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 subjective sense of being a unique individual. This theme issue of the Philosophical Transactions of the Royal Society B draws together state-of-the-art knowledge concerning theoretical, experimental and clinical facets of interoception with the emphasis on cognitive and affective neuroscience. The multidisciplinary and cross-disciplinary perspectives represented in this theme issue disseminate and entrench knowledge about interoception across the scientific community and provide a reference for the conceptualization and further study of interoception across behavioural sciences.

'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 assumption is that people with high IAcc are able, with attention, to prioritize interoception over other sensory modalities and can thus adjust the relative precision of their interoceptive priors and prediction errors, where appropriate, given their personal history. This characterization explains key findings within the interoception literature; links results previously seen as unrelated or contradictory; and may have important implications for understanding cognitive, behavioural and psychopathological consequences of both high and low interoceptive awareness.This article is part of the themed issue 'Interoception beyond homeostasis: affect, cognition and mental health'.

Atypical Self-Focus Effect on Interoceptive Accuracy in Anorexia Nervosa

Background: Interoceptive abilities are known to be affected in anorexia nervosa (AN). Previous studies could show that private self-focus can enhance interoceptive accuracy (IAcc) in healthy participants. As body dissatisfaction is high in AN, confrontation with bodily features such as the own face might have a directly opposed effect in AN. Whether patients with AN can benefit from self-focus in their IAcc and whether this pattern changes over the time-course of cognitive behavioral therapy was investigated in this study.

Methods: Fifteen patients with AN from the Psychosomatic Clinic in Windach were assessed three times in the time course of a standardized cognitive-behavioral therapy. They were compared to 15 controls, recruited from Ulm University and tested in a comparable setting. Both groups performed the heartbeat perception task assessing IAcc under two conditions either enhancing (“Self”) or decreasing (“Other”) self-focused attention. Furthermore, body dissatisfaction was assessed by a subscale of the Eating Disorder (ED) Inventory 2.

Results: Patients with AN scored higher in IAcc when watching others’ faces as compared to one’s own face while performing the heartbeat perception task. The opposite pattern was observed in controls. IAcc remained reduced in AN as compared to controls in the time-course of cognitive-behavioral therapy, while body-dissatisfaction improved in AN. High body dissatisfaction was related to poorer IAcc in the “Self” condition.

Conclusions: Our findings suggest that using self-focused attention reduces IAcc in AN while the opposite pattern was observed in controls. Confronting anorexic patients with bodily features might increase body-related avoidance and therefore decrease IAcc. The current study introduces a new perspective concerning the role of interoceptive processes in AN and generates further questions regarding the therapeutic utility of methods targeting self-focus in the treatment of AN.

Reputation in an economic game modulates premotor cortex activity during action observation

Our interactions with other people - and our processing of their actions - are shaped by their reputation. Research has identified an Action Observation Network (AON) which is engaged when observing other people's actions. Yet, little is known about how the processing of others' actions is influenced by another's reputation. Is the response of the AON modulated by the reputation of the actor? We developed a variant of the ultimatum game in which participants watched either the visible or occluded actions of two 'proposers'. These actions were tied to decisions of how to split a pot of money although the proposers' decisions on each trial were not known to participants when observing the actions. One proposer made fair offers on the majority of trials, establishing a positive reputation, whereas the other made predominantly, unfair offers resulting in a negative reputation. We found significant activations in two regions of the left dorsal premotor cortex (dPMC). The first of these showed a main effect of reputation with greater activation for the negative reputation proposer than the positive reputation proposer. Furthermore individual differences in trust ratings of the two proposers covaried with activation in the right primary motor cortex (M1). The second showed an interaction between visibility and reputation driven by a greater effect of reputation when participants were observing an occluded action. Our findings show that the processing of others' actions in the AON is modulated by an actor's reputation, and suggest a predictive role for the PMC during action observation.

The multisensory basis of the self: From body to identity to others [Formula: see text]

By grounding the self in the body, experimental psychology has taken the body as the starting point for a science of the self. One fundamental dimension of the bodily self is the sense of body ownership that refers to the special perceptual status of one’s own body, the feeling that “my body” belongs to me. The primary aim of this review article is to highlight recent advances in the study of body ownership and our understanding of the underlying neurocognitive processes in three ways. I first consider how the sense of body ownership has been investigated and elucidated in the context of multisensory integration. Beyond exteroception, recent studies have considered how this exteroceptively driven sense of body ownership can be linked to the other side of embodiment, that of the unobservable, yet felt, interoceptive body, suggesting that these two sides of embodiment interact to provide a unifying bodily self. Lastly, the multisensorial understanding of the self has been shown to have implications for our understanding of social relationships, especially in the context of self–other boundaries. Taken together, these three research strands motivate a unified model of the self inspired by current predictive coding models.

