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

Sensing the body matters: profiles of interoceptive sensibility in chronic pain adjustment.

Interoception is critical to health regulation and is often disrupted in individuals with chronic pain (ICPs). Interoceptive sensibility (IS)-the self-reported experience and relationship toward internal states-includes skills such as sensing, interpreting, and using bodily information for self-regulation. Current studies on IS and chronic pain (CP) adjustment are scarce, and how the interplay between different IS skills shapes CP adjustment remains unclear. This cross-sectional study aimed to identify profiles of IS skills among ICPs and examined their associations with pain outcomes and psychological and behavioral risk or protective processes. Individuals with chronic musculoskeletal pain (n = 173; 84.4% women) completed the Multidimensional Assessment of Interoceptive Awareness (MAIA), measures of CP adjustment (depression, anxiety, vitality, pain severity, interference, and physical…

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Premonitory urge to tic in Tourette's is associated with interoceptive awareness.

Background: A contribution of aberrant interoceptive awareness to the perception of premonitory urges in Gilles de la Tourette syndrome (GTS) has been hypothesized. Methods: We assessed interoceptive awareness in 19 adults with GTS and 25 age-matched healthy controls using the heartbeat counting task. We also used multiple regression to explore whether the severity of premonitory urges was predicted by interoceptive awareness or severity of tics and obsessive-compulsive symptoms. Results: We observed lower interoceptive awareness in GTS compared with controls. Interoceptive awareness was the strongest predictor of premonitory urges in GTS, with greater interoceptive awareness being associated with more urges. Greater tic severity was also associated with higher rates of premonitory urges. Conclusion: The observed relationship between severity of premonitory urges and interoceptive awaren…

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How does interoceptive awareness interact with the subjective experience of emotion? An fMRI study.

Recent studies in cognitive neuroscience have suggested that the integration of information about the internal bodily state and the external environment is crucial for the experience of emotion. Extensive overlap between the neural mechanisms underlying the subjective emotion and those involved in interoception (perception of that which is arising from inside the body) has been identified. However, the mechanisms of interaction between the neural substrates of interoception and emotional experience remain unclear. We examined the common and distinct features of the neural activity underlying evaluation of emotional and bodily state using functional magnetic resonance imaging (fMRI). The right anterior insular cortex and ventromedial prefrontal cortex (VMPFC) were identified as commonly activated areas. As both of these areas are considered critical for interoceptive awareness, these resu…

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Interoceptive awareness enhances neural activity during empathy.

Empathy is a multicomponent function that includes sensorimotor, affective, and cognitive components. Although especially the affective component may implicate interoception and interoceptive awareness, the impact of interoception on empathy has never been evaluated behaviorally or neurophysiologically. Here, we tested how a preceding period of interoceptive awareness impacts and modulates neural activity during subsequent empathy. We used functional magnetic resonance imaging (fMRI) and measured the sequential interaction between interoception and empathy using fMRI in 18 healthy subjects. We found that the preceding interoceptive awareness period significantly enhanced neural activity during empathy in bilateral anterior insula and various cortical midline regions. The enhancement of neural activity during empathy in both interoceptive and empathy networks by preceding interoceptive aw…

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Effects of short-term food deprivation on interoceptive awareness, feelings and autonomic cardiac activity.

The perception of internal bodily signals (interoception) plays a relevant role for emotion processing and feelings. This study investigated changes of interoceptive awareness and cardiac autonomic activity induced by short-term food deprivation and its relationship to hunger and affective experience. 20 healthy women were exposed to 24h of food deprivation in a controlled setting. Interoceptive awareness was assessed by using a heartbeat tracking task. Felt hunger, cardiac autonomic activity, mood and subjective appraisal of interoceptive sensations were assessed before and after fasting. Results show that short-term fasting intensifies interoceptive awareness, not restricted to food cues, via changes of autonomic cardiac and/or cardiodynamic activity. The increase of interoceptive awareness was positively related to felt hunger. Additionally, the results demonstrate the role of cardiac…

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The body in the mind: on the relationship between interoception and embodiment.

