be a problem, even when there is no \u0026ldquo;fishing expedition\u0026rdquo; or \u0026ldquo;p-hacking\u0026rdquo; and the research hypothesis was posited ahead of time. \u003cem\u003eDep. Stat. Columbia Univ.\u003c/em\u003e \u003cstrong\u003e348\u003c/strong\u003e, 3 (2013).\u003c/li\u003e\n\u003cli\u003eDuncan, L. G. \u003cem\u003eet al.\u003c/em\u003e Benefits of preparing for childbirth with mindfulness training: a randomized controlled trial with active comparison. \u003cem\u003eBMC Pregnancy Childbirth\u003c/em\u003e \u003cstrong\u003e17\u003c/strong\u003e, 140 (2017).\u003c/li\u003e\n\u003cli\u003eLoucks, E. B. \u003cem\u003eet al.\u003c/em\u003e Mindfulness-Based College: A Stage 1 Randomized Controlled Trial for University Student Well-Being. \u003cem\u003ePsychosom. Med.\u003c/em\u003e \u003cstrong\u003e83\u003c/strong\u003e, 602\u0026ndash;614 (2021).\u003c/li\u003e\n\u003cli\u003eFischer, J. M. \u003cem\u003eet al.\u003c/em\u003e Stress Reduction by Yoga versus Mindfulness Training in Adults Suffering from Distress: A Three-Armed Randomized Controlled Trial including Qualitative Interviews (RELAX Study). \u003cem\u003eJ. Clin. Med.\u003c/em\u003e \u003cstrong\u003e11\u003c/strong\u003e, 5680 (2022).\u003c/li\u003e\n\u003cli\u003eGawande, R. \u003cem\u003eet al.\u003c/em\u003e Impact of warm mindfulness on emotion regulation: A randomized controlled effectiveness trial. \u003cem\u003eHealth Psychol.\u003c/em\u003e (2023) doi:10.1037/hea0001303.\u003c/li\u003e\n\u003cli\u003eGawande, R. \u003cem\u003eet al.\u003c/em\u003e Insurance-reimbursable mindfulness for safety-net primary care patients: a pilot randomized controlled trial. \u003cem\u003eMindfulness\u003c/em\u003e \u003cstrong\u003e10\u003c/strong\u003e, 1744\u0026ndash;1759 (2019).\u003c/li\u003e\n\u003cli\u003eGawande, R. \u003cem\u003eet al.\u003c/em\u003e Mindfulness Training Enhances Self-Regulation and Facilitates Health Behavior Change for Primary Care Patients: a Randomized Controlled Trial. \u003cem\u003eJ. Gen. Intern. Med.\u003c/em\u003e \u003cstrong\u003e34\u003c/strong\u003e, 293\u0026ndash;302 (2019).\u003c/li\u003e\n\u003cli\u003ePrice, C. J., Merrill, J. O., McCarty, R. L., Pike, K. C. \u0026amp; Tsui, J. I. A pilot study of mindful body awareness training as an adjunct to office-based medication treatment of opioid use disorder. \u003cem\u003eJ. Subst. Abuse Treat.\u003c/em\u003e \u003cstrong\u003e108\u003c/strong\u003e, 123\u0026ndash;128 (2020).\u003c/li\u003e\n\u003cli\u003eBornemann, B., Herbert, B. M., Mehling, W. E. \u0026amp; Singer, T. Differential changes in self-reported aspects of interoceptive awareness through 3 months of contemplative training. \u003cem\u003eFront. Psychol.\u003c/em\u003e \u003cstrong\u003e5\u003c/strong\u003e, (2015).\u003c/li\u003e\n\u003cli\u003eClassen, C. C. \u003cem\u003eet al.\u003c/em\u003e A Pilot RCT of A Body-Oriented Group Therapy For Complex Trauma Survivors: An Adaptation of Sensorimotor Psychotherapy. \u003cem\u003eJ. Trauma Dissociation\u003c/em\u003e \u003cstrong\u003e22\u003c/strong\u003e, 52\u0026ndash;68 (2021).\u003c/li\u003e\n\u003cli\u003eLima-Araujo, G. L. D. \u003cem\u003eet al.\u003c/em\u003e The impact of a brief mindfulness training on interoception: A randomized controlled trial. \u003cem\u003ePLOS ONE\u003c/em\u003e \u003cstrong\u003e17\u003c/strong\u003e, e0273864 (2022).\u003c/li\u003e\n\u003cli\u003eGoldberg, S. B., Riordan, K. M., Sun, S. \u0026amp; Davidson, R. J. The Empirical Status of Mindfulness-Based Interventions: A Systematic Review of 44 Meta-Analyses of Randomized Controlled Trials. \u003cem\u003ePerspect. Psychol. Sci.