Can the self become another? Investigating the effects of self-association with a new facial identity

The mental representation of the self is a complex construct, comprising both conceptual information and perceptual information regarding the body. Evidence suggests that both the conceptual self-representation and the bodily self-representation are malleable, and that these different aspects of the self are linked. Changes in bodily self-representation appear to affect how the self is conceptualized, but it is unclear whether the opposite relationship is also true: Do changes to the conceptual self-representation affect how the physical self is perceived? First, we adopted a perceptual matching paradigm to establish an association between the self and an unfamiliar face (Experiment 1). Robust attentional and perceptual biases in the processing of this newly self-associated object suggested that the conceptual self-representation was extended to include it. Next, we measured whether the bodily self-representation had correspondingly changed to incorporate the new face (Experiment 2). Participants rated morphs between their own and the newly-associated according to how similar they were to the self, before and after performing the perceptual matching task. Changes to the conceptual self did not have an effect on the bodily self-representation. These results suggest that modulatory links between aspects of the mental self-representation, when focused on the non-social self, are unidirectional and flow in a bottom-up manner.

Cardio-visual integration modulates the subjective perception of affectively neutral stimuli

Interoception, which refers to the perception of internal body signals, has been consistently associated with emotional processing and with the sense of self. However, its influence on the subjective appraisal of affectively neutral and body-unrelated stimuli is still largely unknown. Across two experiments we sought to investigate this issue by asking participants to detect changes in the flashing rhythm of a simple stimulus (a circle) that could either be pulsing synchronously with their own heartbeats or following the pattern of another person's heart. While overall task performance did not vary as a function of cardio-visual synchrony, participants were better at identifying trials in which no change occurred when the flashes were synchronous with their own heartbeats. This study adds to the growing body of research indicating that we use our body as a reference point when perceiving the world; and extends this view by focusing on the role that signals coming from inside the body, such as heartbeats, may play in this referencing process. Specifically we show that private interoceptive sensations can be combined with affectively neutral information unrelated to the self to influence the processing of a multisensory percept. Results are discussed in terms of both standard multisensory integration processes and predictive coding theories.

Electrophysiological correlates of self-specific prediction errors in the human brain

Recognising one's self, vs. others, is a key component of self-awareness, crucial for social interactions. Here we investigated whether processing self-face and self-body images can be explained by the brain's prediction of sensory events, based on regularities in the given context. We measured evoked cortical responses while participants observed alternating sequences of self-face or other-face images (experiment 1) and self-body or other-body images (experiment 2), which were embedded in an identity-irrelevant task. In experiment 1, the expected sequences were violated by deviant morphed images, which contained 33%, 66% or 100% of the self-face when the other's face was expected (and vice versa). In experiment 2, the anticipated sequences were violated by deviant images of the self when the other's image was expected (and vice versa), or by two deviant images composed of pictures of the self-face attached to the other's body, or the other's face attached to the self-body. This manipulation allowed control of the prediction error associated with the self or the other's image. Deviant self-images (but not deviant images of the other) elicited a visual mismatch response (vMMR)--a cortical index of violations of regularity. This was source localised to face and body related visual, sensorimotor and limbic areas and had amplitude proportional to the amount of deviance from the self-image. We provide novel evidence that self-processing can be described by the brain's prediction error system, which accounts for self-bias in visual processing. These findings are discussed in the light of recent predictive coding models of self-processing.

Action sounds update the mental representation of arm dimension: contributions of kinaesthesia and agency

