Body awareness

Losing trust in body sensations: Interoceptive awareness and depression symptom severity among primary care patients.: Background: Interoceptive dysfunction is emerging as an important biomarker for mental illnesses, such as depression which is a leading cause of disability and death worldwide. Little empirical research explains the relationship between interoception and depression. Methods: Using multivariable linear regression models and cross-sectional baseline data from a randomized control trial of primary care patients (N = 281), we analyzed the relationship between depression severity (none/slight, mild,

Oxytocin Modulates Attention Switching Between Interoceptive Signals and External Social Cues.: Emotional experience involves an integrated interplay between processing of external emotional cues and interoceptive feedback, and this is impaired in a number of emotional disorders. The neuropeptide oxytocin (OT) enhances the salience of external social cues but its influence on interoception is unknown. The present pharmaco-fMRI study therefore investigated whether OT enhances interoceptive awareness and if it influences the interplay between interoceptive and salience processing. In a rando

The relationship between heartbeat counting and heartbeat discrimination: A meta-analysis.: Interoception concerns the perception of the body's internal state. Despite the importance of this ability for health and aspects of higher-order cognition, its measurement remains problematic. Most studies of interoception employ one of two tasks: the heartbeat counting or heartbeat discrimination task. These tasks are thought to index common abilities, an assertion often used to justify the use of a single measure of cardiac interoception. However, mixed findings regarding the relationship bet

Change starts with the body: Interoceptive appreciation mediates the effect of mindfulness training on behavior change - an effect moderated by depression severity.: Mindfulness catalyzes health behavior change. Yet, interoception is dysregulated in depression, potentially impairing behavioral activation. We examined the mediating role of interoceptive appreciation, as measured by how much one trusts and listens to internal bodily signals, on behavior change. Primary care patients with depression, anxiety, or stress disorders related to chronic illness were randomized to Mindfulness Training for Primary Care (MTPC) using the Mindful Behavior Change curriculu

A meta-analysis on the relationship between interoceptive awareness and alexithymia: Distinguishing interoceptive accuracy and sensibility.: Alexithymia-a trait associated with difficulties understanding one's own emotions-is theorized to stem from deficits in interoceptive awareness, or the ability to detect, accurately monitor, and regulate internal bodily processes. The present meta-analysis analyzed all studies that empirically examined the relationship between alexithymia and interoceptive awareness. Across 66 independent samples (N = 7,146), alexithymia had a small, negative correlation with interoceptive awareness (r = -.162,

Sex differences in interoceptive accuracy: A meta-analysis.: Interoceptive accuracy, the ability to correctly perceive internal signals arising from the body, is thought to be disrupted in numerous mental and physical health conditions. Whilst evidence suggests poorer interoceptive accuracy in females compared to males, raising the possibility that interoceptive differences may relate to sex differences in mental and physical health, results concerning sex differences in interoceptive accuracy are mixed. Given such ambiguity, this meta-analysis aimed to e

A four-day Western-style dietary intervention causes reductions in hippocampal-dependent learning and memory and interoceptive sensitivity.

In animals, a Western style diet-high in saturated fat and added sugar-causes impairments in hippocampal-dependent learning and memory (HDLM) and perception of internal bodily state (interoception). In humans, while there is correlational support for a link between Western-style diet, HDLM, and interoception, there is as yet no causal data. Here, healthy individuals were randomly assigned to consume either a breakfast high in saturated fat and added sugar (Experimental condition) or a healthier breakfast (Control condition), over four consecutive days. Tests of HDLM, interoception and biological measures were administered before and after breakfast on the days one and four, and participants completed food diaries before and during the study. At the end of the study, the Experimental condition showed significant reductions in HDLM and reduced interoceptive sensitivity to hunger and fullne…

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Mindfulness-based training attenuates insula response to an aversive interoceptive challenge.

Neuroimaging studies of mindfulness training (MT) modulate anterior cingulate cortex (ACC) and insula among other brain regions, which are important for attentional control, emotional regulation and interoception. Inspiratory breathing load (IBL) is an experimental approach to examine how an individual responds to an aversive stimulus. Military personnel are at increased risk for cognitive, emotional and physiological compromise as a consequence of prolonged exposure to stressful environments and, therefore, may benefit from MT. This study investigated whether MT modulates neural processing of interoceptive distress in infantry marines scheduled to undergo pre-deployment training and deployment to Afghanistan. Marines were divided into two groups: individuals who received training as usual (control) and individuals who received an additional 20-h mindfulness-based mind fitness training (…

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Preliminary evidence about the effects of meditation on interoceptive sensitivity and social cognition.

