Sharon Vaisvaser- School of Society and the Arts, Faculty of Humanities and Social Sciences, Ono Academic College, Kiryat Ono, Israel
Neuroscientific explorations of the self acknowledge the central role of the body and dynamic sensory-motor interactions in sense of self and mental functioning. The multidimensional self-concept comprises pre-reflexive bodily dimensions scaffolding higher-order mental self-representations, which relate to and rely on movement-based relational foundations. Disruptions in ongoing self-constitution, development and expansion call for psychotherapeutic work that recognizes and utilizes dynamic bodily aspects, and formulation of personalized treatment plans. This manuscript discusses the brain-body-mind interface, encompassing experiential and temporal-spatial dynamics supported by integrated hierarchical neural processes, in line with predictive processing accounts. Epistemic affordances, or action possibilities, are anchored in neural mechanisms and interlaced with psychotherapeutic work facilitating the generation of predictive models of the body in the world. Movement within the peripersonal space is linked to self-modeling, along with insights into interoceptive awareness covering multimodal sensory-motor integration that facilitates emotional and cognitive processing. Bodily-anchored, and movement-based temporal aspects of the self are discussed in terms of the ‘temporal thickness’ of experience and further elaborated in relation to mental time travel and autobiographical memory. This grounds the analysis of the implicit and explicit movement within therapeutic relationships. Intersubjective neural mechanisms of mirror-simulation and synchronization are shown to be associated with kinesthetic empathy, embodied mentalization and communicative means of mirroring, attuning, and synchronizing movement. By bridging neuroscientific and clinical perspectives on the embodied, multifaceted dynamics across the nested dimensions of the self, this manuscript outlines pathways for transformative interventions that foster neuroplastic movement toward self-integration.
1 Introduction
Mental health challenges are now widely seen as encompassing complex alterations of self-experience that emerge from the dynamic interactions among behavioral, cognitive, affective, and social processes that place the lived body at the core of these dynamics. Neuroscience research has progressively established the central role of the body in the experience and sense of self (1). Current conceptualizations of brain function as embodied, enactive and relational (2) recognize the dynamic nexus it forms with the body which significantly influences emotions, cognition, and overall mental health (3). The “mind”, which cannot be separated from the living body, manifests and integrates the current state of the entire organism as a bodily subject during its sensory-motor interactions with the (social) environment (4). Thus, in the ongoing experience of the self, perception, cognition and emotion find themselves in a mutual embrace with action (1, 5, 6). These approaches also support neurodiversity, by embracing the inherent interconnectedness of the brain, body, and environment, thus creating more inclusive and supportive environments (7).
The idea that perceptual, affective and cognitive processes are influenced by actual experiences has received substantial support from the well-established Bayesian Predictive Processing (PP) framework of brain function. Based on the Free Energy Principle as applied to any biological system that resists a tendency towards disorder, the PP framework describes how the brain actively (and enactively) infers latent or hidden causes of internal and external sensations in order to anticipate them formulate a reaction and minimize uncertainty (8). The dependence on embodied priors mostly occurs implicitly, without the need to explicitly remember past events (9). The brain is therefore perpetually engaged in a continuous crosstalk between lower and higher levels of the cortical hierarchy, which is consistent with the hierarchical signal exchange between cortical layers (10). Top-down predictions are integrated with bottom-up somatosensorial information, leading to either matches or mismatches, i.e., prediction errors (surprises), where salient prediction errors (having high precision) refine predictive models and drive action (11). This active engagement helps minimize prediction errors through behavior and interaction, thus further refining the brain’s predictive accuracy (12).
The embodied-embedded self, as a self-organizing system, needs continuous and identifiable boundary conditions, which are known as “Markov blankets”; i.e., the set of states that separates internal parts from external ones (13). “Markov blankets” act as a protective screen through which the individual, as a living being, can recognize and distinguish its internal states from the states of the external environment by inferring the internal or external causes of sensations and perceptions (14). Accordingly, selfhood is an agent’s embodied model in the world that constantly searches for evidence of its own existence through its actual activities (15), which give rise to more complex self-representations. Models (predictions) of the self in the world are generative and hierarchical; in other words, higher levels contextualize lower levels, and lower levels provide evidence for higher levels (16). Free energy minimization corresponds to maximizing self-model evidence, which implies the notion of “self-evidencing”; i.e., a free energy minimizing agent that will always try to maximize evidence for its own existence (14, 15). Selfhood, the self-organizing existence within a world separated from the self, relies on dynamic inferential processes, that are achieved through acting upon the world and sampling new sensory states, thus further conforming to goal or object-directed notions of affective intentionality (17, 18).
The critical role of the body and nonverbal behavior and interaction in psychotherapy have attracted increasing interest (19, 20). The 4E cognition principles (embodied, embedded, enactive, and extended) emphasize the multi-level factors of the patient and therapist interaction, including physiological and behavioral/movement parameters (21). A deeper understanding of the multifaceted body may enable psychotherapists to recognize and utilize a larger range of diverse therapeutic approaches and hence select and apply forms of therapy that are more optimally tailored and effective for the unique person in therapy.
Personalized psychotherapeutic care increasingly integrates embodied approaches that consider body movement as a core dimension of self-regulation, affective expression, and interpersonal connection, thus reflecting the growing neuroscientific evidence on the dynamic brain-body coupling in mental health and therapeutic change (18, 22, 23). Understanding mental health through the lens of brain-body coupling supports interventions that work with the patient’s embodied tendencies that are revealed in the shape and quality of movement, emerging within the therapeutic relationship. Dance/Movement Therapy (DMT) is a psychotherapeutic creative arts modality rooted in the idea of a body-mind nexus (24). DMT’s basic premise is that body movement both reflects and impacts inner emotional and mental states. Thus, the therapeutic use of movement in a relational constellation enables the patient to create a more embodied and coherent self-concept and narrative that fosters vitality and expressivity. Acknowledging and inviting expressions from the lived body hold the promise of enhancing self-connectedness, connections with others and with the world around (25, 26). Growing empirical evidence highlights the importance of the arts in the prevention, management and treatment of diverse disorders (27). DMT has been shown to be an effective intervention for a range of psychiatric, neurodevelopmental and neurodegenerative conditions that reduces symptoms while increasing quality of life and well-being, interpersonal skills, physical, emotional and cognitive functions (28–32).