Auditory feedback accompanies almost all our actions, but its contribution to body-representation is understudied. Recently it has been shown that the auditory distance of action sounds recalibrates perceived tactile distances on one's arm, suggesting that action sounds can change the mental representation of arm length. However, the question remains open of what factors play a role in this recalibration. In this study we investigate two of these factors, kinaesthesia, and sense of agency. Across two experiments, we asked participants to tap with their arm on a surface while extending their arm. We manipulated the tapping sounds to originate at double the distance to the tapping locations, as well as their synchrony to the action, which is known to affect feelings of agency over the sounds. Kinaesthetic cues were manipulated by having additional conditions in which participants did not displace their arm but kept tapping either close (Experiment 1) or far (Experiment 2) from their body torso. Results show that both the feelings of agency over the action sounds and kinaesthetic cues signaling arm displacement when displacement of the sound source occurs are necessary to observe changes in perceived tactile distance on the arm. In particular, these cues resulted in the perceived tactile distances on the arm being felt smaller, as compared to distances on a reference location. Moreover, our results provide the first evidence of consciously perceived changes in arm-representation evoked by action sounds and suggest that the observed changes in perceived tactile distance relate to experienced arm elongation. We discuss the observed effects in the context of forward internal models of sensorimotor integration. Our results add to these models by showing that predictions related to action sounds must fit with kinaesthetic cues in order for auditory inputs to change body-representation.

Heartfelt empathy? No association between interoceptive awareness, questionnaire measures of empathy, reading the mind in the eyes task or the director task

Interoception, defined as afferent information arising from within the body, is the basis of all emotional experience and underpins the 'self.' However, people vary in the extent to which interoceptive signals reach awareness. This trait modulates both their experience of emotion and their ability to distinguish 'self' from 'other' in multisensory contexts. The experience of emotion and the degree of self/other distinction or overlap are similarly fundamental to empathy, which is an umbrella term comprising affect sharing, empathic concern and perspective-taking (PT). A link has therefore often been assumed between interoceptive awareness (IA) and empathy despite a lack of clear evidence. To test the hypothesis that individual differences in both traits should correlate, we measured IA in four experiments, using a well-validated heartbeat perception task, and compared this with scores on several tests that relate to various aspects of empathy. We firstly measured scores on the Index of Interpersonal Reactivity and secondly on the Questionnaire of Cognitive and Affective Empathy. Thirdly, because the 'simulationist' account assumes that affect sharing is involved in recognizing emotion, we employed the 'Reading the Mind in the Eyes Task' for the recognition of facial expressions. Contrary to expectation, we found no significant relationships between IA and any aspect of these measures. This striking lack of direct links has important consequences for hypotheses about the extent to which empathy is necessarily embodied. Finally, to assess cognitive PT ability, which specifically requires self/other distinction, we used the 'Director Task' but found no relationship. We conclude that the abilities that make up empathy are potentially related to IA in a variety of conflicting ways, such that a direct association between IA and various components of empathy has yet to be established.

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 awareness suggests that interoception might be involved in self-reported premonitory urges in GTS. High levels of interoceptive awareness might reflect a self-attentive capacity to perceive urges.

Subliminal versus supraliminal stimuli activate neural responses in anterior cingulate cortex, fusiform gyrus and insula: a meta-analysis of fMRI studies

Background

Non-conscious neural activation may underlie various psychological functions in health and disorder. However, the neural substrates of non-conscious processing have not been entirely elucidated. Examining the differential effects of arousing stimuli that are consciously, versus unconsciously perceived will improve our knowledge of neural circuitry involved in non-conscious perception. Here we conduct preliminary analyses of neural activation in studies that have used both subliminal and supraliminal presentation of the same stimulus.

Methods

We use Activation Likelihood Estimation (ALE) to examine functional Magnetic Resonance Imaging (fMRI) studies that uniquely present the same stimuli subliminally and supraliminally to healthy participants during functional magnetic resonance imaging (fMRI). We included a total of 193 foci from 9 studies representing subliminal stimulation and 315 foci from 10 studies representing supraliminal stimulation.

Results

The anterior cingulate cortex is significantly activated during both subliminal and supraliminal stimulus presentation. Subliminal stimuli are linked to significantly increased activation in the right fusiform gyrus and right insula. Supraliminal stimuli show significantly increased activation in the left rostral anterior cingulate.

Conclusions

Non-conscious processing of arousing stimuli may involve primary visual areas and may also recruit the insula, a brain area involved in eventual interoceptive awareness. The anterior cingulate is perhaps a key brain region for the integration of conscious and non-conscious processing. These preliminary data provide candidate brain regions for further study in to the neural correlates of conscious experience.

Electronic supplementary material

The online version of this article (doi:10.1186/s40359-014-0052-1) contains supplementary material, which is available to authorized users.

