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

Interoception in pathological health anxiety.

According to cognitive-behavioral models, pathological health anxiety is triggered and maintained by the perception of mostly mild and benign bodily sensations that are misinterpreted as signs of illness. Arguably, abnormalities in interoception may account for this misguided preoccupation with somatic sensations. Using a multimethod approach, the current study investigated possible abnormalities in interoception in patients with pathological health anxiety (PHA; n = 51) and healthy participants (n = 56). Different types of interoception were assessed with a heartbeat-tracking task and a signal-detection task for nonspecific skin conductance fluctuations (NSCFs task). Patients compared with healthy participants showed a more liberal interoceptive response bias for NSCFs, t(79) = 2.32, p = .02, d = 0.53, 95% confidence interval (CI) (0.30, 0.68). Specifically, patients with a comorbid anx…

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Interoception beyond homeostasis: affect, cognition and mental health.

Interoception refers to the sensing of the internal state of one's body. Interoception is distinct from the processing of sensory information concerning external (non-self) stimuli (e.g. vision, hearing, touch and smell) and is the afferent axis to internal (autonomic and hormonal) physiological control. However, the impact of interoception extends beyond homeostatic/allostatic reflexes: it is proposed to be fundamental to motivation, emotion (affective feelings and behaviours), social cognition and self-awareness. This view is supported by a growing body of experimental evidence that links peripheral physiological states to mental processes. Within this framework, the representation of self is constructed from early development through continuous integrative representation of biological data from the body, to form the basis for those aspects of conscious awareness grounded on the subjec…

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Is the cardiac monitoring function related to the self in both the default network and right anterior insula?

The self has been proposed to be rooted in the neural monitoring of internal bodily signals and might thus involve interoceptive areas, notably the right anterior insula (rAI). However, studies on the self consistently showed the involvement of midline default network (DN) nodes, without referring to visceral monitoring. Here, we investigate this apparent discrepancy. We previously showed that neural responses to heartbeats in the DN encode two different self-dimensions, the agentive 'I' and the introspective 'Me', in a whole-brain analysis of magnetoencephalography (MEG) data. Here, we confirm and anatomically refine this result with intracranial recordings (intracranial electroencephalography, iEEG). In two patients, we show a parametric modulation of neural responses to heartbeats by the self-relatedness of thoughts, at the single trial level. A region-of-interest analysis of the insu…

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Emotional decision-making in autism spectrum disorder: the roles of interoception and alexithymia.

The way choices are framed influences decision-making. These "framing effects" emerge through the integration of emotional responses into decision-making under uncertainty. It was previously reported that susceptibility to the framing effect was reduced in individuals with autism spectrum disorder (ASD) due to a reduced tendency to incorporate emotional information into the decision-making process. However, recent research indicates that, where observed, emotional processing impairments in ASD may be due to co-occurring alexithymia. Alexithymia is thought to arise due to impaired interoception (the ability to perceive the internal state of one's body), raising the possibility that emotional signals are not perceived and thus not integrated into decision-making in those with alexithymia and that therefore reduced framing effects in ASD are a product of co-occurring alexithymia rather than…

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Interoception, homeostatic emotions and sympathovagal balance.

We briefly review the evidence for distinct neuroanatomical substrates that underlie interoception in humans, and we explain how they substantialize feelings from the body (in the insular cortex) that are conjoined with homeostatic motivations that guide adaptive behaviours (in the cingulate cortex). This hierarchical sensorimotor architecture coincides with the limbic cortical architecture that underlies emotions, and thus we regard interoceptive feelings and their conjoint motivations as homeostatic emotions We describe how bivalent feelings, emotions and sympathovagal balance can be organized and regulated efficiently in the bicameral forebrain as asymmetric positive/negative, approach/avoidance and parasympathetic/sympathetic components. We provide original evidence supporting this organization from studies of cardiorespiratory vagal activity in monkeys and functional imaging studies…

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An active inference theory of allostasis and interoception in depression.