Recognizing and analyzing the central role of the body and movement is directly relevant to DMT and offers broader contributions to psychotherapy and psychological practice, supporting integrative mental health care and guiding the development of personalized therapeutic approaches grounded in embodied experience and contemporary neuroscience. This paper reviews and analyzes state-of-the-art neuroscientific perspectives related to the multi-dimensional foundations and temporo-spatial expansion of the self, in a translational approach linking neuroscience underpinnings of the self to body movement. It considers the self and self-other dynamics and their disturbances as they are woven into personalized and clinically applicable psychotherapeutic understandings and means of cultivating selfhood.
2 Action possibilities and generative self-modeling
The PP framework of brain function implies that the way we perceive ourselves and the environment, from the most basic level to the most intricate entanglements of the self, is intertwined with our opportunities for action, or affordances. We sample the world to minimize uncertainty and maintain coherence between internal predictions and sensory inputs. The most important way to reduce prediction error is by acting upon the environment to change the states we want to infer, and the optimal reduction of uncertainty via action is based on the selection of the best option from out of a variety of possible actions (33). Thus, we perceive affordances in our environment, and hence implicitly experience ourselves as agents with the power to perform affordable actions.
Beyond homeostatic adaptation, humans aim to maximize intrinsic or epistemic value, and (enactively) choose the actions that are likely to reduce uncertainty about the states of the body in the changing environment, by curiously seeking surprises and novelty in non-threatening settings (34). The epistemic affordance, or possibilities for action the environment offers, underpins the way we forage for information to achieve self-modeling (35, 36). Affordances (or action possibilities) are formed by the relation between the abilities of an organism and features of the environment, generating a repertoire of potential movements, gestures, and relational actions available to an individual in a given context. Experiences soliciting epistemic affordances determine the direction of future anticipation of affordances (37). The felt states of action readiness manifests as a space of polarities and combinations at the physical, affective and cognitive levels. As the agent prepares to move towards/away, approach/withdraw, and is receptive/defensive to affordances in the environment, these movement tendencies may be consciously felt as pleasant/unpleasant, positive/negative, and relate to affordances the individual likes/dislikes, is attracted/repelled by (38).
Perceived locomotive affordances, reflecting different ways one can move through the environment, form a unique representational space in the brain (39). This strengthens the idea that perception is for action and, inversely, actions create further opportunities for perception. The perception of action-guiding properties of objects in the environment emerges as a novel way of explaining the agentive purposiveness that characterizes how one navigates reality (40). In line with the PP framework, the anticipatory processes involved in action tie action to the particularities of the agent’s affordance space, which is a relational space in that it depends both on the object or environmental feature, and on the agent’s body (41). The recognition of the patient’s bodily features and the identification and incorporation of implicit and explicit expressive movement in psychotherapeutic settings, offer patients opportunities to explore, make meaning of and transform their actions, and thus cultivate their epistemic affordances. Therapeutic change occurs not only through verbal interpretations but through new embodied acts, relational engagements and interpretive action that expand the patient’s generative repertoire of being and acting in the world. Within the psychotherapeutic setting, predictive processes unfold in a dynamic interplay between stability and change, across cycles of alignment (match), surprising expectancy violation (prediction errors\mismatch), and eventual reparation, accompanied by new learning. The therapeutic space may become one where patients can safely generate new actions, postures and relational gestures, counterfactual explorations that produce surprising yet tolerable sensorimotor outcomes. These experiences can update predictive models and epistemic action affordances, enabling the reconstruction of meaning-making processes. The significance of this self-actualization is related to the vital role of the body in selfhood, which is further elaborated on in the next section.
3 The bodily foundations of selfhood
The PP account of brain function points to hierarchical models of the self that resonate with its nested-multidimensionality, and the bodily basis for higher forms of self-consciousness (18). The fundamental pre-reflexive layer of the self captures an experiential essence, grounded in bodily signals, which is ecologically and somatically embedded and experienced in the present moment, and viewed in different perspectives as the “proto-self” (42), “minimal self” (43), or “interoceptive self” (44). The fundamental layer of the self evolves through interactions with the environment, by actively extending to the outer body, which is represented as the “extero-proprioceptive self” (44) or the “core self” (42). This dimension relates to the manifestation of the self, which relies on the degree of integration of the self and significant others, and the actual experiences of the self with the external world (45).
Similarly, the space surrounding the body, termed the “kinesphere” (46) or “peripersonal space” (PPS); i.e., the space within reach of the limbs through movement, represents a multisensory and sensorimotor interface mediating body-environment interactions (47). The occupation and use of PPS is a psycho-physical process influenced by internal aspects and environmental factors such as context, gender or culture, and is thus associated with self and relational disturbances and psychopathologies (48, 49). Accordingly, studies have shown that the PPS is influenced by internal and external factors encompassing emotional salience and social cognitive aspects (50), linking peripersonal actions to a vast spectrum of functions including body representation, goal-directed movements, defensive movements, and social interactions (51).
These dynamic bodily features of the self concur with DMT conceptualizations, observations and insights into body-mind mechanisms, which relate to spatial changes in the shape or form of the body and to the quality of movement that embody, enact, influence and express object relations and self-representations. In brief, different DMT paradigms describe the shape of movement that includes changes in the growing or shrinking of body contours, associated with feelings of comfort\discomfort within the relational environment, thus providing the somatic basis for patterns of reaching to or withdrawing from objects, also enabling differentiation between self and objects. These serve as the foundation for the use of range in space, directional movement and three dimensional “shaping” patterns of the body in the PPS (48, 52–54). The qualities of the movement indicate the implicitly enacted rhythmic patterns of change and regulation in muscle tension, i.e. the transitions between free and bound flow that are indicative of the person’s inner needs, affects and feelings; alongside the developing ways of coping with the environment through alterations seen in the use of space, weight and time, i.e. “efforts” (48, 52–54).
In the brain, the ongoing constitution of primary self-dimensions and PPS representations relies mainly on the neural activation and connectivity of brainstem nuclei that include the periaqueductal gray, subcortical regions such as the amygdala, hippocampus, putamen, thalamus, and cerebellum, the somatosensory and sensorimotor cortices, and the salience network anchored in the anterior insula and anterior cingulate cortex (ACC) (55, 56).