Background: Interoception refers to the conscious perception of body signals. Mindfulness is a meditation practice that encourages individuals to focus on their internal experiences such as bodily sensations, thoughts, and emotions. In this study, we selected a behavioral measure of interoceptive sensitivity (heartbeat detection task, HBD) to compare the effect of meditation practice on interoceptive sensitivity among long term practitioners (LTP), short term meditators (STM, subjects that completed a Mindfulness-Based Stress Reduction (MBSR) program) and controls (non-meditators). All participants were examined with a battery of different tasks including mood state, executive function and social cognition tests (emotion recognition, empathy and theory of mind). Findings: Compared to controls, both meditators' groups showed lower levels of anxiety and depression, but no improvement in ex…

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Bolus isoproterenol infusions provide a reliable method for assessing interoceptive awareness.

Interoception, defined as the perception of internal body states, plays a central role in classic and contemporary theories of emotion. In particular, deviations from baseline body states have been hypothesized to be integral to the experience of emotion and feeling. Consequently, reliable measurement of interoception is critical to the testing of emotion theories. Heartbeat perception tasks have been considered the standard method for assessing interoceptive awareness, primarily due to their non-invasive nature and technical feasibility. However, these tasks are limited by the fact that above chance group performance rates on heartbeat detection (or the frequency of 'good detectors') are rarely higher than 40%, meaning that such tasks (as they are typically utilized) do not obtain a measure of interoceptive awareness in the majority of individuals. Here we describe a novel protocol for …

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Heartbeat counting is unrelated to heartbeat detection: A comparison of methods to quantify interoception.

Recent research has identified individual differences in interoceptive sensitivity as a key source of variation in action, cognition, and emotion. This research has relied heavily on a single method for assessing interoceptive sensitivity: the accuracy of counting heartbeats while at rest. The validity of this method was assessed here by comparing the heartbeat counting (HBC) performance of 48 individuals with their heartbeat detection (HBD) performance. The HBC task required participants to report the numbers of heartbeats counted during brief signaled periods and indexed cardioceptive accuracy by the difference between the numbers of reported and actual heartbeats. In the HBD task, participants indicated the temporal location of heartbeat sensations relative to the onset of ventricular contraction. On each trial, they judged whether heartbeat sensations were or were not simultaneous wi…

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Interoceptive rhythms in the brain.

Sensing internal bodily signals, or interoception, is fundamental to maintain life. However, interoception should not be viewed as an isolated domain, as it interacts with exteroception, cognition and action to ensure the integrity of the organism. Focusing on cardiac, respiratory and gastric rhythms, we review evidence that interoception is anatomically and functionally intertwined with the processing of signals from the external environment. Interactions arise at all stages, from the peripheral transduction of interoceptive signals to sensory processing and cortical integration, in a network that extends beyond core interoceptive regions. Interoceptive rhythms contribute to functions ranging from perceptual detection up to sense of self, or conversely compete with external inputs. Renewed interest in interoception revives long-standing issues on how the brain integrates and coordinates…

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Classifying individual differences in interoception: Implications for the measurement of interoceptive awareness.

It has been suggested that individual differences in interoception (the perception of the body's internal state) can be divided into three distinct dimensions: interoceptive accuracy (performance on objective tests of interoceptive accuracy), interoceptive sensibility (self-reported beliefs concerning one's own interoception) and interoceptive awareness (a metacognitive measure indexed by the correspondence between interoceptive accuracy and interoceptive sensibility). Research conducted under this model underscores the importance of interoceptive awareness for a variety of disorder-specific and transdiagnostic symptoms. However, the clinical importance of interoceptive awareness means that this aspect of interoception warrants further scrutiny, and such scrutiny suggests that revision of the three-dimensional model of interoception is necessary. In this theoretical paper, we outline suc…

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Going at the heart of social cognition: is there a role for interoception in self-other distinction?

Interoception describes the processing and awareness of bodily signals arising from visceral organs, essential for the organism's homeostatic needs. Beyond homeostasis, the integration of exteroceptive and interoceptive signals is required for the coherence of bodily self-awareness. Here, we suggest that interoception also plays a critical role in social cognition. Relating to others as individuals who are distinct from one's self requires the simultaneous yet distinct co-representation of self and others. We propose that interoceptive awareness appears to stabilise the mental representation of one's self as distinct from others. A more nuanced understanding of the role of interoception in the representation of others in relation to ourselves is vital to determine its importance in social cognition.