The processing, representation, and perception of bodily signals (interoception) plays an important role for human behavior. Theories of embodied cognition hold that higher cognitive processes operate on perceptual symbols and that concept use involves reactivations of the sensory-motor states that occur during experience with the world. Similarly, activation of interoceptive representations and meta-representations of bodily signals supporting interoceptive awareness are profoundly associated with emotional experience and cognitive functions. This article gives an overview over present findings and models on interoception and mechanisms of embodiment and highlights its relevance for disorders that are suggested to represent a translation deficit of bodily states into subjective feelings and self-awareness.

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Perceived threat predicts the neural sequelae of combat stress.

Exposure to severe stressors increases the risk for psychiatric disorders in vulnerable individuals, but can lead to positive outcomes for others. However, it remains unknown how severe stress affects neural functioning in humans and what factors mediate individual differences in the neural sequelae of stress. The amygdala is a key brain region involved in threat detection and fear regulation, and previous animal studies have suggested that stress sensitizes amygdala responsivity and reduces its regulation by the prefrontal cortex. In this study, we used a prospective design to investigate the consequences of severe stress in soldiers before and after deployment to a combat zone. We found that combat stress increased amygdala and insula reactivity to biologically salient stimuli across the group of combat-exposed individuals. In contrast, its influence on amygdala coupling with the insul…

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Body signals, cardiac awareness, and the perception of time.

Recent research suggests that our sense of time intervals in the range of seconds is directly related to activity in the insular cortex, which contains the primary sensory area for interoception. We therefore investigated whether performance in a duration reproduction task might correlate with individual interoceptive awareness and with measurable changes in autonomic activity during the task. Thirty-one healthy volunteers participated in an interoceptive (heartbeat) perception task and in repeated temporal reproduction trials using intervals of 8, 14, and 20s duration while skin conductance levels and cardiac and respiratory periods were recorded. We observed progressive increases in cardiac periods and decreases in skin conductance level during the encoding and (less reliably) the reproduction of these intervals. Notably, individuals' duration reproduction accuracy correlated positivel…

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Abnormal body perception and neural activity in the insula in depression: an fMRI study of the depressed "material me".

Objectives: In addition to affective-cognitive symptoms, patients with major depressive disorder (MDD) suffer from somato-vegetative symptoms, suggesting abnormal interoceptive awareness of their "material me". While recent imaging studies have extensively investigated affective-cognitive symptoms in MDD, the neural correlates of somato-vegetative symptoms and abnormal interoception remain unclear. Since the "material me" has been especially associated with the anterior insula in healthy subjects, we hypothesized abnormalities in this region during interoceptive awareness in MDD. Methods: We therefore investigated behavioural and neural correlates of interoception in healthy and depressed subjects using the Body Perception Questionnaire (BPQ) and a well established heartbeat perception task in fMRI. Results: MDD patients showed significantly higher scores in the BPQ and reduced neural ac…

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Differential effects of anxiety and depression on interoceptive accuracy.

Background: Feedback from the body is assumed to be altered in depression. Nevertheless, empirical studies investigating this assumed relationship remain sparse. This study aimed to examine interrelations between the ability to perceive heartbeats accurately (interoceptive awareness), depressive symptoms, and anxiety in healthy participants. Methods: A well-validated heartbeat perception task to measure interoceptive awareness together with two questionnaires indexing anxiety and depression were administered to 119 participants. Results: As main results we observed a negative correlation between heartbeat perception and depression. Only when focussing on high anxiety levels this negative correlation coefficient between depression and interoception remained significant. Conclusions: Our results highlight the possible relationship between depressive symptoms and interoceptive awareness and…

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Brain structures mediating cardiovascular arousal and interoceptive awareness.

