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

Psychological processing in chronic pain: a neural systems approach.

Our understanding of chronic pain involves complex brain circuits that include sensory, emotional, cognitive and interoceptive processing. The feed-forward interactions between physical (e.g., trauma) and emotional pain and the consequences of altered psychological status on the expression of pain have made the evaluation and treatment of chronic pain a challenge in the clinic. By understanding the neural circuits involved in psychological processes, a mechanistic approach to the implementation of psychology-based treatments may be better understood. In this review we evaluate some of the principle processes that may be altered as a consequence of chronic pain in the context of localized and integrated neural networks. These changes are ongoing, vary in their magnitude, and their hierarchical manifestations, and may be temporally and sequentially altered by treatments, and all contribute…

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Interoception and drug addiction.

The role of interoception and its neural basis with relevance to drug addiction is reviewed. Interoception consists of the receiving, processing, and integrating body-relevant signals with external stimuli to affect ongoing motivated behavior. The insular cortex is the central nervous system hub to process and integrate these signals. Interoception is an important component of several addiction relevant constructs including arousal, attention, stress, reward, and conditioning. Imaging studies with drug-addicted individuals show that the insular cortex is hypo-active during cognitive control processes but hyperactive during cue reactivity and drug-specific, reward-related processes. It is proposed that interoception contributes to drug addiction by incorporating an "embodied" experience of drug uses together with the individual's predicted versus actual internal state to modulate approach…

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Thermosensation and emotion: Thermosensory accuracy in a dynamic thermal matching task is linked to depression and anxiety symptomatology.

Interoception is related to the generation of bodily feelings and the awareness of ourselves as 'sentient beings', informing the organism about its bodily needs to guarantee survival. Previous studies have reported links among interoception, emotion processing, and mental health. For example, the alignment of interoceptive dimensions (i.e., accuracy, sensibility, awareness) can predict emotional symptoms, such as anxiety. Here, we aimed to investigate the relationship between the perception of a certain type of skin-mediated interoceptive signal, i.e., thermosensation, and self-reported depression, anxiety, and stress. One hundred seventy participants completed the Depression Anxiety Stress Scale (DASS-21) and a dynamic thermal matching task, a static temperature detection task, and a heartbeat counting task. Our results revealed that self-reported anxiety and depression were related to …

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The Role of the Skin in Interoception: A Neglected Organ?

In the past 2 decades, interoception has received increasing attention in the fields of psychology and cognitive science, as well as neuroscience and physiology. A plethora of studies adopted the perception of cardiac signals as a proxy for interoception. However, recent findings have cast doubt on the methodological and intrinsic validity of the tasks used thus far. Therefore, there is an ongoing effort to improve the existing cardiac interoceptive tasks and to identify novel channels to target the perception of the physiological state of the body. Amid such scientific abundancy, one could question whether the field has been partially neglecting one of our widest organs in terms of dimensions and functions: the skin. According to some views grounded on anatomical and physiological evidence, skin-mediated signals such as affective touch, pain, and temperature have been redefined as inter…

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Neural representations of vicarious rewards are linked to interoception and prosocial behaviour.

Every day we constantly observe other people receiving rewards. Theoretical accounts posit that vicarious reward processing might be linked to people's sensitivity to internal body states (interoception) and facilitates a tendency to act prosocially. However, the neural processes underlying the links between vicarious reward processing, interoception, and prosocial behaviour are poorly understood. Previous research has linked vicarious reward processing to the anterior cingulate gyrus (ACCg) and the anterior insula (AI). Can we predict someone's propensity to be prosocial or to be aware of interoceptive signals from variability in how the ACCg and AI process rewards? Here, participants monitored rewards being delivered to themselves or a stranger during functional magnetic resonance imaging. Later, they performed a task measuring their willingness to exert effort to obtain rewards for ot…

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Do we need to accurately perceive our heartbeats? Cardioceptive accuracy and sensibility are independent from indicators of negative affectivity, body awareness, body image dissatisfaction, and alexithymia.