\u003c/em\u003e \u003cstrong\u003e17\u003c/strong\u003e, 108\u0026ndash;130 (2022).\u003c/li\u003e\n\u003cli\u003eFissler, M. \u003cem\u003eet al.\u003c/em\u003e An Investigation of the Effects of Brief Mindfulness Training on Self-Reported Interoceptive Awareness, the Ability to Decenter, and Their Role in the Reduction of Depressive Symptoms. \u003cem\u003eMindfulness\u003c/em\u003e \u003cstrong\u003e7\u003c/strong\u003e, 1170\u0026ndash;1181 (2016).\u003c/li\u003e\n\u003cli\u003ede Jong, M. \u003cem\u003eet al.\u003c/em\u003e Effects of Mindfulness-Based Cognitive Therapy on Body Awareness in Patients with Chronic Pain and Comorbid Depression. \u003cem\u003eFront. Psychol.\u003c/em\u003e \u003cstrong\u003e7\u003c/strong\u003e, 967 (2016).\u003c/li\u003e\n\u003cli\u003eGoldberg, S. B. \u003cem\u003eet al.\u003c/em\u003e Is Dosage of a Meditation App Associated With Changes in Psychological Distress? It Depends on How You Ask. \u003cem\u003eClin. Psychol. Sci.\u003c/em\u003e 21677026241266567 (2024) doi:10.1177/21677026241266567.\u003c/li\u003e\n\u003cli\u003ePoletti, S., Abdoun, O., Zorn, J. \u0026amp; Lutz, A. Pain regulation during mindfulness meditation: Phenomenological fingerprints in novices and experts practitioners. \u003cem\u003eEur. J. Pain\u003c/em\u003e \u003cstrong\u003e25\u003c/strong\u003e, 1583\u0026ndash;1602 (2021).\u003c/li\u003e\n\u003cli\u003eBinstock, M., Morinis, L., Adler, S. \u0026amp; Mehling, W. E. Students\u0026rsquo; response to a Massage \u0026amp; Meditation medical school course elective. \u003cem\u003eMedEdPublish\u003c/em\u003e \u003cstrong\u003e9\u003c/strong\u003e, 28 (2020).\u003c/li\u003e\n\u003cli\u003eCarpenter, J. K., Conroy, K., Gomez, A. F., Curren, L. C. \u0026amp; Hofmann, S. G. The relationship between trait mindfulness and affective symptoms: A meta-analysis of the Five Facet Mindfulness Questionnaire (FFMQ). \u003cem\u003eClin. Psychol. Rev.\u003c/em\u003e \u003cstrong\u003e74\u003c/strong\u003e, 101785 (2019).\u003c/li\u003e\n\u003cli\u003eMcShane, B. B. \u0026amp; B\u0026ouml;ckenholt, U. Multilevel Multivariate Meta-analysis with Application to Choice Overload. \u003cem\u003ePsychometrika\u003c/em\u003e \u003cstrong\u003e83\u003c/strong\u003e, 255\u0026ndash;271 (2018).\u003c/li\u003e\n\u003cli\u003eMayer-Benarous, H., Benarous, X. \u0026amp; Robin, M. Disrupted profiles of interoception and mental health in youths: a systematic review. \u003cem\u003eEur. Child Adolesc. Psychiatry\u003c/em\u003e (2025) doi:10.1007/s00787-025-02705-w.\u003c/li\u003e\n\u003cli\u003eOpdensteinen, K. D. \u003cem\u003eet al.\u003c/em\u003e Interoception in preschoolers: New insights into its assessment and relations to emotion regulation and stress. \u003cem\u003eBiol. Psychol.\u003c/em\u003e \u003cstrong\u003e165\u003c/strong\u003e, 108166 (2021).\u003c/li\u003e\n\u003cli\u003eKoch, A. \u0026amp; Pollatos, O. Interoceptive sensitivity, body weight and eating behavior in children: a prospective study. \u003cem\u003eFront. Psychol.\u003c/em\u003e \u003cstrong\u003e5\u003c/strong\u003e, (2014).\u003c/li\u003e\n\u003cli\u003eAddabbo, M. \u0026amp; Milani, L. Measuring interoception from infancy to childhood: A scoping review. \u003cem\u003eNeurosci. Biobehav. Rev.\u003c/em\u003e \u003cstrong\u003e173\u003c/strong\u003e, 106161 (2025).\u003c/li\u003e\n\u003cli\u003eBrotto, L. \u003cem\u003eet al.\u003c/em\u003e Mindfulness and Sex Education for Sexual Interest/Arousal Disorder: Mediators and Moderators of Treatment Outcome. \u003cem\u003eJ. Sex Res.