While typically characterized as having dynamic and flexible boundaries that are sensitive to motor action factors (57), as well as to affective context (58, 59), PPS disturbances have been found in various disorders of the self (60–62), pointing to its importance in psychotherapeutic evaluations and interventions. Alterations in the shape and qualities of movement within the PPS can be evaluated at the beginning and throughout the therapeutic process. More flexible boundaries, adaptively boosted according to the social situation, can be created by fostering awareness and exploring the perception and use of the PPS, as well as the relationship to the extrapersonal space, i.e., the space far from the body and the PPS of others. This process also involves sensing the dynamic interplay between these external spatial boundaries and the internal milieu, i.e., interoception. Experiencing oneself as both undergoing the sensations and being the source of and initiating actions is fundamental to self-consciousness and underpins senses of ownership and agency (63). Movement-related weak or altered sense of ownership and agency have been associated with disruptions in body image and body schema, in conditions such as depersonalization (64), schizophrenia (65), eating disorders (66), and autism spectrum disorder (67), in which the embodied sense of self becomes fragmented or distorted. The relational context fosters a shared process of predictive multisensory integration linking one’s own actions with the anticipation of the other’s behavior and enabling mutual adjustment during motor interactions (68). Therapists can help patients reorient themselves to the body, a capacity which is for the most part impaired under traumatic circumstances (69), and generally across a range of psychiatric conditions (70). This critical aspects of self-awareness and multisensory integration are further elaborated on in the next section.
4 Dwelling in the soma: developing awareness of body and action
The embodied presence within the lived body relies on interoceptive processes; namely, the moment-by-moment mapping of the body’s internal milieu across conscious and unconscious levels, which have been suggested to be the building blocks of the sense of self underlying emotions and feelings (36, 71). Interoception encompasses information about the physiological condition of the entire body, including signals originating from internal organs such as the viscera, heart and lungs, as well as signals from the skin including pleasure from gentle touch, and pain, conveyed by specialized afferent pathways (72, 73).
Within the PP framework, interoception can be seen as the generation of predictive models of the changing sensory conditions within the body that are influenced by sensorimotor and allostatic functions. Signals from the body reach the level of consciousness to regain allostatic balance, thus generating bodily-affective feelings, informing the organism about its bodily needs (e.g., changes in breathing or heart rate due to anxiety, and stress) (74). However, interoception extends beyond immediate physiological responses and adaptive reactions, and has been shown to be deeply interconnected with impulsive processes, affective states and emotional experiences, motivations, and cognition (75). Thus, the impact of interoception is thought to relate to the awareness of oneself as a feeling entity at any given time (76; A. 77).
The neural representation of somatic and visceral information is transmitted through multiple anatomical pathways to several target sites in the brain. These interoceptive pathways include the spinothalamic sympathetic nervous system and vagal parasympathetic nervous system pathways, and brain regions spanning the periaqueductal gray and brainstem centers, subcortical limbic regions, and cortical regions implicated in predicting and representing information from the body, i.e., the somatosensory cortex, the insular cortices, the ACC and ventro-medial prefrontal cortex (78). The posterior insula is thought to be the major site for receiving and processing visceral and other bodily signals and affective states, whereas the anterior insula serves as an association cortex which, as part of the salience network, integrates information from the posterior insula with other continuously perceived sensory input, while detecting salient stimuli to guide motivated behavior through its downstream targets such as the ventral striatum, a central part of the reward network (79). Studies have characterized the anterior insular cortex as a hub mediating interoceptive attention and generating interoceptive predictions (80).
The link between interoception and selfhood has been demonstrated and established in extensive empirical studies (81). The strongest evidence for the role of interoception in emotional and affective experience comes from the striking overlap in neuroanatomical substrates underlying interoception, bodily regulation, and emotional processing (82). Similarly, the PP framework views emotion as “interoceptive inference” (71), and posits that emotional experiences arise from active inference about the presumed causes of interoceptive signals (83). This view holds that interoceptive sense data give rise to affective qualia, which are inferred and categorized within a given context using emotion concepts such as “anger” or “happiness” (82). Alternatively, having a predictive model of the body has been proposed as the basis of the self (77). This self-model depends on the integration of multiple modes of perception, including interoceptive, proprioceptive, somatosensory, and exteroceptive information.
Accordingly, movement and bodily action are integral to emotion construction and regulation (84–86), thus pivotal for psychotherapeutic work. Specific movement qualities are associated with and can induce corresponding emotional states, for example, movements characterized by openness, fluidity, and upward dynamics tend to evoke positive affect, whereas closed, bound, or downward movements are associated with negative emotions (87). Movement therefore becomes both a diagnostic and a transformative tool, enabling access to implicit emotional patterns and offering new embodied routes for emotional expression regulation, and integration.
Therefore, both the awareness of one’s own body and the awareness of one’s own movements are necessary for the experience of selfhood (88). Accordingly, a bidirectional, functional connection between motor actions and interoception was suggested (89). The insula hub was shown to be engaged in both body perception and action awareness, forming a sense of body ownership and of self-agency (56, 90). Embodiment as a basic feature of selfhood is based on the integration of multiple visual, tactile, vestibular, proprioceptive and interoceptive bodily signals (81, 91). Thus, interoception is no longer viewed as an isolated domain, but rather as one that interacts with exteroception, cognition, and action to maintain the organism’s integrity. These interactions generate bodily awareness and self-consciousness, which underlie the formation of coherent bodily self-models (92, 93). Through oscillatory synchrony, predictive coding and multisensory integration in the brain, interoception is anatomically and functionally intertwined with the processing of signals from the external environment (94). The anterior insula subserves key functions of affective processing through monitoring interoceptive signals and connecting them with exteroceptive cues. Such neural processing creates an integrative interface that enables embodiment, emotional mirroring, and higher-order representation (71, 76, 95), which guides attention between internal and external directed cognition (79, 90). Importantly, during the process of integration of multimodal information, the insular cortices are involved in social cognitive processing and self-other differentiation (92).