Assessment of the acuity of heartbeat perception, dubbed cardioceptive accuracy, as well as its association with various psychological characteristics are hot topics of interoception research. In this study, we aimed (1) to replicate previously reported findings on the association between the mental tracking task and a novel motor tracking task that eliminates disturbing tactile sensations; and (2) to explore associations between performance in the latter task and indicators of negative affectivity (anxiety, depression, anxiety sensitivity, somatic symptom distress), alexithymia, body focus, and dissatisfaction with body image. 102 young people (age = 20.8±5.08 yrs) participated in the study. Mental tracking score was significantly higher than motor tracking scores, although they were strongly associated. Frequentist correlation analysis showed no significant associations between indicat…

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Towards a comprehensive assessment of interoception in a multi-dimensional framework.

Interoception has historically been assessed using behavioural tests of accuracy, self-report measures or through the characterisation of neural signals underlying interoceptive processing. More recent conceptualisations of interoception incorporate interoceptive attention and higher-order measures related to the interpretation of interoceptive signals. At present, these interoceptive dimensions are largely assessed in isolation, yet this fails to capture the complexity of interoception. Comprehensive assessment across interoceptive dimensions can determine the full operation of general interoceptive function. Current work suggests that these interoceptive processes may be dissociable across dimensions and bodily axes, with differential mapping to cognitive and emotion processing. To characterise differences in interoceptive profiles, all interoceptive dimensions can be assessed within i…

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The heart rate discrimination task: A psychophysical method to estimate the accuracy and precision of interoceptive beliefs.

Interoception - the physiological sense of our inner bodies - has risen to the forefront of psychological and psychiatric research. Much of this research utilizes tasks that attempt to measure the ability to accurately detect cardiac signals. Unfortunately, these approaches are confounded by well-known issues limiting their validity and interpretation. At the core of this controversy is the role of subjective beliefs about the heart rate in confounding measures of interoceptive accuracy. Here, we recast these beliefs as an important part of the causal machinery of interoception, and offer a novel psychophysical "heart rate discrimination" method to estimate their accuracy and precision. By applying this task in 223 healthy participants, we demonstrate that cardiac interoceptive beliefs are more biased, less precise, and are associated with poorer metacognitive insight relative to an exte…

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The respiratory resistance sensitivity task: An automated method for quantifying respiratory interoception and metacognition.

The ability to sense, monitor, and control respiration - e.g., respiratory interoception (henceforth, respiroception) is a core homeostatic ability. Beyond the regulation of gas exchange, enhanced awareness of respiratory sensations is directly related to psychiatric symptoms such as panic and anxiety. Indeed, chronic breathlessness (dyspnea) is associated with a fourfold increase in the risk of developing depression and anxiety, and the regulation of the breath is a key aspect of many mindfulness-based approaches to the treatment of mental illness. Physiologically speaking, the ability to accurately monitor respiratory sensations is important for optimizing cardiorespiratory function during athletic exertion, and can be a key indicator of illness. Given the important role of respiroception in mental and physical health, it is unsurprising that there is increased interest in the quantifi…

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Female sweet-likers have enhanced cross-modal interoceptive abilities.

There are well known phenotypic differences in sweet-liking across individuals, but it remains unknown whether these are related to broader underlying differences in interoceptive abilities (abilities to sense the internal state of the body). Here, healthy women (N = 64) classified as sweet likers (SLs) or sweet dislikers (SDs) completed a bimodal interoception protocol. A heartbeat tracking and a heartbeat discrimination task determined cardiac interoception; both were accompanied by confidence ratings. A water load task, where participants consumed water to satiation and then to maximum fullness was used to assess gastric interoceptive abilities. Motivational state, psychometric characteristics and eating behaviour were also assessed. SLs performed significantly better than SDs on both heartbeat tasks, independently of impulsivity, anxiety, depression, and alexithymia. No differences i…

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The "embreathment" illusion highlights the role of breathing in corporeal awareness.