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From the body's viscera to the body's image: Is there a link between interoception and body image concerns?

Interoception, the sense of the physiological condition of the body originating from within its internal organs, and body image, namely the perception, feelings and attitudes one has about one's body, are two fundamental components of our sense of personal identity and overall well-being. However, the relation between interoception and body image remains poorly understood. We here review recent behavioural and neuroimaging evidence from non-clinical and clinical populations (e.g. eating disorders) to propose that basic interoceptive processes and interoceptive awareness may crucially contribute to the complex formation of body image, as well as to its disturbances. In particular, lower interoceptive accuracy and awareness are associated with body-image concerns. We provide a potential mechanistic explanation of the link between interoception and body image, which aims to integrate intero…

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Contingent biofeedback outperforms other methods to enhance the accuracy of cardiac interoception: A comparison of short interventions.

Background and objectives: Deviations in interoception might contribute to the development and maintenance of mental disorders. The improvement of interoceptive accuracy (IA) is desirable but assessment and training methods remain controversial. For instance, it was assumed that performance increases in heartbeat counting paradigms after cardiac feedback were due to an improvement of knowledge with regard to heart rate rather than due to an actual improvement in IA. Methods: Here, we examined effects of contingent cardiac feedback training, non-contingent cardiac feedback, mindfulness practice, and a waiting period with external attentional focus on IA. 100 healthy participants underwent a mental tracking paradigm before and after 20 min of training or waiting. Results: Results revealed a significant increase of IA in the contingent feedback condition (d = 1.21, p ≤ .001) and no signific…

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Effects of mindfulness training on body awareness to sexual stimuli: implications for female sexual dysfunction.

Objectives: Treatments of female sexual dysfunction have been largely unsuccessful because they do not address the psychological factors that underlie female sexuality. Negative self-evaluative processes interfere with the ability to attend and register physiological changes (interoceptive awareness). This study explores the effect of mindfulness meditation training on interoceptive awareness and the three categories of known barriers to healthy sexual functioning: attention, self-judgment, and clinical symptoms. Methods: Forty-four college students (30 women) participated in either a 12-week course containing a "meditation laboratory" or an active control course with similar content or laboratory format. Interoceptive awareness was measured by reaction time in rating physiological response to sexual stimuli. Psychological barriers were assessed with self-reported measures of mindfulness…

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The Fundamental Basis of Palpitations: A Neurocardiology Approach.

Background and objective: Palpitations are a common symptom that may indicate cardiac arrhythmias, be a somatic complaint in anxiety disorders, and can be present in patients without either condition. The objective of this review was to explore the pathways and fundamental mechanisms through which individuals appreciate palpitations. Observations: Cardiac afferents provide beat-to-beat sensory information on the heart to the spinal cord, brain stem, and higher brain centers. Cardioception, a subset of interoception ('the physiological sense of the condition of the body'), refers to sensing of the heartbeat. High cardioception is present in persons with lower body mass index, lower percentages of body fat, and anxiety disorders. Low cardioception (lower interoceptive awareness) is associated with psychiatric disorders, such as depression, personality disorders, and schizophrenia. CNS site…

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Towards a psychophysics of interoceptive processes: the measurement of heartbeat detection.

It is difficult to collect objective evidence of interoception. Unlike exteroception, the effective stimuli for interoception are often unknown, and even when identifiable, they are difficult to control experimentally. Furthermore, direct stimulation of the interoceptors is seldom appropriate in human experimentation. Hence, non-invasive behavioural measures of accuracy in heartbeat detection have frequently been adopted to index interoceptive sensitivity. However, there has been little standardization and the two most popular methods for assessing heartbeat detection, heartbeat tracking and two alternative forced choice methods, appear to be biased and of questionable validity. These issues do not arise with other methods that are based on classical psychophysics and that enable subjects to indicate when during the cardiac cycle their heartbeat sensations occur. Not only are these class…

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GABA in the insula - a predictor of the neural response to interoceptive awareness.

The insula has been identified as a key region involved in interoceptive awareness. Whilst imaging studies have investigated the neural activation patterns in this region involved in intero- and exteroceptive awareness, the underlying biochemical mechanisms still remain unclear. In order to investigate these, a well-established fMRI task targeting interoceptive awareness (heartbeat counting) and exteroceptive awareness (tone counting) was combined with magnetic resonance spectroscopy (MRS). Controlling for physiological noise, neural activity in the insula during intero- and exteroceptive awareness was confirmed in an independent data sample using the same fMRI design. Focussing on MRS values from the left insula and combining them with neural activity during intero- and exteroceptive awareness in the same healthy individuals, we demonstrated that GABA concentration in a region highly in…

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Listen to your heart: the cultural shaping of interoceptive awareness and accuracy.