In this paper, we integrate recent theoretical and empirical developments in predictive coding and active inference accounts of interoception (including the Embodied Predictive Interoception Coding model) with working hypotheses from the theory of constructed emotion to propose a biologically plausible unified theory of the mind that places metabolism and energy regulation (i.e. allostasis), as well as the sensory consequences of that regulation (i.e. interoception), at its core. We then consider the implications of this approach for understanding depression. We speculate that depression is a disorder of allostasis, whose myriad symptoms result from a 'locked in' brain that is relatively insensitive to its sensory context. We conclude with a brief discussion of the ways our approach might reveal new insights for the treatment of depression. This article is part of the themed issue 'Inter…

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Changes in interoceptive processes following brain stimulation.

The processing and perception of individual internal bodily signals (interoception) has been differentiated to comprise different levels and processes involved. The so-called heartbeat-evoked potential (HEP) offers an additional possibility to examine automatic processing of cardiac signals. Knowledge on neural structures potentially supporting different facets of interoception is still sparse. One way to get insights into neuroanatomical function is to manipulate the activity of different brain structures. In this study, we used repetitive transcranial magnetic stimulation (rTMS) and a continuous theta-burst protocol to inhibit specific central locations of the interoceptive network including the right anterior insula and the right somatosensory cortices and assessed effects on interoceptive facets and the HEP in 18 male participants. Main results were that inhibiting anterior insula re…

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How the heart speaks to the brain: neural activity during cardiorespiratory interoceptive stimulation.

Prominent theories emphasize key roles for the insular cortex in the central representation of interoceptive sensations, but how this brain region responds dynamically to changes in interoceptive state remains incompletely understood. Here, we systematically modulated cardiorespiratory sensations in humans using bolus infusions of isoproterenol, a rapidly acting peripheral beta-adrenergic agonist similar to adrenaline. To identify central neural processes underlying these parametrically modulated interoceptive states, we used pharmacological functional magnetic resonance imaging (phMRI) to simultaneously measure blood-oxygenation-level dependent (BOLD) and arterial spin labelling (ASL) signals in healthy participants. Isoproterenol infusions induced dose-dependent increases in heart rate and cardiorespiratory interoception, with all participants endorsing increased sensations at the high…

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The integration of the internal and external milieu in the insula during dynamic emotional experiences.

Whilst external events trigger emotional responses, interoception (the perception of internal physiological states) is fundamental to core emotional experience. By combining high resolution functional neuroimaging with concurrent physiological recordings, we investigated the neural mechanisms of interoceptive integration during free listening to an emotionally salient audio film. We found that cardiac activity, a key interoceptive signal, was robustly synchronised across participants and centrally represented in the posterior insula. Effective connectivity analysis revealed that the anterior insula, specifically tuned to the emotionally salient moments of the audio stream, serves as an integration hub of interoceptive processing: interoceptive states represented in the posterior insula are integrated with exteroceptive representations by the anterior insula to highlight these emotionally…

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(Dis)connected: An examination of interoception in individuals with suicidality.

Sensing one's internal physiological sensations is a process known as interoception. Several lines of research suggest that poor interoception may facilitate engagement in dangerous self-harm. In 2 studies, we investigated interoceptive abilities in individuals with differing degrees of suicidality. In Study 1, we compared interoception in controls (n = 27) and suicide ideators (n = 35), planners (n = 14), and attempters (n = 30). We found that those with suicidality had worse interoception than controls. Further, attempters reported worse interoception than planners or ideators. In Study 2, we compared interoception in psychiatric outpatients who had (n = 136) or had not (n = 459) attempted suicide. Again, we found that attempters reported worse interoception than nonattempters. In addition, we found that recent attempts were more strongly associated with interoceptive deficits than dis…

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Disrupted effective connectivity of cortical systems supporting attention and interoception in melancholia.