Different emotions are accompanied by different bodily states and it is unclear which brain structures are involved in both, the cerebral representation of the bodily change and the representation of its perception. Structures connecting bodily signals and interoceptive awareness could trigger, in a feedforward manner, behavioral responses appropriate to maintain a desired state of the cardiovascular system. The present functional magnetic resonance imaging study aimed at identifying brain structures that are mutually activated during interoceptive awareness of heartbeats and during cardiovascular arousal. Additionally, we searched for brain regions connecting interoception with feelings. During the interoceptive task (directing attention towards heartbeats in relation to an exteroceptive task) the thalamus, the insula, the medial frontal/dorsal cingulate and the inferior frontal gyrus, …

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Heartbeat perception and P300 amplitude in a visual oddball paradigm.

Objective: The perception of bodily signals ("interoceptive awareness") was found to modulate evoked potential components, especially the P300, in response to emotional pictures and to internal signals. It remains an open question whether this variable is related to more elaborated information processing in general. Methods: The present study investigated the relationship between heartbeat perception and the amplitude of the P300 to target stimuli in a visual oddball paradigm. Results: Interoceptive awareness was positively correlated with the P300 amplitude at Cz which remained significant after controlling for anxiety differences. Conclusions: Our results demonstrate a positive relationship between interoceptive awareness and the attentive processing of visual stimuli. Significance: Interoception is related to more elaborated information processing in general. This effect could be medi…

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Striking discrepancy of anomalous body experiences with normal interoceptive accuracy in depersonalization-derealization disorder.

Background: Disembodiment is a core feature of depersonalization disorder (DPD). Given the narratives of DPD patients about their disembodiment and emotional numbing and neurobiological findings of an inhibition of insular activity, DPD may be considered as a mental disorder with specific impairments of interoceptive awareness and body perception. Methods: We investigated cardioceptive accuracy (CA) of DPD patients (n=24) as compared to healthy controls (n=26) with two different heartbeat detection tasks ("Schandry heartbeat counting task" and "Whitehead heartbeat discrimination task"). Self-rated clearness of body perception was measured by questionnaire. Results: Contrary to our hypothesis, DPD patients performed similarly to healthy controls on the two different heartbeat detection tasks, and they had equal scores regarding their self-rated clearness of body perception. There was no c…

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Phantom fetal movements after pregnancy termination: a risk factor for pathological grief?

Background: Phantom fetal movements (PFM) are sensations resembling fetal kicks or shifts that persist after pregnancy, including following miscarriage or termination. While PFM are commonly reported, their underlying mechanisms and psychological impact remain poorly understood. Emerging evidence suggests they may contribute to emotional distress, particularly in cases of perinatal loss. Results: We report the case of a 37-year-old woman who developed PFM following a pregnancy termination at 29 weeks of gestation. She subsequently experienced major depression with pathological grief. The PFM were described as kicks and pressure sensations in the abdomen and ribs, which triggered anxiety and complicated the grieving process. Following the initiation of antidepressant treatment, both the intensity and frequency of the PFM progressively diminished over the course of follow-up, ultimately re…

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Autonomic, neurodevelopmental, and early adversity correlates of acquired aphantasia.

Aphantasia (the inability to voluntarily generate mental imagery) has traditionally been studied as a congenital or neurological condition. However, historical and clinical reports also implicate affective and stress-related factors in the onset of imagery loss, which are themselves associated with disrupted interoception and autonomic nervous system dysfunction. To investigate these links, we surveyed individuals with self-identified acquired aphantasia (N = 59) using structured questions and validated questionnaires assessing early adversity (Childhood Trauma Questionnaire), anxiety symptoms (GAD-7), autonomic reactivity (Body Perception Questionnaire-Short Form; Atrial Fibrillation Symptoms Questionnaire), and neurodevelopmental traits (AQ-10, ASRS-6). 62 % of participants reported psychological triggers for their aphantasia, 41 % cited neurological or physiological events, and 30 % i…

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Involvement of mediodorsal thalamus and its related neural circuit in pain regulation in mice.

