Multidimensional Assessment of Interoceptive Awareness – Version 2 (MAIA-2)

The Multidimensional Assessment of Interoceptive Awareness – Version 2 (MAIA-2) is an 8-subscale state-trait self-report questionnaire to measure multiple dimensions of interoception (awareness of bodily sensations). The MAIA-2 is suitable for adults (18+) and has 37 items. There is a parallel youth version (MAIA-Y) for use with individuals 7 – 17 years of age.

Interoception refers to the sensation, interpretation, and integration of internal somatic signals (Eggart et al., 2021). There is compelling evidence demonstrating links between poor interoceptive awareness and difficulties with emotion awareness and emotion regulation (Price & Hooven, 2018). Interoception may be of clinical importance for individuals presenting with autism, eating disorders, alexithymia or chronic pain.

It can be beneficial to measure interoception in a therapeutic setting because effective emotion regulation involves the ability to accurately detect and evaluate cues related to physiological reactions to stressful events. The therapist and client can then work together on appropriate regulation strategies that temper and influence the emotional response.

The MAIA consists of 8 scales (addressing 5 dimensions of body awareness):

1. Noticing (Awareness of Body Sensations)
2. Not-Distracting (Emotional Reaction and Attentional Response to Sensations)
3. Not-Worrying (Emotional Reaction and Attentional Response to Sensations)
4. Attention Regulation (Capacity to Regulate Attention)
5. Emotional Awareness (Awareness of Mind-Body Integration)
6. Self-Regulation (Awareness of Mind-Body Integration)
7. Body Listening (Awareness of Mind-Body Integration)
8. Trust (Trusting Body Sensations)    

Psychometric Properties

The original MAIA (Mehling et al., 2012) was 32 questions and had some internal consistency weaknesses (Mehling et al., 2018). To improve upon the original the MAIA-2 added additional items (Mehling et al., 2018), yielding higher Cronbach alphas and improved psychometrics. Two subscales were below the standard Cronbach alpha criterion of 0.70 – Noticing (.64) and Not Worrying (.67). The eight MAIA-2 scales are sensitive to change and so can detect the effects of interventions aimed at improving interoception (Eggart et al., 2021).

A validation study by Mehling et al. (2018), based upon a convenience sample of 1,090 individuals between 18 and 69 years old, provided means and standard deviations for all 8 scales. The mean score (between 0 – 5) for each scale was:

1. Noticing (M = 3.34, SD = 0.90)
2. Not-Distracting (M = 2.06, SD = 0.80)
3. Not-Worrying (M = 2.52, SD = 0.85)
4. Attention Regulation (M = 2.84, SD = 0.86)
5. Emotional Awareness (M = 3.44, SD = 0.96)
6. Self-Regulation (M = 2.78, SD = 1.01)
7. Body Listening (M = 2.20, SD = 1.17)
8. Trust (M = 3.37, SD = 1.11)    

Scoring and Interpretation 

Scores are between 0 and 5, where higher score equates to more awareness of bodily sensation. A percentile is also calculated, indicating how the responded scored in comparison to a normative sample. Interpretation using percentiles helps contextualise scores. For example, percentile below 50 indicate that the individual scored below what is typical. Extreme percentile scores (below 10 or above 90) are of particular clinical significance.

The MAIA-2 consists of eight scales:

1. Noticing (Items 1-4): Awareness of uncomfortable, comfortable, and neutral body sensations
2. Not-Distracting (Items 5-10): Higher scores suggest a more tuned in relationship to unpleasant sensations, and is typically considered to be adaptive. Lower scores indicate the tendency to ignore or distract oneself from sensations of pain or discomfort.
3. Not-Worrying (Items 11-15): Higher scores indicate less rumination about discomfort. Low scores indicate emotional distress or worry with sensations of pain or discomfort
4. Attention Regulation (Items 16-22): Ability to sustain and control attention to body sensation
5. Emotional Awareness (Items 23-27): Awareness of the connection between body sensations and emotional states
6. Self-Regulation (Items 28-31): Ability to regulate psychological distress by attention to body sensations
7. Body Listening (Items 32-34): Actively listens to the body for insight
8. Trust (Items 35-37): Experiences one’s body as safe and trustworthy

The results from the MAIA-2 focus upon the individual scale scores as a total score is not meaningful (Mehling et al., 2012).   

Developer

Mehling WE, Acree M, Stewart A, Silas J, Jones A (2018) The Multidimensional Assessment of Interoceptive Awareness, Version 2 (MAIA-2). PLoS ONE 13(12): e0208034. https://doi.org/10.1371/journal.pone.0208034

References

Eggart, M., Todd, J., & Valdés-Stauber, J. (2021). Validation of the Multidimensional Assessment of Interoceptive Awareness (MAIA-2) questionnaire in hospitalized patients with major depressive disorder. PloS One, 16(6), e0253913. https://doi.org/10.1371/journal.pone.0253913

Mehling, W. E., Price, C., Daubenmier, J. J., Acree, M., Bartmess, E., & Stewart, A. (2012). The Multidimensional Assessment of Interoceptive Awareness (MAIA). PloS One, 7(11), e48230. https://doi.org/10.1371/journal.pone.0048230

Price, C. J., & Hooven, C. (2018). Interoceptive Awareness Skills for Emotion Regulation: Theory and Approach of Mindful Awareness in Body-Oriented Therapy (MABT). Frontiers in psychology, 9, 798. https://doi.org/10.3389/fpsyg.2018.00798