Importance: Patients with melancholia report a distinct and intrusive dysphoric state during internally generated thought. Melancholia has long been considered to have a strong biological component, but evidence for its specific neurobiological origins is limited. The distinct neurocognitive, psychomotor, and mood disturbances observed in melancholia do, however, suggest aberrant coordination of frontal-subcortical circuitry, which may best be captured through analysis of complex brain networks. Objective: To investigate the effective connectivity between spontaneous (resting-state) brain networks in melancholia, focusing on networks underlying attention and interoception. Design, setting, and participants: We performed a cross-sectional, observational, resting-state functional magnetic resonance imaging study of 16 participants with melancholia, 16 with nonmelancholic depression, and 16…

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Probing the Interoceptive Network by Listening to Heartbeats: An fMRI Study.

Exposure to cues of homeostatic relevance (i.e. heartbeats) is supposed to increase the allocation of attentional resources towards the cue, due to its importance for self-regulatory, interoceptive processes. This functional magnetic resonance imaging (fMRI) study aimed at determining whether listening to heartbeats is accompanied by activation in brain areas associated with interoception, particularly the insular cortex. Brain activity was measured with fMRI during cue-exposure in 36 subjects while listening to heartbeats vs. sinus tones. Autonomic markers (skin conductance) and subjective measures of state and trait anxiety were assessed. Stimulation with heartbeat sounds triggered activation in brain areas commonly associated with the processing of interoceptive information, including bilateral insular cortices, the inferior frontal operculum, and the middle frontal gyrus. A psychophy…

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On the interaction of self-regulation, interoception and pain perception.

Background: Interoceptive processes were found to be associated with better self-regulation capacities in healthy participants. Further empirical research suggests that interoceptive sensitivity is also important for the perception of pain both in healthy participants and in somatoform patients. Nevertheless, little is known about the interaction of interoceptive processes and self-regulation for pain. We therefore conducted a study examining the interaction of interoception and self-regulation in somatoform patients. Methods: We investigated interoceptive sensitivity and self-regulatory capacities in 30 somatoform patients and 30 healthy controls when experimentally assessing pain threshold and pain tolerance. Results: Interoceptive sensitivity was associated with better self-regulation capacities. Somatoform patients exhibited a significantly reduced interoceptive sensitivity and reduc…

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Mapping emotional feeling in the body: A tripartite framework for understanding the embodied mind.

People often speak of being "moved beyond words" when witnessing awe-inspiring natural beauty, experiencing profound moral elevation, or encountering powerful works of art and music. Such moments evoke intensely embodied sensations-a swelling in the chest, a quickened heartbeat, or a sudden stillness that floods the entire body. These experiences are difficult to articulate, yet they are vividly real and spatially anchored in bodily experience. How, then, can science begin to access and understand these deeply felt, yet ineffable, emotional states? This review examines the emerging method of body mapping, which captures how individuals subjectively localize emotional sensations across the body. Drawing on over two dozen empirical studies, we integrate findings from affective neuroscience, psychophysiology, cognitive linguistics, and cross-cultural psychology to propose a tripartite frame…

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The Gut-Brain Axis.

Preclinical evidence has firmly established bidirectional interactions among the brain, the gut, and the gut microbiome. Candidate signaling molecules and at least three communication channels have been identified. Communication within this system is nonlinear, is bidirectional with multiple feedback loops, and likely involves interactions between different channels. Alterations in gut-brain-microbiome interactions have been identified in rodent models of several digestive, psychiatric, and neurological disorders. While alterations in gut-brain interactions have clearly been established in irritable bowel syndrome, a causative role of the microbiome in irritable bowel syndrome remains to be determined. In the absence of specific microbial targets for more effective therapies, current approaches are limited to dietary interventions and centrally targeted pharmacological and behavioral app…

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Brain default-mode network dysfunction in addiction.

