Breath, Belief, and Brain: A Tripartite Map of Respiratory Interoception

Interoception, the perception of signals from the body, has become central to understanding why bodily states are felt differently across individuals. Rather than being unitary, interoception is best understood as a family of processes (Crucianelli et al., 2022). A useful taxonomy (Savage and Garfinkel, 2025) distinguishes sensing from higher-order processes: interoceptive accuracy (e.g., noticing that breathing is harder), interoceptive insight (e.g., how well your confidence about your breathing sensation matches how accurate you are in detecting changes in your breathing sensation), attribution (e.g., deciding whether shortness of breath is due to anxiety or cold air), and appraisal (e.g., judging whether that sensation is threatening or harmless). Neuroanatomically, interoception relies on distributed circuits. Craig (2002) highlighted the insular cortex, particularly posterior and anterior divisions, as central for mapping interoceptive signals and supporting subjective feeling. Complementary accounts, including a consensus paper by Khalsa et al. (2018), emphasized that interoception is embedded in a hierarchical network spanning brainstem, thalamic, limbic, and cortical systems and integrated homeostatic regulation with affective and cognitive functions. Variation in these systems can be clinically relevant: individuals with anxiety, depression, eating, or substance-use disorders often show atypical estimates of the precision or reliability of bodily signals (that is, the degree of weight the brain gives to interoceptive evidence), which in turn is associated with reduced interoceptive accuracy, metacognitive insight (confidence calibration), and subsequent attribution and appraisal (Smith et al., 2020). Whether these alterations generalize across interoceptive modalities remains unclear. Most experimental work on interoception has focused on cardiac interoception, yet respiration provides an especially tractable and affectively meaningful modality. Inspiratory resistance can be manipulated in finely graded steps, which makes rigorous psychophysics possible. Breathing also carries emotional salience: a single breath may signal both a homeostatic challenge and affective threat or relief. Peripheral mechanoreceptors, chemoreceptors, and stretch receptors … Correspondence should be addressed to Dominika Radziun at dominika.radziun{at}donders.ru.nl.