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

Testing the independence of self-reported interoceptive accuracy and attention.

It has recently been proposed that measures of the perception of the state of one's own body ("interoception") can be categorised as one of several types depending on both how an assessment is obtained (objective measurement vs. self-report) and what is assessed (degree of interoceptive attention vs. accuracy of interoceptive perception). Under this model, a distinction is made between beliefs regarding the degree to which interoceptive signals are the object of attention and beliefs regarding one's ability to perceive accurately interoceptive signals. This distinction is difficult to test, however, because of the paucity of measures designed to assess self-reported perception of one's own interoceptive accuracy. This article therefore reports on the development of such a measure, the Interoceptive Accuracy Scale (IAS). Use of this measure enables assessment of the proposed distinction b…

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Estimation of Current and Future Physiological States in Insular Cortex.

Interoception, the sense of internal bodily signals, is essential for physiological homeostasis, cognition, and emotions. While human insular cortex (InsCtx) is implicated in interoception, the cellular and circuit mechanisms remain unclear. We imaged mouse InsCtx neurons during two physiological deficiency states: hunger and thirst. InsCtx ongoing activity patterns reliably tracked the gradual return to homeostasis but not changes in behavior. Accordingly, while artificial induction of hunger or thirst in sated mice via activation of specific hypothalamic neurons (AgRP or SFOGLUT) restored cue-evoked food- or water-seeking, InsCtx ongoing activity continued to reflect physiological satiety. During natural hunger or thirst, food or water cues rapidly and transiently shifted InsCtx population activity to the future satiety-related pattern. During artificial hunger or thirst, food or water…

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Computerized Exposure Therapy for Spider Phobia: Effects of Cardiac Timing and Interoceptive Ability on Subjective and Behavioral Outcomes.

Objective: Spider phobia is a common form of anxiety disorder for which exposure therapy is an effective first-line treatment. Motivated by the observed modulation of threat processing by afferent cardiac signals, we tested the hypothesis that interoceptive information concerning cardiovascular arousal can influence the outcomes of computerized exposure therapy for spider phobia. Method: Fifty-three normal healthy participants with high spider phobia scores underwent one of the following three modified computerized exposure protocols, defined by the timing of exposure to brief spider stimuli within the cardiac cycle: systole (during afferent baroreceptor firing); diastole (during baroreceptor-quiescent interbeat interval); random (noncontingent on cardiac cycle). Outcomes were judged on phobic and anxiety measures and physiological data (skin conductance). Individuals were also rated on …

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Does atypical interoception following physical change contribute to sex differences in mental illness?

Sex differences in the prevalence and presentation of mental illnesses are well documented. Women are more likely to experience common mental health disorders (e.g., anxiety and depression), and when they experience these conditions, they often present differently to men (e.g., women are more likely to report somatic complaints). Periods of physical and hormonal change (e.g., adolescence, pregnancy, and menopause) are particular risk periods for the development of mental illness in women. In this article, we advance the proposal that interoception (the perception of the body's internal state) is one mechanism that might explain sex differences in vulnerability to mental illness. We argue that known sex differences in interoception, whereby women, compared to men, report heightened attention to internal signals coupled with worse interoceptive accuracy, may result from the increased amoun…

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Focus of attention modulates the heartbeat evoked potential.

Theoretical frameworks such as predictive coding suggest that the perception of the body and world - interoception and exteroception - involve intertwined processes of inference, learning, and prediction. In this framework, attention is thought to gate the influence of sensory information on perception. In contrast to exteroception, there is limited evidence for purely attentional effects on interoception. Here, we empirically tested if attentional focus modulates cortical processing of single heartbeats, using a newly-developed experimental paradigm to probe purely attentional differences between exteroceptive and interoceptive conditions in the heartbeat evoked potential (HEP) using EEG recordings. We found that the HEP is significantly higher during interoceptive compared to exteroceptive attention, in a time window of 524-620 ms after the R-peak. Furthermore, this effect predicted se…

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Interoceptive deficits in patients with obsessive-compulsive disorder in the time course of cognitive-behavioral therapy.