Atypical interoception, including primary disturbances in implicit interoceptive signaling, as well as aberrant explicit interoceptive and action awareness, have been observed across a range of psychological conditions, suggesting it may be a transdiagnostic factor and common vulnerability in psychopathology (74, 96, 97). Interoceptive dysfunction contributes to disrupted symbolic representations of feeling states, making it difficult to communicate emotions and leading to greater reliance on concrete (i.e., non-symbolic) processes for identifying and regulating them (98).
The association between body awareness and various mental health conditions advocates the importance of integration of its assessments in clinical settings, not only as a diagnostic tool but also as a component of therapeutic strategies (75). Engagement in practices that enhance embodied awareness, such as DMT, could offer a promising avenue for addressing psychopathological conditions and healthcare, by providing valuable insights into the patient’s capabilities to perceive and interpret bodily sensations, and suggesting ways to cultivate them to guide actions (75, 99). The incorporation of action possibilities may facilitate restorative interactions, thus engendering the vital integration and reciprocal interplay between the inner and outer environment. The orientation towards the ongoing salient information originating from the body and expressed in movement, elicits and invites awareness of body sensations and actions that arise, evolve and fluctuate (31). The embodied temporal aspects of these processes are discussed in the following section.
5 Embodied subjective temporality in self-modeling
Self-models require a temporal dimension for subjectivity to arise. As conscious beings, people must be able to make inferences about the consequences of their own actions in the future, which relies upon the ability to project oneself through time to select actions that minimize expected or future uncertainty (100). “Temporal thickness” refers to the capacity to make inferences not only about the present moment but also about the past and the future. This ongoing self-evidencing process has a “temporal thickness” involving counterfactual processing; that is, imagining what the next sensory input would be if I were to perform a particular action (101). In this perspective, consciousness is the self-evidencing consequences of what I could do (100).
Along convergent lines, Husserl viewed perception as having three temporal aspects, which he coined retention, the immediate present, and protention, which emphasizes the flow through which each moment of protention becomes the retention of the next (102). Subjective time is associated with the conscious self as an enduring entity over time, where processing of time is seen in essence as being embodied. This perceived continuation of time coincides with Winnicott’s moment-by-moment continuous presence that he termed “going on being” (103), as well as conceptualizations such as the “remembered present” and “specious present” (102). Temporality, the subjective experience of time, encompasses more than sensing the time passing; it includes the way experience unfolds as a continuous stream of consciousness rather than as fragmented or discontinuous moments (104). Gallagher has argued that temporality is what explains the directedness of both consciousness and action towards something in the environment (102). Self-movement thus unfolds along a particular trajectory based both on a retention of the body’s configuration in relation to the environment, and an anticipation of where movement is heading next, or the “apprehension of the possibilities or affordances in the present” (p. 13) (102).
Studies in contemporary neuroscience have shown that temporal regularity constitutes a foundational building block for organizing the exteroceptive sensorium, segmenting the world into objects, events, and relationships, and its disruptions may significantly impact perception, emotion and cognition across a range of clinical conditions (105). Moreover, temporal processing is an embodied process that arises from the continuous integration of exteroceptive and interoceptive processes (106), and representations of simultaneity, contingency or duration are rooted in sensorimotor and interoceptive experience. The insular cortex, cerebellum, and supplementary motor area have consistently been shown to be involved in the perceived passage of time, as well as temporal distortions in neurological and psychiatric conditions (107–109). The insular hub integrates exteroceptive and interoceptive signals, to highlight and process emotionally salient moments. It does so by processing temporal cues from changing bodily states and continuously integrating signals across the body, effectively tracking time through internal physiological rhythms. Accordingly, interoceptive processing relies on the influence of temporal oscillations, i.e., cardiac, respiratory and gastric rhythms, on the brain (94). These interoceptive signals shape neural activity and perception (110), prompting and sustaining brain dynamics during an emotional experience (111), which in turn modulates how time is experienced (112). Through its significant roles integrating streams of information from the moving body engaging with the world, the insula shapes our personal, social, and reward-driven actions, our subjective interpretation of our surroundings and our self, which significantly contributes to time perception and our self-consciousness (113).
The central role of subjective temporality underscores the clinical potential of temporal assessments for diagnostic and therapeutic interventions. Therapeutic work should consider the intrinsic subjective temporality of perception and action and be attentive to the patient’s sense of time and duration, the simultaneity or continuity of actions, and the experience of time within the relational context, noticing the pace of experience, cohesion or fragmentation of events and movement synchronization and desynchronization. Therapeutic approaches emphasizing rhythmic movement, temporal attunement, and embodied synchrony may enhance the brain’s capacity for sensory integration and temporal prediction, relational processes that are explored and discussed in greater detail in chapter 8.
The temporally thick generative models suggest that consciousness is fundamentally a memory-dependent process of ‘protension’ or ‘mental time travel’, i.e., the capacity to recall past experiences and simulate possible futures, in embodied agents (16). While “temporal thickness” captures the pre-reflective, embodied organization of moment-to-moment experience, the temporal continuity of self refers to the way we perceive and experience our body and mental states as the same self across time, through mentalization and autobiographical memory. Embodied temporal processes associated with mental time travel abilities, self-referential processes and autobiographical memories, are further addressed in the next section.
6 Autobiographical memory and mentalizing entwined with body movement
The sense of self-continuity over time matures into the extended representational dimension of the self, which has been termed the “autobiographical” (42), “narrative” (43) or “mental” self (44) that remembers and reflects on the past, compares it to present experience, envisions and prepares for the future. This dimension relates to reflective self-awareness, metacognitive insight, and more developed social aspects of selfhood. This higher-order self-awareness is necessary for self-identity and autobiographical memory, because it enables the person to differentiate a mental representation of a past event from current experience (114). Intrinsic self-reflection processes, recollection, spontaneous thought, mind-wandering, and mentalizing are mediated by the Default Mode Network (DMN), which sits atop the neural hierarchy, and consists of the medial prefrontal cortex, the posterior cingulate cortex and the adjacent precuneus, bilateral inferior parietal lobes, as well as the medial temporal lobe memory system (including the hippocampus and parahippocampus) (115). The DMN functions as a “sense-making” network that integrates incoming extrinsic (including social) information with prior intrinsic information (memories) to form rich, context-dependent models of situations as they unfold over time (116).