Predictive codes of familiarity and context during the perceptual learning of facial identities

Face recognition is a key component of successful social behaviour. However, the computational processes that underpin perceptual learning and recognition as faces transition from unfamiliar to familiar are poorly understood. In predictive coding, learning occurs through prediction errors that update stimulus familiarity, but recognition is a function of both stimulus and contextual familiarity. Here we show that behavioural responses on a two-option face recognition task can be predicted by the level of contextual and facial familiarity in a computational model derived from predictive-coding principles. Using fMRI, we show that activity in the superior temporal sulcus varies with the contextual familiarity in the model, whereas activity in the fusiform face area covaries with the prediction error parameter that updated facial familiarity. Our results characterize the key computations underpinning the perceptual learning of faces, highlighting that the functional properties of face-processing areas conform to the principles of predictive coding.

Sensitivity to differences in the motor origin of drawings: from human to robot

This study explores the idea that an observer is sensitive to differences in the static traces of drawings that are due to differences in motor origin. In particular, our aim was to test if an observer is able to discriminate between drawings made by a robot and by a human in the case where the drawings contain salient kinematic cues for discrimination and in the case where the drawings only contain more subtle kinematic cues. We hypothesized that participants would be able to correctly attribute the drawing to a human or a robot origin when salient kinematic cues are present. In addition, our study shows that observers are also able to detect the producer behind the drawings in the absence of these salient kinematic cues. The design was such that in the absence of salient kinematic cues, the drawings are visually very similar, i.e. only differing in subtle kinematic differences. Observers thus had to rely on these subtle kinematic differences in the line trajectories between drawings. However, not only motor origin (human versus robot) but also motor style (natural versus mechanic) plays a role in attributing a drawing to the correct producer, because participants scored less high when the human hand draws in a relatively mechanical way. Overall, this study suggests that observers are sensitive to subtle kinematic differences between visually similar marks in drawings that have a different motor origin. We offer some possible interpretations inspired by the idea of "motor resonance".

Change my body, change my mind: the effects of illusory ownership of an outgroup hand on implicit attitudes toward that outgroup

The effect of multisensory-induced changes on body-ownership and self-awareness using bodily illusions has been well established. More recently, experimental manipulation of bodily illusions have been combined with social cognition tasks to investigate whether changes in body-ownership can in turn change the way we perceive others. For example, experiencing ownership over a dark-skin rubber hand reduces implicit bias against dark-skin groups. Several studies have also shown that processing of skin color and facial features play an important role in judgements of racial typicality and racial categorization independently and in an additive manner. The present study aimed at examining whether using multisensory stimulation to induce feelings of body-ownership over a dark-skin rubber hand would lead to an increase in positive attitudes toward black faces. We here show, that the induced ownership of a body-part of a different skin color affected the participants' implicit attitudes when processing facial features, in addition to the processing of skin color shown previously. Furthermore, when the levels of pre-existing attitudes toward black people were taken into account, the effect of the rubber hand illusion on the post-stimulation implicit attitudes was only significant for those participants who had a negative initial attitude toward black people, with no significant effects found for those who had positive initial attitudes toward black people. Taken together, our findings corroborate the hypothesis that the representation of the self and its relation to others, as given to us by body-related multisensory processing, is critical in maintaining but also in changing social attitudes.

Embodying an outgroup: the role of racial bias and the effect of multisensory processing in somatosensory remapping

We come to understand other people's physical and mental states by re-mapping their bodily states onto our sensorimotor system. This process, also called somatosensory resonance, is an essential ability for social cognition and is stronger when observing ingroup than outgroup members. Here we investigated, first, whether implicit racial bias constrains somatosensory resonance, and second, whether increasing the ingroup/outgroup perceived physical similarity results in an increase in the somatosensory resonance for outgroup members. We used the Visual Remapping of Touch effect as an index of individuals' ability in resonating with the others, and the Implicit Association Test to measure racial bias. In Experiment 1, participants were asked to detect near-threshold tactile stimuli delivered to their own face while viewing either an ingroup or an outgroup face receiving a similar stimulation. Our results showed that individuals' tactile accuracy when viewing an outgroup face being touched was negatively correlated to their implicit racial bias. In Experiment 2, participants received the interpersonal multisensory stimulation (IMS) while observing an outgroup member. IMS has been found to increase the perceived physical similarity between the observer's and the observed body. We tested whether such increase in ingroup/outgroup perceived physical similarity increased the remapping ability for outgroup members. We found that after sharing IMS experience with an outgroup member, tactile accuracy when viewing touch on outgroup faces increased. Interestingly, participants with stronger implicit bias against the outgroup showed larger positive change in the remapping. We conclude that shared multisensory experiences might represent one key way to improve our ability to resonate with others by overcoming the boundaries between ingroup and outgroup categories.