Aberrant patterns of brain functional connectivity in the default mode network (DMN) have been observed across different classes of substance use disorder (SUD) and are associated with craving and relapse. In addicted individuals resting functional connectivity (RSFC) of the anterior DMN, which participates in attribution of personal value and emotional regulation, tends to be decreased, whereas RSFC of the posterior DMN, which directs attention to the internal world, tends to be increased. Aberrant RSFC within the DMN is believed to contribute to impaired self-awareness, negative emotions and to ruminations in addiction. Additionally, the disrupted connectivity between DMN and cortical regions involved with executive function, memory and emotion could be critical to drug-taking regardless of negative consequences and to stress-triggered relapse. At the system level, the dynamics of DMN …

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Interoceptive Awareness Skills for Emotion Regulation: Theory and Approach of Mindful Awareness in Body-Oriented Therapy (MABT).

Emotion regulation involves a coherent relationship with the self, specifically effective communication between body, mind, and feelings. Effective emotion regulation involves the ability to accurately detect and evaluate cues related to physiological reactions to stressful events, accompanied by appropriate regulation strategies that temper and influence the emotional response. There is compelling evidence demonstrating links between poor or disrupted awareness of sensory information, or interoceptive awareness, and difficulties with emotion regulation. This paper presents a framework, based on psychological and neurobiological research, for understanding how interoceptive awareness facilitates regulation and an integrated sense of self, and thus contributes to health and well-being. A mind-body therapeutic approach called mindful awareness in body-oriented therapy (MABT), uniquely desi…

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Interoception across modalities: on the relationship between cardiac awareness and the sensitivity for gastric functions.

The individual sensitivity for ones internal bodily signals ("interoceptive awareness") has been shown to be of relevance for a broad range of cognitive and affective functions. Interoceptive awareness has been primarily assessed via measuring the sensitivity for ones cardiac signals ("cardiac awareness") which can be non-invasively measured by heartbeat perception tasks. It is an open question whether cardiac awareness is related to the sensitivity for other bodily, visceral functions. This study investigated the relationship between cardiac awareness and the sensitivity for gastric functions in healthy female persons by using non-invasive methods. Heartbeat perception as a measure for cardiac awareness was assessed by a heartbeat tracking task and gastric sensitivity was assessed by a water load test. Gastric myoelectrical activity was measured by electrogastrography (EGG) and subjecti…

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Overlapping activity in anterior insula during interoception and emotional experience.

Classic theories of emotion posit that awareness of one's internal bodily states (interoception) is a key component of emotional experience. This view has been indirectly supported by data demonstrating similar patterns of brain activity - most importantly, in the anterior insula - during both interoception and emotion elicitation. However, no study has directly compared these two phenomena within participants, leaving it unclear whether interoception and emotional experience truly share the same functional neural architecture. The current study addressed this gap in knowledge by examining the neural convergence of these two phenomena within the same population. In one task, participants monitored their own heartbeat; in another task they watched emotional video clips and rated their own emotional responses to the videos. Consistent with prior research, heartbeat monitoring engaged a cir…

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Heartbeat evoked potentials mirror altered body perception in depressed patients.

Objective: Awareness of stimuli originating inside of the body (interoceptive awareness) is thought to have an impact on psychopathology. The aim of the present study was to analyze whether heartbeat perception accuracy is reduced in depressed patients. Furthermore, we investigated whether putative differences are reflected in heartbeat-evoked potentials. Method: We assessed the heartbeat perception score in 16 depressed patients and in matched healthy controls. A 63-channel EEG was recorded while participants counted pseudo-randomly presented target tones or heartbeats during a fixed number of cardiac cycles. ECG R-waves served as the trigger for EEG averaging. The cardiac-field artifact was minimized using independent component analysis and current-source density. Results: Behaviorally, the depressed sample showed less accurate heartbeat perception in comparison to the control group (p…

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Can you feel the beat? Interoceptive awareness is an interactive function of anxiety- and depression-specific symptom dimensions.