Self-dimensions are connected at their root and dynamically interact, as indicated in studies of brain functionality (117). The ventromedial prefrontal cortex of the DMN was posited to play a major role in integrating physiology, interoception, affect, and self-related processing (118). Volitional action includes temporal dynamics and self-referential processes and was shown to drive the bodily self, sense of ownership and agency through recruitment of the DMN (90). Even the most complex cognitive and emotional mental operations maintain their dependence on the action repertoire of the individual (119) and regions of the DMN appear to be coupled to bodily rhythms (94). Recent evidence suggests, for example, that the act of breathing exerts a substantive, rhythmic influence on perception, emotion, and cognition, through direct modulation of neural oscillations not only in the brainstem but across the cortical hierarchy, including the insular, cingulate and prefrontal cortices (120). The body moves in rhythm with breathing, and breathing rhythmicity is observed in the aforementioned “shape-flow” of the body, i.e., in the growing or shrinking of bodily dimensions in a relational context (52, 120). DMN driven introspective self-reflection, mind-wandering, recall of past events and internal simulation of future events may thus shape and be shaped by the living interactive body and by the interactive encounter with the gestures and actions of other social agents, in a reciprocal manner (116). The anterior insula, mediating interoception, has been proposed to coordinate activity across the DMN and central executive network, by acting as a gatekeeper for executive control, including response inhibition, working memory and cognitive flexibility (121). This view aligns with embodied accounts suggesting that interoceptive predictions shape the dynamic organization of brain activity (122).
Another interesting point in the temporal-spatial context of the self has to do with the role of the hippocampus, an essential hub for episodic memory processing affiliated with the DMN, which is also crucial for spatial cognition. Intriguingly, the same hippocampal circuits that support spatial navigation are also involved in memory, prospection and imagination (123). Considerable research has shown that the hippocampus supports memory formation through its role in representing space (124). The hippocampus was hypothesized to perform a function that relates sequential and relational mechanisms to the actions performed by the body, or to an internalized version of these action sequences (125). Memory can thus be seen as a transmission mechanism gathered from past experiences to guide current and future actions (126). Thus, navigation through either a physical space or an imagined landscape (i.e., mental time travel and planning ahead for an action) maybe accomplished through similar neural mechanisms that may have evolved from the need to predict future needs of the body (119). The ability for mental time travel consists of moving along a cognitive and spatially oriented representation of time, thus allowing for mental travel into the past (memory) and the future (planning) (127). As of early stages of development, reasoning about navigation allows individuals to represent where they are, where they can go and provides an anchor for memories (128). Locations in space overlap social networks, as reflected in the language people use, e.g., feeling “close” to someone or “distant”, standing “above you” or being on “equal footing”, and being in the “same circle” (129). These insights underscore how individual and interpersonal movement can serve as a powerful medium for both the formation and reformation of memory. They further suggest that movement-based therapeutic processes may support the updating, re-contextualization, and integration of past experiences within new spatio-temporal relational contexts.
Unlike autobiographical memories, traumatic memories are not deliberately retrieved as a coherent narrative but instead triggered involuntarily by incoming stimuli that interact with its neural representations, engendering a fragmented re-experience of the event’s sensory and motoric details. Altered activation levels and diminished functional connectivity within and between the DMN and other regions have been identified as a consistent and defining feature of Post-Traumatic Stress Disorder and traumatic re-experiencing (130). Importantly, trauma memories have been suggested to be a transdiagnostic feature of multiple mental health issues (131), highlighting their critical relevance for psychotherapeutic work. Sensorimotor cues can directly reactivate embodied traces of past trauma, because traumatic memories are often stored in bodily sensations and movement patterns. Sensory and motor fragments may require new experiences that contradict past trauma. When old sensations or movements resurface, they can be re-contextualized through present-moment feedback that anchors the body in current time and space, and completing previously inhibited defensive actions can help update the sensorimotor representations of the traumatic event (132). Indeed, essential ingredients of therapeutic change were suggested to involve reactivating old memories, introducing new emotional experiences that can be integrated into those memories during reconsolidation, and then reinforcing the updated memory structure by repeatedly practicing new ways of behaving and experiencing the world across varied contexts (133). Therefore, treatment approaches that utilize emotional expression of differently contextualized sensorimotor reactions, facilitated through the therapist’s attuned presence, coupled with intentional/volitional movement, may encourage the integration of traumatic memories (132, 134). Archaic and traumatic memory traces stored in the sensorimotor system point to their important acknowledgement within the transferential relationship and suggest the potential of using movement improvisation as type of free association (135). The inclusion of bodily movement in therapeutic interventions may act upon and alter ways in which sensory and motor traces are re-experienced in a secure relational setting, which may also foster the contextualization and integration of sensorimotor fragments into meaningful, and possibly verbally accessible autobiographical narratives (136, 137).
Other dysphoric and depressive distortions in memory and affect include excessive mental activity, i.e. rumination, that intensifies the disconnection from embodied experience, creating a recursive loop of alienation from both the body and the external world. This reflects an imbalance in the hierarchical layers of the self, with heightened mental self-referential processing overriding bodily and interoceptive dimensions (138). Incorporating creative movement into psychotherapy may enable the construction and expression of subjective meaningful narratives that cannot be narrated by conventional means (139).
Emotional memory, supported by medial temporal lobe structures involved in emotion and memory, i.e., the amygdala and hippocampus, in conjunction with DMN cortical regions, relies on their coordinated activity during the encoding and retrieval of emotional episodic experiences. Stress-induced emotional arousal, modulated by the neurotransmitter and hormone noradrenaline, results in amplified amygdala-hippocampal circuit, which leads to enhanced encoding and consolidation of the gist of the emotionally arousing information at the expense of contextual details (140). The adaptive prolonged cortisol response, the end product of the hypothalamus-pituitary-adrenal (HPA) axis, modulates hippocampal and prefrontal functions that enable contextualization and coherent memory processing, promoting resilience (141). Sustained post-stress increase in amygdala-hippocampal connectivity was related to attenuated cortisol responsiveness (142), which may underscore stress vulnerability. Movement-related shared experiences have been shown to modulate cortisol responses, having regulatory effects on stress-recovery cycles. Accordingly, infant-mother cortisol synchrony is considered as the physiological manifestation of a dyad’s shared emotional and behavioral experiences (143), facilitating the memory consolidation of these experiences into meaningful emotional knowledge. The embodied neuropsychological mechanisms that lie at the core of these interactive experiences and related therapeutic processes are the topic of the following sections.
