Chapter 2 48 Table 1. Some areas of the brain that play a role in the processing of interoceptive signals. Brain area name Location Function Somatosensory cortex Outer shell Higher processing and perception of incoming bodily signals. Prefrontal cortex (anteromedial and orbitofrontal) Outer shell Higher processing, such as making decisions without emotional awareness (‘gut feelings’), (implicit) emotion regulation. Cingulate cortex (frontal part) Middle shell Explicit focus (attention) on emotion (and pain). Regulation of visceral stimuli. Affective meaning of interoceptive stimuli and motivation. Insula Middle shell Representation of the global internal state of the body through integration of external sensory input and internal somatic stimuli (interoception). Thalamus Core Passing on of sensory and interoceptive stimuli. Source: Houtveen [90] 4 .1 Model of Levels of Emotional Awareness As early as the late 1980s, Lane and his colleagues developed a cognitive-affective developmental model of emotions that describes the process of emotional awareness at different levels [46, 91]. Within this model, alexithymia is seen as a comprehensive disruption of the structural organization of emotional experiences on a psychological, neuroanatomical, and physiological level. In normative development, a constant process of differentiation and generalization leads from the implicit, preconscious expression of affective arousal such as bodily sensations, action tendencies, or global states of positive or negative tension, to the explicit representation of affective arousal as distinct, consciously experienced feeling states. From this viewpoint, individuals may differ quantitively and qualitatively in their capacity for emotional awareness. Disruptions in development may lead to
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