Recent theories posit that physiological signals contribute to corporeal awareness, the basic feeling that one has a body (body ownership) that acts according to one's will (body agency) and occupies a specific position (body location). Combining physiological recordings with immersive virtual reality, we found that an ecological mapping of real respiratory patterns onto a virtual body illusorily changes corporeal awareness. This new way of inducing a respiratory bodily illusion, called "embreathment," revealed that breathing is almost as important as visual appearance for inducing body ownership and more important than any other cue for body agency. These effects were moderated by individual levels of interoception, as assessed through a standard heartbeat-counting task and a new "pneumoception" task. By showing that respiratory, visual, and spatial signals exert a specific and weighted…

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Heart-brain interactions shape somatosensory perception and evoked potentials.

Even though humans are mostly not aware of their heartbeats, several heartbeat-related effects have been reported to influence conscious perception. It is not clear whether these effects are distinct or related phenomena, or whether they are early sensory effects or late decisional processes. Combining electroencephalography and electrocardiography, along with signal detection theory analyses, we identify two distinct heartbeat-related influences on conscious perception differentially related to early vs. late somatosensory processing. First, an effect on early sensory processing was found for the heartbeat-evoked potential (HEP), a marker of cardiac interoception. The amplitude of the prestimulus HEP negatively correlated with localization and detection of somatosensory stimuli, reflecting a more conservative detection bias (criterion). Importantly, higher HEP amplitudes were followed b…

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Dimensions of Body-Awareness and Depressed Mood and Anxiety.

Interoception, the multidimensional ability to sense the physiological condition of the body, is a key mechanism in emotional processing. However, the relationships between interoceptive dimensions and depressed mood and anxiety have not been widely studied. The aim of this secondary analysis, correlational and cross-sectional study, was to determine the relationships among interoceptive accuracy, interoceptive sensibility, depressed mood, and anxiety in adults with hypertension. The sample consisted of 76 adults, predominately African American women. Correlational analysis showed that most participants had low levels of interoceptive accuracy and relatively high levels of interoceptive sensibility. Interoceptive sensibility was negatively associated with depressed mood and anxiety. Interoceptive accuracy and interoceptive sensibility were not associated between each other. Further exami…

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Knowledge of resting heart rate mediates the relationship between intelligence and the heartbeat counting task.

Evidence suggests that intelligence is positively associated with performance on the heartbeat counting task (HCT). The HCT is often employed as measure of interoception - the ability to perceive the internal state of one's body - however it's use remains controversial as performance on the HCT is strongly influenced by knowledge of resting heart rate. This raises the possibility that heart rate knowledge may mediate the previously-observed association between intelligence and HCT performance. Study One demonstrates an association between intelligence and HCT performance (N = 94), and Study Two demonstrates that this relationship is mediated by knowledge of the average resting heart rate (N = 134). These data underscore the need to account for the influence of prior knowledge and beliefs when examining individual differences in cardiac interoceptive accuracy using the HCT.

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Interoceptive ingredients of body ownership: Affective touch and cardiac awareness in the rubber hand illusion.

The sense of body ownership represents a fundamental aspect of bodily self-consciousness. Using multisensory integration paradigms, recent studies have shown that both exteroceptive and interoceptive information contribute to our sense of body ownership. Interoception refers to the physiological sense of the condition of the body, including afferent signals that originate inside the body and outside the body. However, it remains unclear whether individual sensitivity to interoceptive modalities is unitary or differs between modalities. It is also unclear whether the effect of interoceptive information on body ownership is caused by exteroceptive 'visual capture' of these modalities, or by bottom-up processing of interoceptive information. This study aimed to test these questions in two separate samples. In the first experiment (N = 76), we examined the relationship between two different …

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Interoceptive accuracy scores from the heartbeat counting task are problematic: Evidence from simple bivariate correlations.