7 Brains-bodies-minds connection: on kinesthetic empathy and embodied mentalization
The discovery of mirror neurons revealed that other-related multimodal information about sensations, actions, emotions, and communicative messages are mapped onto the beholder’s neural substrates devolved to these first-person self-related processes (144). Mirror neurons, which are activated both while executing and witnessing the actions of others, are widely spread throughout different brain regions, including regions traditionally associated with motor control such as the premotor cortex, supplementary motor cortex, and the cerebellum (i.e., the action observation network). The involvement of mirror mechanisms in the somatosensory cortex prompted the realization that the brain of the witness not only enables the performance of similar actions but also the somatosensory representations of what it would feel like to move in the observed way (145). These processes entail neural representations of motor actions and somatosensory feedback. Accumulating neuroimaging studies have shown that the salience network, i.e., the anterior insula and ACC, critical for interoceptive awareness, becomes reactivated by the same emotional state witnessed in others, a mechanism that allows for an understanding of others’ actions as emotional events, through simulated shared body states, i.e., embodied simulation (144, 146). This implies that people use their own bodily experiences and their processing and representations to understand both their own and others’ intentions and emotional experiences (147). This is in line with the notion that body and action awareness contribute to subjective emotional feeling states that can also guide empathic understanding of the emotions of others, thus serving as a crossmodal target for interventions to enhance interpersonal skills.
Importantly, it is the quality of movement that is critical for linking action and emotion. Closely linked to DMT conceptualizations, “vitality forms”, the how-dimension of the unfolding of actions, detected based on movement dynamics, related to the temporal profile, force, space and direction, matching shape and effort and providing an access to unconscious past relational experience (148), were shown to selectively activate the central insula and middle cingulate cortex when an action is performed, imagined, and observed in others (149). The activity of the insula while processing affective information was recently shown to precede and foreshadow action, modulating the premotor cortex (150). Findings also indicate that vitality forms that are characteristic of everyday interactions are atypical in neurodivergent individuals, such as in autism, both in their expression and recognition, thus preventing fluid, preverbal social alignment (151–153). Psychotherapeutic relational mirroring and rhythmic movement interventions, such as the ones used in DMT, were suggested to initiate and clarify these forms and support their predictive processing and then build toward sharing more nuanced actions (154).
The use of the embodied simulation mechanism enables kinesthetic empathy to arise, i.e., the ability to feel and understand the experience of others with and through movement (155). This is central to DMT and is considered one of its major contributions to psychotherapy. It refers to the therapists’ awareness of their corporal feelings and sensation of movement that arise in response to their patients’ body movements or postures, which enable therapists to infer and respond to their patient’s emotional state (156). Kinesthetic empathy may be fostered through affective attunement, somatic mirroring and synchronous movement. The hormone and neurotransmitter oxytocin has been suggested to underlie this kinesthetic dimension of empathy fostering interpersonal synchrony (157). Social stressors, such as social isolation, exposure to social trauma and loss, are often paralleled by maladaptation of the oxytocin system, whereas restoring this system functioning can reinstate socio-emotional allostasis (158).
It is important to note that although influential, the mirror-neuron framework has been challenged for offering an overly narrow and often unsupported account of how humans understand others’ actions. Recent critiques point out that mirror neuron brain areas contribute to low-level processing of observed actions (e.g., distinguishing types of grip), and copying of body movement topography, but not to high-level action interpretation (e.g., inferring actors’ intentions), and argue that social and action understanding relies more on mechanisms such as associative learning (159).
In addition to embodied simulation mirror mechanisms, i.e., shared representations of firsthand and vicarious experiences of affective states, empathy entails reflective participation enabling mental state attribution, which relies on symbolic and abstract processing. Affective and cognitive understanding of the other involves the activation of a theory of mind or “mentalizing” network that primarily taps the temporo-parietal junction (TPJ) and regions of the DMN (160). This mentalizing process is bodily-anchored. The functioning of the DMN is deeply rooted in interoceptive and sensorimotor processes (94, 116). The TPJ has been shown to be implicated in bodily self-location, ownership and self-identification (161), in visuo-spatial perspective taking, sense of agency, mental imagery of one’s own body, and biological motion, as well as in distinguishing between self and other, both mentally and behaviorally in imitation of action experiments (44, 162, 163). Multisensory disintegration at the TPJ may result in out-of-body experiences (164). By navigating between representations of mental states of self and others, the mentalizing network is involved in the attribution of beliefs, emotions and intentions (165, 166), using episodic prospection, facilitating predictive processing (33). By integrating inputs from multiple brain regions through its functional connections with the sensory cortices, hippocampus, and salience network, the DMN is thought to generate both visceral and motor embodied simulations of others’ actions and mental states (167).
The embodied mentalization of the psychotherapist can drive processes of working through unconscious, unformulated or unrepresented states, in which implicit automatic bodily responses that have yet to be mentally represented can be recognized, using embodied narration, symbolic formation and metaphoric work. Such processes may facilitate the functional crosstalk and integration of brain networks, which can prompt experience-dependent neuroplasticity (168).
Embodied attunement within the psychotherapeutic relationship forms the basis for emotional communication and regulation of the bond between the patient and the empathic therapist (169–171). Embodied “dialectical attunement” grounds higher-order abstract thinking, which is considered a re-enactment of the internalized primary dialogue through which individuals acquired the concepts in the first place (172, 173). The therapist helps generate top-down predictive inferences on the causes of bodily signals by resonating with the patient’s experience and by gradually training the patient to mentalize via embodied reflective discourse.