West African cultural contexts foster higher levels of attention to the bodily signals compared with the European American contexts. Interoception, or the processing of signals from the body, is a key component of emotional reactivity. Interoceptive awareness (i.e., the self-reported tendency to attend to physiological changes) and accuracy (i.e., the ability to accurately detect physiological changes) are distinct aspects of interoception. Does the West African cultural emphasis on interoceptive awareness affect individuals' abilities to accurately perceive physiological changes in response to emotional stimuli? West African and European American young adults watched a fear-inducing film clip and continuously rated their perception of heart rate changes in response to the clip. Actual heart rates were also recorded continuously. Cross-correlations were calculated between measures of per…

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A Systematic Review of Associations Between Interoception, Vagal Tone, and Emotional Regulation: Potential Applications for Mental Health, Wellbeing, Psychological Flexibility, and Chronic Conditions.

Background: Interoception and heart rate variability have been found to predict outcomes of mental health and well-being. However, these have usually been investigated independently of one another. Objectives: This systematic review aimed to explore a key gap in the current literature, that being, identifying whether HRV and interoception predict emotional regulation outcomes and strategies. Methods: The process of article retrieval and selection followed the PRISMA guidelines. Databases PsychINFO, Web of Science, PubMed, CINAHL, and MEDLINE were scanned for papers published. Preliminary inclusion and exclusion criteria were specified following the PICO framework, whilst the CHARMS framework was used to help formulate the research question, and critically assess for bias. Results: Two hundred and thirty-seven studies were identified after initial database searches. Of these, eight studie…

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Perceptual insensitivity to the modulation of interoceptive signals in depression, anxiety, and substance use disorders.

This study employed a series of heartbeat perception tasks to assess the hypothesis that cardiac interoceptive processing in individuals with depression/anxiety (N = 221), and substance use disorders (N = 136) is less flexible than that of healthy individuals (N = 53) in the context of physiological perturbation. Cardiac interoception was assessed via heartbeat tapping when: (1) guessing was allowed; (2) guessing was not allowed; and (3) experiencing an interoceptive perturbation (inspiratory breath hold) expected to amplify cardiac sensation. Healthy participants showed performance improvements across the three conditions, whereas those with depression/anxiety and/or substance use disorder showed minimal improvement. Machine learning analyses suggested that individual differences in these improvements were negatively related to anxiety sensitivity, but explained relatively little varian…

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Using bodily postures to reduce anxiety and improve interoception: A comparison between powerful and neutral poses.

Background: Previous research has shown that anxiety syndromes are highly prevalent among university students. Effective treatments are needed to reduce the burden of anxiety in this population. Powerful postures have been found to impact affective states, as well as interoception (i.e. the ability to perceive inner bodily signals). However, no previous study has compared the effects of powerful- and neutral postures in regards to anxiety and interoceptive ability. Methods: The first part of the study measured the single-session effect of adopting powerful- vs. neutral postures on students' (n = 57) interoceptive ability and state anxiety. The second part of the study measured the effect of adopting powerful or neutral postures twice daily for two weeks, on individuals' interoceptive ability and trait anxiety. Results: State anxiety decreased in both conditions whereas interoceptive accu…

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Anorexia Nervosa and Functional Motor Symptoms: Two Faces of the Same Coin?

The aim of this study was to compare anorexia nervosa (AN) patients and functional motor symptoms (FMS) patients by assessing their variability in demographic and clinical characteristics, risk factors, precipitators, and family history. The authors assessed levels of depression and anxiety, alexithymia, dissociation, body awareness, self-objectification, and interoception in the two groups, using 20 healthy controls (HCs) as a control group for psychometric assessment and for interoception. Unexpectedly, no differences in the three groups were observed for the measures related to awareness of physical state, including body awareness, self-objectification, and interoceptive ability via the heartbeat task. However, the AN and FMS groups were not different from each other but were different from the HC group with regard to anxiety, depression, alexithymia, and dissociation. In light of the…

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Panic Anxiety in Humans with Bilateral Amygdala Lesions: Pharmacological Induction via Cardiorespiratory Interoceptive Pathways.