Interoception, the capacity to perceive internal bodily states, is thought to influence cognitive, affective and interpersonal functioning. It is frequently assessed using the heartbeat counting task, introduced recently in interoceptive research. In this task participants are requested to count their heartbeats without relying on external cues. Interoceptive Accuracy (i.e., IAcc) scores are then computed based on absolute comparisons between actual and reported heartbeats. In a large sample of participants (N = 572), we observed that, whereas IAcc scores are meant to be theoretically agnostic to error type (i.e., over- or underestimation of heartbeats), these scores massively (i.e., > 95%) reflect under-reports. Of concern too, the correlation between actual and reported heartbeats is low overall (r = .16), varies non-linearly across IAcc score quantiles, and suggests undistinguishable …

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Interoceptive influences on peripersonal space boundary.

Integration of body-related signals within the peripersonal space (PPS) contributes to bodily self-awareness. Whereas several studies have shown how individual PPS extension is shaped by external factors, e.g. during interactions with people and objects, no studies have looked at interoceptive influences on PPS extension. We exposed participants to an audio-tactile interaction task, to measure their PPS boundary (Session 1), and to a heartbeat counting task and a time estimation task, to specifically assess their interoceptive accuracy (Session 2). Participants' traits of private self-consciousness and social anxiety were also evaluated, to account for their possible effect on the relation between interoception and PPS representation. We found that higher interoceptive accuracy specifically predicts narrower PPS boundary. Moreover, this relation is moderated by individual traits of priva…

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Direct and indirect effects of age on interoceptive accuracy and awareness across the adult lifespan.

Various aspects of physical and mental health have been linked to an individual's ability to perceive the physical condition of their body ('interoception'). In addition, numerous studies have demonstrated a role for interoception in higher-order cognitive abilities such as decision-making and emotion processing. The importance of interoception for health and typical cognitive functioning has prompted interest in how interoception varies over the lifespan. However, few studies have investigated interoception into older adulthood, and no studies account for the set of physiological changes that may influence task performance. The present study examined interoception from young to very late adulthood (until 90 years of age) utilising a self-report measure of interoception (Study One) and an objective measure of cardiac interoception (Study Two). Across both studies, interoception decreased…

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'Bodily precision': a predictive coding account of individual differences in interoceptive accuracy.

Individuals differ in their awareness of afferent information from within their bodies, which is typically assessed by a heartbeat perception measure of 'interoceptive accuracy' (IAcc). Neural and behavioural correlates of this trait have been investigated, but a theoretical explanation has yet to be presented. Building on recent models that describe interoception within the free energy/predictive coding framework, this paper applies similar principles to IAcc, proposing that individual differences in IAcc depend on 'precision' in interoceptive systems, i.e. the relative weight accorded to 'prior' representations and 'prediction errors' (that part of incoming interoceptive sensation not accounted for by priors), at various levels within the cortical hierarchy and between modalities. Attention has the effect of optimizing precision both within and between sensory modalities. Our central a…

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The Insula Mediates Access to Awareness of Visual Stimuli Presented Synchronously to the Heartbeat.

Unlabelled: The processing of interoceptive signals in the insular cortex is thought to underlie self-awareness. However, the influence of interoception on visual awareness and the role of the insular cortex in this process remain unclear. Here, we show in a series of experiments that the relative timing of visual stimuli with respect to the heartbeat modulates visual awareness. We used two masking techniques and show that conscious access for visual stimuli synchronous to participants' heartbeat is suppressed compared with the same stimuli presented asynchronously to their heartbeat. Two independent brain imaging experiments using high-resolution fMRI revealed that the insular cortex was sensitive to both visible and invisible cardio-visual stimulation, showing reduced activation for visual stimuli presented synchronously to the heartbeat. Our results show that interoceptive insular pro…

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Auditory Feedback Differentially Modulates Behavioral and Neural Markers of Objective and Subjective Performance When Tapping to Your Heartbeat.