The “relational dance” between patient and therapist (174) promotes the development of the patient’s “inner witness” (175), through the capability to notice, observe and mentalize bodily sensations, associations, images, feelings or thoughts which arise moment-to-moment (176). This coincides with the integration and crosstalk between neural networks associated with the different self-dimensions, e.g., subcortical regions such as the brainstem, amygdala and cerebellum, somatosensory and sensorimotor cortices, salience network, and DMN. In order to do so, the mover needs the therapist as a holding, seeing, and mentalizing “outer witness” that can use somatic countertransference and the function of self-observation, being an “inner witness” to her/himself, fluctuating attention between the internal experience and the awareness of the moving other, further facilitating a reflective dialogue. This is why developing an “inner witness” is needed before becoming an “outer witness” to others (174), both of which functions are cultivated in DMT training and practice (177).
Through empathic therapeutic relationships, predictive models about the availability and support of another with whom one can share meaning are created. Such interpersonal processes relate to the mechanisms of synchrony.
8 Brain-to-brain coupling linked with movement synchronicity
When experiencing meaningful moments of togetherness and affect sharing, interpersonal neuro-physio-psychological synchrony can emerge (178). Second-person neuroscience has operationalized and empirically demonstrated synchronization patterns between people at the neural, physiological, and behavioral level via multi-brain recording approaches using hyperscanning techniques that simultaneously record activity from two or more interacting individuals. Coordinated or synchronized brain activation between two people or more, i.e., Interpersonal Neural Synchrony (INS), has been associated with the mirror mechanism, where synchronizing the actions of one individual with the perceptions of another and vice- versa may then lead to interpersonal synchronization of brain oscillations (178).
Social and emotional alignment was shown to be interrelated to the synchronization of movement, as processes that rely on shared neural networks (179). This spontaneous and dynamic synchronization between individuals was found to be present in large-scale brain networks related to sensory perception, attentional salience and embodied simulation, reward processing, and mentalizing processes (180). Robust brain regional correlates of biobehavioral synchrony were found in the TPJ, involved in bodily-anchored self-other processing, and the ventromedial prefrontal cortex, a hub of integration promoting self and social processing (180). INS may be directly mediated by the person-to-person communicative signals through which the interaction is conveyed (e.g., eye contact, facial expression, bodily gestures and movements, and vocal prosody) (181).
Serving as an anchor to human interaction, INS has been proposed as a neurobiological mechanism in psychotherapy that makes it possible to infer the patient’s inner states and facilitate mutual understanding and emotional exchange (182), as an experience-dependent phenomenon (183). Similarly, nonverbal movement synchrony has recently been identified as a central aspect of psychotherapy facilitating the therapeutic alliance (19, 22, 23). Through mutual attention, and behavioral mirroring, INS has been shown to be indicative of empathic relationships, bonding and rapport (184) that is also associated with the development of resilience (185).
Shared interactive moments within psychotherapeutic relationships can induce INS, when fostered by rhythmic movement synchronization, a basic element of DMT (25), as therapists attune to and share the physical and emotional form and quality of their patients’ movement. Synchronization between patient and therapist was shown to be accompanied by physiological synchrony of autonomic signals, as observed during psychotherapy sessions at the hormonal level, i.e. oxytocin (186), heart rate and respiration (187), and skin conductance (188). Oxytocin has been linked to both enhanced INS and behavioral synchrony (189), and its release during interpersonal interaction may underlie the affiliative consequences of synchronous movement. A recent analysis has strengthened the central role intersubjective synchrony in psychotherapy, fostering a stronger alliance and deeper connectedness, thereby promoting therapeutic progress (190). The study highlighted the layered dynamics of synchrony, showing that physiological synchrony facilitates moment-to-moment affective attunement, whereas behavioral synchrony supports sustained relational engagement over time. Therapist-led nonverbal synchrony has been specifically linked to a stronger therapeutic alliance and improved treatment outcomes.
Interpersonal communication depends on shared predictive models (191, 192). Indeed, INS was suggested to entrain shared PP, where the oscillatory synchrony between people may bind potentially disruptive “free energy” together (193). This implies that when people engage in meaningful interpersonal engagement by interacting on a physical, emotional and mental level, they not only predict each other, but (en)actively entrain their perceptual and motor states, thus forming a shared entity of active inference in embodied creative ways (18). Inferential models may become similar over time, thus enabling mutual understanding to develop, a process that was linked with interbrain plasticity, or the change in interbrain coupling over time in neural networks associated with social learning, e.g., via the mentalizing network, hippocampus, action observation network, and salience network (194). Through its functional connections, the DMN representation of the other’s behavior and underlying mental states may result in a synchronized response facilitating shared understanding and empathy (167). Such moments in which the minds of both parties intersect and co-construct a shared experience that can be perceived by each participant, have been suggested to relate to the sharing of “vitality forms” of movement (195).
By contrast, mental disorders have been associated with a lesser ability to achieve synchrony at the neural, behavioral and psychological levels (196, 197). Restoring interpersonal synchrony emerges as a key therapeutic aim, whereby therapists and patients may become dynamically coupled across sensory-motor, affective, and neural domains (198). Indeed, recurring opportunities for synchronization in therapy may lead to plastic and lasting changes in a person’s overall ability to synchronize (168, 199). In psychotherapy, and particularly in movement-based approaches, such synchrony can be used to explore and reshaped dysfunctional interaction patterns. Attuned therapists and patients spontaneously synchronize in their movement behavior, and aspects of their voice, along with neurophysiological processes (200), promoting emotional processing and regulation (182). Throughout a therapeutic interaction therapists move in and out of sync with the patients, from states of match to mismatch and reparation, enabling the therapeutic relationship to be curative, so that a lower trait ability to sync with others can be subject to state-like manipulation (201). Therapists can notice and intentionally work with movement synchrony, breath, rhythm, pacing, distance or proximity and variations in peripersonal and extrapersonal space, direction, the use of power, and interoceptive awareness scaffolding to connect with their patients, reduce uncertainty and induce new learning, experiencing moments of co-regulation. These moments of synchrony are fundamental to the dialectical process between self and other that shapes the sense of self (45). Through these embodied dynamics patients can sense, enact, and reflect on their habitual relational strategies, gaining insight into maladaptive patterns while experiencing new possibilities for connection, agency, and mutual regulation.