Interoception is impaired in different psychiatric disorders and is also associated with emotions. Only one study could show a higher interoceptive accuracy (IAcc) in patients with obsessive-compulsive disorder (OCD). Based on the predictive coding system we assume contrary results, indicating a decreased IAcc in patients with OCD. So far, there is no study investigating the effect of cognitive-behavioral therapy on IAcc in patients with OCD. Therefore, we hypothesize that patients with OCD improve their IAcc during the time course of therapy compared to healthy controls. Twenty-six patients with OCD from the Psychosomatic Clinic in Windach were examined in the time course of cognitive-behavioral therapy. They were compared to 26 matched healthy controls. IAcc via the heartbeat perception task as well as questionnaire data (OCD-, depression- and anxiety symptoms) were assessed. Results s…

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Brain connection pattern under interoceptive attention state predict interoceptive intensity and subjective anxiety feeling.

Interoception involves the processing of a variety of different types of information ascending from the body. Accumulating evidence has indicated that interoception plays a fundamental role in cognitive and emotional processes, such as anxiety, but how different functional connectivity patterns contribute to emotions and visceral feelings during an interoceptive attention state is still unclear. In the present study, an interoceptive attention task was performed during functional magnetic resonance imaging of healthy subjects, and the participants' subjective ratings of the intensity of interoception and feelings of anxiety were recorded. Several network nodes were selected, based on previous studies, to construct task-dependent functional connectivity patterns, which were processed by support vector regression to predict the corresponding feeling scores. The results showed that for inte…

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Acute cortisol response to a psychosocial stressor is associated with heartbeat perception.

The aim of the present study was to examine the effect of an acute increase in cortisol in response to a psychosocial stressor on heartbeat perception, in a laboratory environment. Thirty-six participants (20 women, 16 men, mean age = 21.7 years, standard deviation = 1.7 years) completed a heartbeat counting task (Schandry paradigm) before and after exposure to an acute psychosocial stressor (Trier Social Stress Test; TSST). Heartbeat counting performance was compared between participants who exhibited strong cortisol responses (>15.5% increase in cortisol from baseline; responders) and those who did not (non-responders). Responders showed increased heartbeat counting accuracy following the TSST, which was not observed in non-responders. The two groups did not differ in their responsivity to subjective anxiety ratings or heart rate. These results indicated that acutely elevated cortisol …

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Relationship between interoception and emotion regulation: New evidence from mixed methods.

Background: Interoception is the ability to perceive one's inner bodily feelings and is thought to be associated with the capacity of recognising and experiencing emotions. Previous research on interoception and emotion regulation has presented limitations arising from the low reliability of the interoceptive measurement and provided inconsistent results. The current study used a mixed method approach to investigate this relationship from the individuals' perspective. Methods: In the first phase (quantitative), questionnaires assessing interoceptive sensibility, the subjective, self-reported ability to perceive internal states, were administered to 100 healthy participants. In the second phase (qualitative), individual semi-structured interviews were conducted with nine participants. The interviews were analysed using the Interpretative Phenomenological Analysis. Three main dimensions we…

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Affective interoceptive inference: Evidence from heart-beat evoked brain potentials.

The perception of internal bodily signals (interoception) is central to many theories of emotion and embodied cognition. According to recent theoretical views, the sensory processing of visceral signals such as one's own heartbeat is determined by top-down predictions about the expected interoceptive state of the body (interoceptive inference). In this EEG study we examined neural responses to heartbeats following expected and unexpected emotional stimuli. We used a modified stimulus repetition task in which pairs of facial expressions were presented with repeating or alternating emotional content, and we manipulated the emotional valence and the likelihood of stimulus repetition. We found that affective predictions of external socially relevant information modulated the heartbeat-evoked potential, a marker of cardiac interoception. Crucially, the HEP changes highly relied on the expecte…

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Interoceptive accuracy and interoceptive sensibility in individuals with alcohol use disorder-Different phenomena with different clinical correlations?