\u003c/em\u003e \u003cstrong\u003e60\u003c/strong\u003e, 1\u0026ndash;14 (2022).\u003c/li\u003e\n\u003cli\u003eFrancis, S. E. B., Shawyer, F., Cayoun, B., Enticott, J. \u0026amp; Meadows, G. N. Group Mindfulness-Integrated Cognitive Behavior Therapy (MiCBT) Reduces Depression and Anxiety and Improves Flourishing in a Transdiagnostic Primary Care Sample Compared to Treatment-as-Usual: A Randomized Controlled Trial. \u003cem\u003eFront. Psychiatry\u003c/em\u003e \u003cstrong\u003eVolume 13-2022\u003c/strong\u003e, (2022).\u003c/li\u003e\n\u003cli\u003eGaylord, S. \u003cem\u003eet al.\u003c/em\u003e Mindfulness Training Reduces the Severity of Irritable Bowel Syndrome in Women: Results of a Randomized Controlled Trial. \u003cem\u003eAm. J. Gastroenterol.\u003c/em\u003e \u003cstrong\u003e106\u003c/strong\u003e, 1678\u0026ndash;88 (2011).\u003c/li\u003e\n\u003cli\u003eHenrich, J., Gjelsvik, B., Surawy, C., Evans, E. \u0026amp; Martin, M. A Randomized Clinical Trial of Mindfulness-Based Cognitive Therapy for Women With Irritable Bowel Syndrome\u0026mdash;Effects and Mechanisms. \u003cem\u003eJ. Consult. Clin. Psychol.\u003c/em\u003e \u003cstrong\u003e88\u003c/strong\u003e, (2020).\u003c/li\u003e\n\u003cli\u003eKaring, C. \u0026amp; Beelmann, A. Evaluating the Implementation and Effectiveness of a Low-Dose Mindfulness-Based Intervention in a Student Sample: a Randomized Controlled Trial. \u003cem\u003eMindfulness\u003c/em\u003e \u003cstrong\u003e12\u003c/strong\u003e, (2021).\u003c/li\u003e\n\u003cli\u003eMittal, T. K. \u003cem\u003eet al.\u003c/em\u003e Mindfulness-based intervention in patients with persistent pain in chest (MIPIC) of non-cardiac cause: a feasibility randomised control study. \u003cem\u003eOpen Heart\u003c/em\u003e \u003cstrong\u003e9\u003c/strong\u003e, e001970 (2022).\u003c/li\u003e\n\u003cli\u003eUgarte P\u0026eacute;rez, C. \u003cem\u003eet al.\u003c/em\u003e Comparative efficacy of remotely delivered mindfulness-based eating awareness training versus behavioral-weight loss counseling during COVID-19. \u003cem\u003eFront Psychol\u003c/em\u003e \u003cstrong\u003e14\u003c/strong\u003e, 1101120 (2023).\u003c/li\u003e\n\u003cli\u003ePrice, C. Body-oriented therapy in recovery from child sexual abuse: an efficacy study. \u003cem\u003eAltern. Ther. Health Med.\u003c/em\u003e \u003cstrong\u003e11\u003c/strong\u003e, 46\u0026ndash;57 (2005).\u003c/li\u003e\n\u003cli\u003ePrice, C. J., Wells, E. A., Donovan, D. M. \u0026amp; Rue, T. Mindful awareness in body-oriented therapy as an adjunct to women\u0026rsquo;s substance use disorder treatment: a pilot feasibility study. \u003cem\u003eJ. Subst. Abuse Treat.\u003c/em\u003e \u003cstrong\u003e43\u003c/strong\u003e, 94\u0026ndash;107 (2012).\u003c/li\u003e\n\u003cli\u003ePrice, C. J., Sevinc, G. \u0026amp; Farb, N. A. S. Within-Person Modulation of Neural Networks following Interoceptive Awareness Training through Mindful Awareness in Body-Oriented Therapy (MABT): A Pilot Study. \u003cem\u003eBrain Sci.\u003c/em\u003e \u003cstrong\u003e13\u003c/strong\u003e, 1396 (2023).\u003c/li\u003e\n\u003cli\u003eRoberts, R. L., Ledermann, K. \u0026amp; Garland, E. L. Mindfulness-oriented recovery enhancement improves negative emotion regulation among opioid-treated chronic pain patients by increasing interoceptive awareness. \u003cem\u003eJ. Psychosom. Res.\u003c/em\u003e \u003cstrong\u003e152\u003c/strong\u003e, 110677 (2021).\u003c/li\u003e\n\u003cli\u003eSegal, Z. V. \u003cem\u003eet al.