The mediodorsal thalamus (MD) constitutes an integral component of the medial nociceptive transmission system, although its precise role and related neural pathway in pain processing remains incompletely elucidated. While anatomical studies have confirm reciprocal projections between the MD and anterior cingulate cortex (ACC), the functional contribution of ACC-MD neural circuitry to nociceptive regulation has not yet been systematically investigated. In this study, we used immunohistochemistry, pharmacogenetic manipulations, and multidimensional behavioral assessments to investigate the role of the MD and ACC-MD pathway in pain modulation. The MD can be activated by nociceptive stimuli, and mediates both exteroception-evoked reflexive-defensive reactions and interoception-mediated self-caring responses. Chemogenetics activation of the MD or the ACC-MD pathway induced hyperalgesia alongs…

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A novel self-report scale of interoception: the three-domain interoceptive sensations questionnaire (THISQ).

Objectives: The self-reported perception of bodily sensations is assumed predictive for health and disease. Existing questionnaires mostly focus on aversive sensations, and associated emotions and cognitions, which potentially confounds associations between interoception and illness. Therefore, we developed the Three-domain Interoceptive Sensations Questionnaire (THISQ), assessing self-reported perception of neutral respiratory, cardiac, and gastroesophageal sensations. Design: Using cross-sectional surveys, we developed and validated the THISQ. Main outcome measures: In Sample 1 (n = 357), a pool of 28 Dutch items was subjected to exploratory factor analysis. Eighteen items with a primary factor loading >.40 were retained for confirmatory factor analysis in Sample 2 (n = 374) and Sample 3 (n = 484) for the validation of the Dutch and English questionnaire, respectively. Results: Analyse…

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Interoception, alexithymia, and anxiety among individuals with alcohol use disorder.

Background: Interoception (i.e., the ability to recognize bodily signals), alexithymia (i.e., the inability to recognize emotional states) and negative affect (i.e., unpleasant feelings such as anxiety) have been associated with alcohol use disorder (AUD). Previous research suggests that interoception may underlie alexithymia, which in turn may be associated with negative affectivity. However, this remains to be empirically tested. This study investigates whether alexithymia mediates the association between interoception and anxiety and whether this association differs across individuals with AUD and a healthy control (HC) comparison group. Methods: The AUD group consisted of 99 participants enrolled in an 8-week abstinence-based inpatient treatment program. The HC group included 103 healthy individuals. The heartbeat counting task (HCT) was used to assess interoception (cardiac interoce…

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A chatbot-based intervention with ELME to improve stress and health-related parameters in a stressed sample: Study protocol of a randomised controlled trial.

Background: Stress levels in the general population had already been increasing in recent years, and have subsequently been exacerbated by the global pandemic. One approach for innovative online-based interventions are "chatbots" - computer programs that can simulate a text-based interaction with human users via a conversational interface. Research on the efficacy of chatbot-based interventions in the context of mental health is sparse. The present study is designed to investigate the effects of a three-week chatbot-based intervention with the chatbot ELME, aiming to reduce stress and to improve various health-related parameters in a stressed sample. Methods: In this multicenter, two-armed randomised controlled trial with a parallel design, a three-week chatbot-based intervention group including two daily interactive intervention sessions via smartphone (á 10-20 min.) is compared to a tr…

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Anterior insula morphology and vulnerability to psychopathology-related symptoms in response to acute inflammation.

Introduction: The role of inflammation in common psychiatric diseases is now well acknowledged. However, the factors and mechanisms underlying inter-individual variability in the vulnerability to develop psychopathology-related symptoms in response to inflammation are not well characterized. Herein, we aimed at investigating morphological brain regions central for interoception and emotion regulation, and if these are associated with acute inflammation-induced sickness and anxiety responses. Methods: Systemic inflammation was induced using an intravenous injection of lipopolysaccharide (LPS) at a dose of 0.6 ng/kg body weight in 28 healthy individuals, while 21 individuals received an injection of saline (placebo). Individuals' gray matter volume was investigated by automated voxel-based morphometry technique on T1-weighted anatomical images derived from magnetic resonance imaging (MRI).…

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Neural Pathway for Gut Feelings: Vagal Interoceptive Feedback From the Gastrointestinal Tract Is a Critical Modulator of Anxiety-like Behavior.