Background: Interoception may contribute to substance use disorder as it relates to the body's experience of substance use or withdrawal. However, only a few studies have directly investigated associations between interoception and alcohol use. The objective of this study was to compare individuals with alcohol use disorder (AUD) and healthy controls on interoceptive sensibility and accuracy. Methods: The sample was comprised of two groups: individuals meeting criteria for AUD (N = 114) and healthy controls (N = 110) not meeting criteria for AUD. Interoceptive sensibility was assessed with a self-report measure (the Private Body Consciousness subscale) and interoceptive accuracy - with a behavioral measure (the Schandry test). In addition, associations between interoception and other well-recognized correlates of AUD (sleep problems, depressive and anxiety symptoms, impulsivity) were tes…

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Interoceptive accuracy moderates the response to a glucose load: a test of the predictive coding framework.

Recently, interoception and homeostasis have been described in terms of predictive coding and active inference. Afferent signals update prior predictions about the state of the body, and stimulate the autonomic mediation of homeostasis. Performance on tests of interoceptive accuracy (IAc) may indicate an individual's ability to assign precision to interoceptive signals, thus determining the relative influence of ascending signals and the descending prior predictions. Accordingly, individuals with high IAc should be better able to regulate during the postprandial period. One hundred females were allocated to consume glucose, an artificially sweetened drink, water or no drink. Before, and 30 min after a drink, IAc, heart rate (HR) and blood glucose (BG) were measured, and participants rated their hunger, thirst and mood. A higher IAc was related to lower BG levels, a decline in anxiety and…

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The Insular Cortex Dynamically Maps Changes in Cardiorespiratory Interoception.

Palpitations and dyspnea are fundamental to the human experience of panic anxiety, but it remains unclear how the brain dynamically represents changes in these interoceptive sensations. We used isoproterenol, a rapidly acting peripheral beta-adrenergic agonist similar to adrenaline, to induce sensations of palpitation and dyspnea in healthy individuals (n=23) during arterial spin labeling functional magnetic resonance imaging (fMRI). We hypothesized that the right mid-insular cortex, a central recipient of viscerosensory input, would preferentially respond during the peak period of cardiorespiratory stimulation. Bolus infusions of saline and isoproterenol (1 or 2 μg) were administered in a blinded manner while participants continuously rated the intensity of their cardiorespiratory sensation using a dial. Isoproterenol elicited dose-dependent increases in cardiorespiratory sensation, wit…

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Is alexithymia characterised by impaired interoception? Further evidence, the importance of control variables, and the problems with the Heartbeat Counting Task.

Interoception, the perception of one's internal state, is commonly quantified using the heartbeat counting task (HCT) - which is thought to be a measure of cardiac interoceptive sensitivity (accuracy). Interoceptive sensitivity has been associated with a number of clinical traits and aspects of higher order cognition, including emotion processing and decision-making. It has been proposed that alexithymia (difficulties identifying and describing one's own emotions) is associated with impaired interoceptive sensitivity, but new research questions this association. Problematically, much evidence attesting to the absence of this association has been conducted using the HCT, a measure affected by various physiological and psychological factors. Here, we present novel data (N = 287) examining the relationship between alexithymia and HCT performance, controlling for a number of potential confou…

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Interoception: the forgotten modality in perceptual grounding of abstract and concrete concepts.

Conceptual representations are perceptually grounded, but when investigating which perceptual modalities are involved, researchers have typically restricted their consideration to vision, touch, hearing, taste and smell. However, there is another major modality of perceptual information that is distinct from these traditional five senses; that is, interoception, or sensations inside the body. In this paper, we use megastudy data (modality-specific ratings of perceptual strength for over 32 000 words) to explore how interoceptive information contributes to the perceptual grounding of abstract and concrete concepts. We report how interoceptive strength captures a distinct form of perceptual experience across the abstract-concrete spectrum, but is markedly more important to abstract concepts (e.g. hungry, serenity) than to concrete concepts (e.g. capacity, rainy). In particular, interocepti…

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Interoceptive processing deficit: A behavioral marker for subtyping Parkinson's disease.