We previously demonstrated that carbon dioxide inhalation could induce panic anxiety in a group of rare lesion patients with focal bilateral amygdala damage. To further elucidate the amygdala-independent mechanisms leading to aversive emotional experiences, we retested two of these patients (B.G. and A.M.) to examine whether triggering palpitations and dyspnea via stimulation of non-chemosensory interoceptive channels would be sufficient to elicit panic anxiety. Participants rated their affective and sensory experiences following bolus infusions of either isoproterenol, a rapidly acting peripheral β-adrenergic agonist akin to adrenaline, or saline. Infusions were administered during two separate conditions: a panic induction and an assessment of cardiorespiratory interoception. Isoproterenol infusions induced anxiety in both patients, and full-blown panic in one (patient B.G.). Although …

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The Insular Cortex: An Interface Between Sensation, Emotion and Cognition.

The insula is a complex brain region central to the orchestration of taste perception, interoception, emotion, and decision-making. Recent research has shed light on the intricate connections between the insula and other brain regions, revealing the crucial role of this area in integrating sensory, emotional, and cognitive information. The unique anatomical position and extensive connectivity allow the insula to serve as a critical hub in the functional network of the brain. We summarize its role in interoceptive and exteroceptive sensory processing, illustrating insular function as a bridge connecting internal and external experiences. Drawing on recent research, we delineate the insular involvement in emotional processes, highlighting its implications in psychiatric conditions, such as anxiety, depression, and addiction. We further discuss the insular contributions to cognition, focusi…

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Internal senses of the vagus nerve.

The vagus nerve is an indispensable body-brain connection that controls vital aspects of autonomic physiology like breathing, heart rate, blood pressure, and gut motility, reflexes like coughing and swallowing, and survival behaviors like feeding, drinking, and sickness responses. Classical physiological studies and recent molecular/genetic approaches have revealed a tremendous diversity of vagal sensory neuron types that innervate different internal organs, with many cell types remaining poorly understood. Here, we review the state of knowledge related to vagal sensory neurons that innervate the respiratory, cardiovascular, and digestive systems. We focus on cell types and their response properties, physiological/behavioral roles, engaged neural circuits and, when possible, sensory receptors. We are only beginning to understand the signal transduction mechanisms used by vagal sensory ne…

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The neurobiology of interoception in health and disease.

Interoception is the sensing of internal bodily sensations. Interoception is an umbrella term that encompasses (1) the afferent (body-to-brain) signaling through distinct neural and humoral (including immune and endocrine) channels; (2) the neural encoding, representation, and integration of this information concerning internal bodily state; (3) the influence of such information on other perceptions, cognitions, and behaviors; (4) and the psychological expression of these representations as consciously accessible physical sensations and feelings. Interoceptive mechanisms ensure physiological health through the cerebral coordination of homeostatic reflexes and allostatic responses that include motivational behaviors and associated affective and emotional feelings. Furthermore, the conscious, unitary sense of self in time and space may be grounded in the primacy and lifelong continuity of …

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Is meditation associated with altered brain structure? A systematic review and meta-analysis of morphometric neuroimaging in meditation practitioners.

Numerous studies have begun to address how the brain's gray and white matter may be shaped by meditation. This research is yet to be integrated, however, and two fundamental questions remain: Is meditation associated with altered brain structure? If so, what is the magnitude of these differences? To address these questions, we reviewed and meta-analyzed 123 brain morphology differences from 21 neuroimaging studies examining ∼300 meditation practitioners. Anatomical likelihood estimation (ALE) meta-analysis found eight brain regions consistently altered in meditators, including areas key to meta-awareness (frontopolar cortex/BA 10), exteroceptive and interoceptive body awareness (sensory cortices and insula), memory consolidation and reconsolidation (hippocampus), self and emotion regulation (anterior and mid cingulate; orbitofrontal cortex), and intra- and interhemispheric communication …

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Interoceptive contributions to healthy eating and obesity.

Obesity results from persistent failure by the brain to balance food intake with energy needs, resulting in a state of chronic energy surplus. Although there are many factors that predispose individuals to weight gain and obesity, the current review focuses on two ways eating behavior may be influenced by sensitivity to interoceptive signals of hunger, satiety, and metabolic energy reserves. First, obesity may be related to hypersensitivity to interoceptive signals of hunger, leading to positive alliesthesia for food cues that undermine attempts to change unhealthy eating behaviors. Second, overeating and obesity may arise from an inability to accurately detect interoceptive signals of satiety and positive energy balance. The findings reviewed herein demonstrate that obesity may be related to altered interoception, and warrant the continued development of novel obesity interventions aime…

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