Delineating the differential effects of anxiety versus depression on patterns of information processing has proved challenging. The tripartite model of mood disorders (Clark & Watson, 1991) suggests that one way forward is to adopt a dimensional rather than categorical approach, making it possible to explore the main and interaction effects of depression- and anxiety-specific symptoms on a given cognitive-affective process. Here we examined how the interplay of anxiety-specific arousal and depression-specific anhedonia symptoms in the same individuals relate to interoceptive (bodily) awareness. 113 participants with varying levels of mood disorder symptoms completed a heartbeat perception task to assess interoceptive accuracy. Superior interoception was associated with anxiety-specific arousal symptoms, and this relationship held when controlling for depression-specific anhedonia symptom…

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Multisensory integration across exteroceptive and interoceptive domains modulates self-experience in the rubber-hand illusion.

Identifying with a body is central to being a conscious self. The now classic "rubber hand illusion" demonstrates that the experience of body-ownership can be modulated by manipulating the timing of exteroceptive (visual and tactile) body-related feedback. Moreover, the strength of this modulation is related to individual differences in sensitivity to internal bodily signals (interoception). However the interaction of exteroceptive and interoceptive signals in determining the experience of body-ownership within an individual remains poorly understood. Here, we demonstrate that this depends on the online integration of exteroceptive and interoceptive signals by implementing an innovative "cardiac rubber hand illusion" that combined computer-generated augmented-reality with feedback of interoceptive (cardiac) information. We show that both subjective and objective measures of virtual-hand …

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Interoception, emotion and brain: new insights link internal physiology to social behaviour. Commentary on:: "Anterior insular cortex mediates bodily sensibility and social anxiety" by Terasawa et al. (2012).

In this issue, Terasawa and colleagues used functional neuroimaging to test for common neural substrates supporting conscious appraisal of subjective bodily and emotional states and explored how the relationship might account for personality and experience of anxiety symptoms. Their study highlights a role for the same region of anterior insula cortex in appraisal of emotions and bodily physiology. The reactivity of this region also mediated the relationship between 'bodily sensibility' and social fear, translating a cognitive representation of subjective physical state into an individual personality trait that influences social interaction. The task used by Terasawa and colleagues taps into conscious aspects to the expression of this dynamic. These findings add to increasing evidence for the role of anterior insula as the interface between physiologically driven internal motivational st…

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A common gustatory and interoceptive representation in the human mid-insula.

The insula serves as the primary gustatory and viscerosensory region in the mammalian cortex. It receives visceral and gustatory afferent projections through dedicated brainstem and thalamic nuclei, which suggests a potential role as a site for homeostatic integration. For example, while human neuroimaging studies of gustation have implicated the dorsal mid-insular cortex as one of the primary gustatory regions in the insula, other recent studies have implicated this same region of the insula in interoception. This apparent convergence of gustatory and interoceptive information could reflect a common neural representation in the insula shared by both interoception and gustation. This idea finds support in translational studies in rodents, and may constitute a medium for integrating homeostatic information with feeding behavior. To assess this possibility, healthy volunteers were asked to…

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Enteric nervous system: sensory transduction, neural circuits and gastrointestinal motility.

The gastrointestinal tract is the only internal organ to have evolved with its own independent nervous system, known as the enteric nervous system (ENS). This Review provides an update on advances that have been made in our understanding of how neurons within the ENS coordinate sensory and motor functions. Understanding this function is critical for determining how deficits in neurogenic motor patterns arise. Knowledge of how distension or chemical stimulation of the bowel evokes sensory responses in the ENS and central nervous system have progressed, including critical elements that underlie the mechanotransduction of distension-evoked colonic peristalsis. Contrary to original thought, evidence suggests that mucosal serotonin is not required for peristalsis or colonic migrating motor complexes, although it can modulate their characteristics. Chemosensory stimuli applied to the lumen can…

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