Background: Non-motor symptoms in Parkinson's disease (PD), such as cognitive, emotional, autonomic and somatosensory alterations, are not ubiquitous but vary between the tremor dominant (TD) and postural instability/gait difficulty (PIGD) subtypes of the syndrome. Non-motor phenomena (e.g., anxiety, depression and apathy) have been related to representation of autonomic and somatosensory sensations (interoception), and recent findings suggest interoceptive deficits in PD. Objectives: To test whether interoceptive processing is differently affected in TD and PIGD phenotypes, by assessing both interoceptive accuracy and sensibility in PD patients with TD and PIGD subtypes, and in healthy controls. Methods: Interoceptive accuracy was measured by the heartbeat perception task requiring participants to count their own heartbeats in a given time interval. A time-estimation, control task was a…

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The heartbeat counting task largely involves non-interoceptive processes: Evidence from both the original and an adapted counting task.

The heartbeat counting task (HCT) is among the most frequently used measures of interoceptive accuracy (i.e., IAcc). Growing concerns, however, have been raised regarding the validity of this task, as well as the validity of the IAcc scores that are derived from it. In the present study, healthy participants (N = 123) performed both the original task and an adapted version of it that stressed the importance of reporting only their perceptually felt heartbeats. In the original task, we found that participants report relying on three different strategies (i.e., detection of heartbeats in a specific body location, detection of heartbeats in a diffuse way and heart rate estimation) to complete the task. In the adapted task, we found that IAcc scores are drastically reduced (about 50%) when asking participants to avoid relying on non-interoceptive signals and to only report the heartbeats the…

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The error-related negativity for error processing in interoception.

The error-related negativity (ERN) is an event-related potential in the electroencephalogram (EEG) observed within the first 100 ms after commission of an error. Increased ERN amplitudes have been observed in several psychological disorders characterized by high negative affect. While the ERN has extensively been studied in tasks using exteroceptive stimuli, its relation to interoceptive stimuli is unknown. Since errors related to interoception might be particularly relevant for survival and negative affect, this study aimed to explore the ERN for errors related to interoceptive, respiratory sensations (intERN). Moreover, we compared the intERN with a commonly observed ERN related to exteroceptive, visual stimuli (extERN) and examined their associations with interoception-related negative affect. We studied the ERN using a respiratory occlusion task (intERN) and a visual flanker task (ex…

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The role of mid-insula in the relationship between cardiac interoceptive attention and anxiety: evidence from an fMRI study.

Interoception refers to the perception of the internal bodily states. Recent accounts highlight the role of the insula in both interoception and the subjective experience of anxiety. The current study aimed to delve deeper into the neural correlates of cardiac interoception; more specifically, the relationship between interoception-related insular activity, interoceptive accuracy, and anxiety. This was done using functional magnetic resonance imaging (fMRI) in an experimental design in which 40 healthy volunteers focused on their heartbeat and anxious events. Interoceptive accuracy and anxiety levels were measured using the Heartbeat Perception Task and State Trait Anxiety Inventory, respectively. The results showed posterior, mid and anterior insular activity during cardiac interoception, whereas anxiety-related activation showed only anterior insular activity. Activation of the anterio…

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Emotional orienting during interoceptive threat in orthostatic intolerance: Dysautonomic contributions to psychological symptomatology in the postural tachycardia syndrome and vasovagal syncope.