Interoception, the perception of our body internal signals, plays a key role in maintaining homeostasis and guiding our behavior. Sometimes, we become aware of our body signals and use them in planning and strategic thinking. Here, we show behavioral and neural dissociations between learning to follow one's own heartbeat and metacognitive awareness of one's performance, in a heartbeat-tapping task performed before and after auditory feedback. The electroencephalography amplitude of the heartbeat-evoked potential in interoceptive learners, that is, participants whose accuracy of tapping to their heartbeat improved after auditory feedback, was higher compared with non-learners. However, an increase in gamma phase synchrony (30-45 Hz) after the heartbeat auditory feedback was present only in those participants showing agreement between objective interoceptive performance and metacognitive a…

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When weak imagery is worse than none: Core aphantasia and hypophantasia relate differently to mental health, mediated by subjective interoception.

Aphantasia, characterized by absent or reduced visual mental imagery, has been associated with alexithymia and negative mental health outcomes. However, the underlying mechanisms remain unclear. Visual imagery has been proposed as part of an inwardly focused cognitive style that also encompasses interoceptive processing and emotion regulation, suggesting these constructs may be functionally linked. Since mental health is closely tied to interoception, we examined whether interoceptive processing mediates the relationship between imagery ability and mental health. We assessed self-reported imagery vividness (VVIQ), subjective interoceptive accuracy and attention, alexithymia, anxiety, and depression in individuals with aphantasia (n = 153, VVIQ = 16-32) and typical imagers (n = 680, VVIQ = 33-80). Within the aphantasia group, we distinguished core aphantasia (VVIQ 16-23, n = 96) from hypo…

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Individual differences in interoceptive accuracy and prediction error in motor functional neurological disorders: A DTI study.

In motor functional neurological disorders (mFND), relationships between interoception (a construct of high theoretical relevance to its pathophysiology) and neuroanatomy have not been previously investigated. This study characterized white matter in mFND patients compared to healthy controls (HCs), and investigated associations between fiber bundle integrity and cardiac interoception. Voxel-based analysis and tractography quantified fractional anisotropy (FA) in 38 mFND patients compared to 38 HCs. Secondary analyses compared functional seizures (FND-seiz; n = 21) or functional movement disorders (n = 17) to HCs. Network lesion mapping identified gray matter origins of implicated fiber bundles. Within-group mFND analyses investigated relationships between FA, heartbeat tracking accuracy and interoceptive trait prediction error (discrepancies between interoceptive accuracy and self-repor…

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Altered neural signatures of interoception in multiple sclerosis.

Multiple sclerosis (MS) patients present several alterations related to sensing of bodily signals. However, no specific neurocognitive impairment has yet been proposed as a core deficit underlying such symptoms. We aimed to determine whether MS patients present changes in interoception-that is, the monitoring of autonomic bodily information-a process that might be related to various bodily dysfunctions. We performed two studies in 34 relapsing-remitting, early-stage MS patients and 46 controls matched for gender, age, and education. In Study 1, we evaluated the heartbeat-evoked potential (HEP), a cortical signature of interoception, via a 128-channel EEG system during a heartbeat detection task including an exteroceptive and an interoceptive condition. Then, we obtained whole-brain MRI recordings. In Study 2, participants underwent fMRI recordings during two resting-state conditions: min…

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The inner world of overactive monitoring: neural markers of interoception in obsessive-compulsive disorder.

Background: Obsessive-compulsive disorder (OCD) patients typically overmonitor their own behavior, as shown by symptoms of excessive doubt and checking. Although this is well established for the patients' relationship with external stimuli in the environment, no study has explored their monitoring of internal body signals, a process known to be affected in anxiety-related syndromes. Here, we explored this issue through a cardiac interoception task that measures sensing of heartbeats. Our aim was to explore key behavioral and electrophysiological aspects of internal-cue monitoring in OCD, while examining their potential distinctiveness in this condition. Method: We administered a heartbeat detection (HBD) task (with related interoceptive confidence and awareness measures) to three matched groups (OCD patients, panic disorder patients, healthy controls) and recorded ongoing modulations of …

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