9 Summary and conclusions
Current views of brain function anchor the link and bridge the divide between the somatic and the psychic, by revealing the multifaceted clinical aspects of the living moving body, as applied in DMT and applicable to psychotherapy in general. The primacy of body movement in the constitution and development of the self, and at every level of mental functioning and dysfunctioning, makes it a vital source of information and intervention.
Recognition of patients’ movement repertoire and use of the PPS, as well as its broadening, can be a critical part of the assessment and treatment processes. Embodied mentalization, observation and analysis of the shape and qualities of movement, while linking them to internal sensations, emotions and mental processes of both patient and therapist, may help therapists better understand their patients’ functioning and inform the transference-countertransference matrix. The epistemic affordance of the therapeutic encounter can be manifested through its actualization by offering a wide range of action possibilities that enable the generation of updated models of the self within the relational context.
Psychotherapy that cultivates awareness of the body and action prompts individuals’ ability to perceive, integrate and interpret their bodily cues as feelings and cognitions, and consequently better regulate their emotions. Interpersonal communicative methods based on kinesthetic empathy and embodied resonance using bodily means of attunement, mirroring, and synchronous movement, meaningfully coincide with the relational neural mirroring mechanisms enabling embodied simulation, and neurophysiological synchronization. The therapy process, encompassing both experiential and reflective meaning-making processes, can encourage embodied mentalization and integration of the self-dimensions.
Psychotherapeutic interventions can build up self-awareness involving inferential processes with counterfactual depth. The experiential body can thus be entwined with the “temporal thickness” of the specious present, thus raising awareness to the subjective experience of time and further developing the capacity for mental time travel and the consolidation of long-term autobiographical episodic memories. Embodied attention and the accumulating experiences of movement possibilities can ground inferences about the (relational) consequences of action. Autobiographical narratives that might never have been narrated by conventional means can be reassembled, given meaning and sequential temporal and spatial properties, reconsolidating trauma memories, and at the same time creating shared emotionally corrective narratives. The psychotherapeutic use of body movement involves vital transitions between immersion (first-person perspective) and distancing (third-person perspective), allowing for a more flexible, adaptive, integrated self experience.
Psychotherapy mobilizes active inference in the context of intimate relationships by enabling a trustful atmosphere and by “loaning” the therapist’s brain functions, creating a “reverie” that can provide a way to enter the predictive moment (2). Moments of creative uncertainty may emerge and through them the need for active exploration, innovation and generative possibilities. Psychotherapy can encompass two strategies to engage predictive processing neurodynamics. The first relates to the “bottom-up” promotion of prediction errors, by opening up opportunities for action within corrective relational emotional experiences, increasing “free energy”, and sampling new sensorimotor input through action (active/enactive inference). The second regards the “top-down” shaping of the internal models of the body in the world (prediction signals) through reflective meaning-making processes. These are interlaced in the therapeutic process within which subjects become meaning-makers who dynamically co-evolve with the world they inhabit and predict (139).
The broad body-oriented range of intervention techniques drawing on implicit relational knowing and embodied participatory sense making, enables practitioners to work at all levels of mental functioning. Primary self-disturbances may require intensified vitalizing interventions to enliven self-awareness and the perception of body boundaries and PPS, thus engaging patients in interpersonal exchange (202, 203). Higher level self-related processes require symbolic transformation, allowing psychic reality to transform “primary psychic matter” (‘free energy’) into a matter endowed with reflexivity and subjectivity (18). The use of imagery, symbolism, metaphoric language and reflective dialogue facilitates meaning-making and body-mind connections, thus nurturing the formation of increasingly complex, embodied and coherent internal (generative) representations, models of the embodied, embedded, enactive, and extended self in the world.
Future directions and strategies to further strengthen evidence-based neuroscience research on the psychotherapeutic use of body-oriented interventions in conjunction with brain circuitry and brain-body-mind interactions are highly valuable. Future studies may seek to advance analytical approaches to uncover neural synchronization mechanisms related to the similarity of shared behavioral creative experiences (204). The use of mobile technology such as Mobile Brain-Body Imaging (MoBI) in a hyperscanning setting is at the forefront of advancing our understanding of the intricate interaction between the brain, the body, and the social environment (139, 205). MoBI has been used to investigate the multi-modal nature of expressive movement, such as dance, using real-time changes in brain dynamics and behavior, thus paving the way to explore the neural computations underlying complex motor action, timing and memory (206). In order to assess psychotherapeutic outcomes, the combination of neural biomarkers from MoBI recordings and patients’ subjective reported experiences in a mixed-method research design could provide a more holistic integrative approach for examining the interplay between neuronal dynamics and phenomenological accounts of self-experience (138, 207, 208). Moreover, hyperscanning research that tracks INS over time, integrated with behavioral and psychological observations, can help meet the need for longitudinal designs and highlight their potential in studying mechanisms underlying therapeutic change (168, 209, 210).
Grounded in neuroscience perspectives on the self and self-other relations, this article aimed to shed light on the ways in which body- and movement-informed psychotherapy can act upon, manifest, and cultivate the multidimensional aspects of selfhood. By recognizing the multifaceted meanings of movement both as a vital source of information and a catalyst for change, psychotherapy can foster body-mind integration through creatively and relationally minding the moving self.
Author contributions
SV: Conceptualization, Formal analysis, Investigation, Resources, Writing – original draft, Writing – review & editing.
Funding
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Keywords: multidimensional self, predictive processing, body awareness, mirroring, embodied mentalization, interpersonal synchronization
Citation: Vaisvaser S (2025) Minding the moving self: the centrality of body movement in the neurodynamics of the self and psychotherapeutic implications. Front. Psychiatry 16:1726099. doi: 10.3389/fpsyt.2025.1726099
Received: 15 October 2025; Accepted: 14 November 2025; Revised: 11 November 2025;
Published: 18 December 2025.
Edited by:
Yoshihiro Noda, IUHW Mita Hospital, JapanReviewed by:
Sandra Kay Lauffenburger, S K Lauffenburger P/L, AustraliaGernot Hauke, Embodiment Resource Academy, Germany
Copyright © 2025 Vaisvaser. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Sharon Vaisvaser, c2hhcm9uLnZhaXN2YXNlckBvbm8uYWMuaWw=; eXNoYXJvbnZAZ21haWwuY29t