Cognitive and emotional processes are influenced by interoception (homeostatic somatic feedback), particularly when physiological arousal is unexpected and discrepancies between predicted and experienced interoceptive signals may engender anxiety. Due to the vulnerability for comorbid psychological symptoms in forms of orthostatic intolerance (OI), this study investigated psychophysiological contributions to emotional symptomatology in 20 healthy control participants (13 females, mean age 36 ± 8 years), 20 postural tachycardia syndrome (PoTS) patients (18 females, mean age 38 ± 13 years) and 20 vasovagal syncope (VVS) patients (15 females, mean age 39 ± 12 years). We investigated indices of emotional orienting responses (OR) to randomly presented neutral, pleasant and unpleasant images in the supine position and during the induced interoceptive threat of symptom provocation of head-up ti…

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Cortical Connections Position Primate Area 25 as a Keystone for Interoception, Emotion, and Memory.

The structural and functional integrity of subgenual cingulate area 25 (A25) is crucial for emotional expression and equilibrium. A25 has a key role in affective networks, and its disruption has been linked to mood disorders, but its cortical connections have yet to be systematically or fully studied. Using neural tracers in rhesus monkeys, we found that A25 was densely connected with other ventromedial and posterior orbitofrontal areas associated with emotions and homeostasis. A moderate pathway linked A25 with frontopolar area 10, an area associated with complex cognition, which may regulate emotions and dampen negative affect. Beyond the frontal lobe, A25 was connected with auditory association areas and memory-related medial temporal cortices, and with the interoceptive-related anterior insula. A25 mostly targeted the superficial cortical layers of other areas, where broadly disperse…

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Alexithymia is associated with a multidomain, multidimensional failure of interoception: Evidence from novel tests.

Interoception, the perception of the body's internal state, contributes to numerous aspects of higher-order cognition. Several theories suggest a causal role for atypical interoception in specific psychiatric disorders, including a recent claim that atypical interoception represents a transdiagnostic impairment across disorders characterized by reduced perception of one's own emotion (alexithymia). Such theories are supported predominantly by evidence from only one interoceptive domain (cardiac); however, evidence of domain-specific interoceptive ability highlights the need to assess interoception in noncardiac domains. Using novel interoceptive tasks, we demonstrate that individuals high in alexithymic traits show a reduced propensity to utilize interoceptive cues to gauge respiratory output (Experiment 1), reduced accuracy on tasks of muscular effort (Experiment 2), and taste sensitivi…

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Neurobehavioral evidence of interoceptive sensitivity in early infancy.

Interoception, the sensitivity to visceral sensations, plays an important role in homeostasis and guiding motivated behaviour. It is also considered to be fundamental to self-awareness. Despite its importance, the developmental origins of interoceptive sensitivity remain unexplored. We here provide the first evidence for implicit, flexible interoceptive sensitivity in 5 month old infants using a novel behavioural measure, coupled with an established cortical index of interoceptive processing. These findings have important implications for the understanding of the early developmental stages of self-awareness, self-regulation and socio-emotional abilities.

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Getting to the heart of the matter: Does aberrant interoceptive processing contribute towards emotional eating?

According to estimates from Public Health England, by 2034 70% of adults are expected to be overweight or obese, therefore understanding the underpinning aetiology is a priority. Eating in response to negative affect contributes towards obesity, however, little is known about the underlying mechanisms. Evidence that visceral afferent signals contribute towards the experience of emotion is accumulating rapidly, with the emergence of new influential models of 'active inference'. No longer viewed as a 'bottom up' process, new interoceptive facets based on 'top down' predictions have been proposed, although at present it is unclear which aspects of interoception contribute to aberrant eating behaviour and obesity. Study one examined the link between eating behaviour, body mass index and the novel interoceptive indices; interoceptive metacognitive awareness (IAw) and interoceptive prediction …

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The theory of constructed emotion: an active inference account of interoception and categorization.

The science of emotion has been using folk psychology categories derived from philosophy to search for the brain basis of emotion. The last two decades of neuroscience research have brought us to the brink of a paradigm shift in understanding the workings of the brain, however, setting the stage to revolutionize our understanding of what emotions are and how they work. In this article, we begin with the structure and function of the brain, and from there deduce what the biological basis of emotions might be. The answer is a brain-based, computational account called the theory of constructed emotion.

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