\u003c/em\u003e Practice of therapy acquired regulatory skills and depressive relapse/recurrence prophylaxis following cognitive therapy or mindfulness based cognitive therapy. \u003cem\u003eJ. Consult. Clin. Psychol.\u003c/em\u003e \u003cstrong\u003e87\u003c/strong\u003e, 161\u0026ndash;170 (2019).\u003c/li\u003e\n\u003cli\u003eSharp, M. \u003cem\u003eet al.\u003c/em\u003e Prenatal Mindfulness Training and Interoceptive Awareness in Pregnant People at Risk for Hypertensive Disorders. \u003cem\u003eJ. Integr. Complement. Med.\u003c/em\u003e \u003cstrong\u003e30\u003c/strong\u003e, 1200\u0026ndash;1208 (2024).\u003c/li\u003e\n\u003cli\u003eThomas, E. A. \u003cem\u003eet al.\u003c/em\u003e Mindfulness-Oriented Recovery Enhancement Restructures Reward Processing and Promotes Interoceptive Awareness in Overweight Cancer Survivors: Mechanistic Results From a Stage 1 Randomized Controlled Trial. \u003cem\u003eIntegr. Cancer Ther.\u003c/em\u003e \u003cstrong\u003e18\u003c/strong\u003e, 1534735419855138 (2019).\u003c/li\u003e\n\u003cli\u003evan der Velden, A. M. \u003cem\u003eet al.\u003c/em\u003e Mindfulness Training Changes Brain Dynamics During Depressive Rumination: A Randomized Controlled Trial. \u003cem\u003eBiol. Psychiatry\u003c/em\u003e \u003cstrong\u003e93\u003c/strong\u003e, 233\u0026ndash;242 (2023).\u003c/li\u003e\n\u003cli\u003eVollbehr, N. K. \u003cem\u003eet al.\u003c/em\u003e Mindful yoga intervention as add-on to treatment as usual for young women with major depressive disorder: Results from a randomized controlled trial. \u003cem\u003eJ. Consult. Clin. Psychol.\u003c/em\u003e \u003cstrong\u003e90\u003c/strong\u003e, 925\u0026ndash;941 (2022).\u003c/li\u003e\n\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"mindfulness, interoception, MAIA, body awareness, meditation, meta-analysis","lastPublishedDoi":"10.21203/rs.3.rs-6792067/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6792067/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eMindfulness meditation training may cultivate interoceptive awareness and provide therapeutic benefit when implemented within mental and physical health interventions. This pre-registered meta-analysis evaluated the impact of mindfulness interventions on self-reported interoception measures and associated relationships with psychological outcomes. Twenty-nine randomized controlled trials with 2,191 participants (77.8% female, mean age 32.8 years) were meta-analyzed using correlated and hierarchical effects models. Interventions included mindfulness-based programs (\u003cem\u003ek\u003c/em\u003e\u0026thinsp;=\u0026thinsp;15), body-based approaches (incorporating elements like massage, \u003cem\u003ek\u003c/em\u003e\u0026thinsp;=\u0026thinsp;8), and other variations (\u003cem\u003ek\u003c/em\u003e\u0026thinsp;=\u0026thinsp;6). Five SIMs were tested; the Multidimensional Assessment of Interoceptive Awareness was the most common (22 studies). Results showed a small-to-medium positive effect on interoception measures across all studies (\u003cem\u003eg\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.31, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, 95% CI [0.21, 0.42]) with low-to-moderate heterogeneity (\u003cem\u003eτ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.16). Mindfulness-based programs demonstrated the largest effects (\u003cem\u003eg\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.41). No evidence of publication bias was found. No other moderators, such as practice dosage or clinical sample, were significant. Improvements in self-reported interoception were similar in size to improvements in self-reported mindfulness and were related to improvements in psychological distress. These meta-analytic findings provide evidence that mindfulness-based interventions lead to adaptive changes in the subjective experience of interoception, perhaps contributing to improved mental wellbeing.