Background: Anxiety disorders are associated with an altered perception of the body's internal state. Therefore, understanding the neuronal basis of interoception can foster novel anxiety therapies. In rodents, the feeding status bidirectionally modulates anxiety-like behavior but how the sensing of gastrointestinal state affects anxiety remains unclear. Methods: We combined chemogenetics, neuropharmacology, and behavioral approaches in male and female rats to test whether vagal afferents terminating in the gastrointestinal tract mediate feeding-induced tuning of anxiety. Using saporin-based lesions and transcriptomics, we investigated the chronic impact of this gut-brain circuit on anxiety-like behavior. Results: Both feeding and selective chemogenetic activation of gut-innervating vagal afferents increased anxiety-like behavior. Conversely, chemogenetic inhibition blocked the increase …

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Embodiment-related risk factors for Posttraumatic Stress, Anxiety and Depression in female victims of intimate partner violence.

A central notion in the field of embodiment is that body sensorimotor processes and body mental representations influence emotion, cognition and behavior. By affecting the body, intimate partner violence (IPV) can leave victims with a fragile self, and significant physical and mental health problems. In this study, we aim to examine embodiment-related variables and mental health of female victims of IPV, as well as the impact of embodiment on mental health. A total of 38 female victims of IPV (mean age 40.3 ± 10.9 years) were recruited from shelters and the community. The study assessed the levels of Posttraumatic Stress Disorder (PTSD), Anxiety and Depression, and abilities of Movement Imagery, Interoceptive Accuracy, Interoceptive Sensibility, Body Ownership and Bodily Dissociation. Univariate, bivariate and binary regression analysis were used. PTSD, Anxiety and Depression were highly…

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Interoceptive accuracy is related to the psychological mechanisms of the burning mouth syndrome: a cross-sectional study.

Background: Different perspectives are needed to understand the pathophysiology of burning mouth syndrome (BMS), including physiological and psychological standpoints. The significance of interoception in chronic pain has been suggested. However, few studies have investigated this relationship in BMS. Therefore, we examined the role of interoception in BMS. Methods: This is a cross-sectional study. BMS patients (N = 64) participated in the study. We used interoceptive accuracy (IAc) based on the heartbeat counting task. Then, participants were divided into high and low IAc groups, and their scores on clinical assessment including pain and psychological evaluation were compared. Results: The Visual Analogue Scale scores indicating pain in low IAc patients, but not high IAc patients, were positively correlated with the Beck Depression Inventory-Second Edition (BDI-II) and the State-Trait A…

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Baseline Psychological Traits Contribute to Lake Louise Acute Mountain Sickness Score at High Altitude.

Talks, Benjamin James, Catherine Campbell, Stephanie J. Larcombe, Lucy Marlow, Sarah L. Finnegan, Christopher T. Lewis, Samuel J.E. Lucas, Olivia K. Harrison, and Kyle T.S. Pattinson. Baseline psychological traits contribute to Lake Louise Acute Mountain Sickness score at high altitude. High Alt Med Biol. 23:69-77, 2022. Background: Interoception refers to an individual's ability to sense their internal bodily sensations. Acute mountain sickness (AMS) is a common feature of ascent to high altitude that is only partially explained by measures of peripheral physiology. We hypothesized that interoceptive ability may explain the disconnect between measures of physiology and symptom experience in AMS. Methods: Two groups of 18 participants were recruited to complete a respiratory interoceptive task three times at 2-week intervals. The control group remained in Birmingham (140 m altitude) for …

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A framework for understanding the pathophysiology of functional neurological disorder.

The symptoms of functional neurological disorder (FND) are a product of its pathophysiology. The pathophysiology of FND is reflective of dysfunction within and across different brain circuits that, in turn, affects specific constructs. In this perspective article, we briefly review five constructs that are affected in FND: emotion processing (including salience), agency, attention, interoception, and predictive processing/inference. Examples of underlying neural circuits include salience, multimodal integration, and attention networks. The symptoms of each patient can be described as a combination of dysfunction in several of these networks and related processes. While we have gained a considerable understanding of FND, there is more work to be done, including determining how pathophysiological abnormalities arise as a consequence of etiologic biopsychosocial factors. To facilitate advan…

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