\u003c/p\u003e","manuscriptTitle":"Minding the Body: A Meta-analysis of the Effects of Mindfulness Meditation Training on Self-reported Interoception","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-04 12:51:24","doi":"10.21203/rs.3.rs-6792067/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-21T18:37:00+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"225901688855653690278651564855893250256","date":"2025-08-20T00:28:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-19T15:54:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"119700782866534408863635664620426810440","date":"2025-08-19T09:07:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"126004396638220692239389381780880783856","date":"2025-08-18T21:31:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"113023450059677196462645653318813096622","date":"2025-08-18T09:47:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"23177465993342063598061600307046920455","date":"2025-08-14T14:33:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"73911963471142705488674089389744999300","date":"2025-08-14T11:44:50+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-14T03:39:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"164752025078938639356020692939503057124","date":"2025-08-13T17:19:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"40714062654132854508490788113278260451","date":"2025-08-13T15:45:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"147299243185856047034124281233159817869","date":"2025-08-11T21:56:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"162732193968476471701371434825261752828","date":"2025-08-11T15:18:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"19228424780346917456490712313987792594","date":"2025-08-11T13:18:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"322729341065450701763771363881655910591","date":"2025-08-11T12:56:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"214092556270569459731181381185389489746","date":"2025-07-27T23:19:50+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-25T14:14:15+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-04T17:27:54+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-04T01:58:17+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-02T11:28:47+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-05-31T16:21:26+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e8178298-a6fd-4894-9893-2d529cb5ee93","owner":[],"postedDate":"June 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":49384496,"name":"Biological sciences/Psychology/Human behaviour"},{"id":49384497,"name":"Health sciences/Medical research/Translational research"}],"tags":[{"value":"featured","date":"2025-06-04 13:58:01"}],"updatedAt":"2025-11-10T16:00:47+00:00","versionOfRecord":{"articleIdentity":"rs-6792067","link":"https://doi.org/10.1038/s41598-025-22661-4","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-11-06 15:57:25","publishedOnDateReadable":"November 6th, 2025"},"versionCreatedAt":"2025-06-04 12:51:24","video":"","vorDoi":"10.1038/s41598-025-22661-4","vorDoiUrl":"https://doi.org/10.1038/s41598-025-22661-4","workflowStages":[]},"version":"v1","identity":"rs-6792067","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6792067","identity":"rs-6792067","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}