Interoception, contemplative practice, and health

A scientometric analysis and visualization of kinesiophobia research from 2002 to 2022: A review

Kinesiophobia is an excessive, irrational, debilitating fear of physical movement and activity caused by a sense of vulnerability to pain or re-injury, which can have a direct impact on physical functioning and mental well-being of patients. This paper aims to provide reliable support for future in-depth research on kinesiophobia through scientometrics and historical review. Studies on kinesiophobia published from 2002 to 2022 were retrieved from the Web of Science Core Collection. CiteSpace and VOSviewer were used to conduct bibliometric analysis of the included studies and map knowledge domains. Keywords were manually clustered, and the results were analyzed and summarized in combination with a literature review. A total of 4157 original research articles and reviews were included. Research on kinesiophobia is developing steadily and has received more attention from scholars in recent years. There are regional differences in the distribution of research. Chronic pain is the focus of research in this field. A multidisciplinary model of pain neuroscience education combined with physical therapy based on cognitive-behavioral therapy and the introduction and development of virtual reality may be the frontier of research. There is a large space for the study of kinesiophobia. In the future, to improve regional academic exchanges and cooperation, more attention should be given to the clinical applicability and translation of scientific work, which will be conducive to improving the quality of life and physical and mental health outcomes of kinesiophobia patients.

Assessment of the mind-body connection: preliminary psychometric evidence for a new self-report questionnaire

OBJECTIVES

While interoceptive self-report scales provide a foundation for measuring the mind-body connection, they variably consider other important factors that could influence interpretations of internal bodily sensations and perceptions related to mind-body integration. The proposed Body-Mind Connection Questionnaire (BMCQ) aimed to operationalise the notion that this construct involves three major components: (a) Interoceptive Attention, (b) Sensation-Emotion Articulation, and (c) Body-Mind Values.

METHODS

Following panel review and piloting with the target population, the developed BMCQ was evaluated in 316 participants (189 identifying as female) aged 18-50 (MAge=30.78), alongside established self-report measures of interoceptive sensibility, body awareness, sensory processing sensitivity, and alexithymia. We examined the BMCQ factor structure through exploratory factor analysis and analysed convergent and discriminant validity.

RESULTS

Exploratory factor analysis supported three scales of the BMCQ, which explained 54.03% of variance. Factor loadings (>0.44) and reliability indices (0.74 to 0.85) were acceptable. Inter-scale correlations suggested that the scales are distinct but related (rs=0.38 to 0.59). BMCQ scales were supported by convergent (r=0.33 to 0.67) and discriminant evidence (rs=0.01 to 0.39, p range n.s. to <.05).

CONCLUSIONS

Preliminary psychometric properties indicate that the BMCQ is multidimensional and consists of three constructs that differentially relate to theoretically associated measures. Interoceptive Attention, Sensation-Emotion Articulation, and Body-Mind Values may serve as a basis for efficiently assessing the mind-body connection more holistically, which could be useful for developing interventions aimed at enhancing mind-body integration.

A meta-analytic review of acceptance-based interventions for migraine

OBJECTIVE

To determine the efficacy of acceptance and mindfulness-based interventions on migraine disability, medication use, and attack frequency.

BACKGROUND

Acceptance-based approaches to headache management are those in which individuals learn to mitigate the influence of pain-related experiences on their general functioning without controlling pain itself. Treatment approaches include acceptance and commitment therapy (ACT) and mindfulness-based practices. Both have shown promise in improving broad functioning and disability among individuals with headache. Despite a growing body of research examining acceptance-based interventions for headache broadly and migraine specifically, no meta-analytic review of ACT interventions for headache exists, and two meta-analytic reviews of mindfulness-based practices yielded conflicting results.

METHODS

The present study aimed to systematically and quantitatively review the literature related to the efficacy of acceptance-based interventions among adults with migraine. A multi-database search (PubMed/MEDLINE, Scopus, PsycINFO, and the Cochrane Central Register of Controlled Trials) identified clinical trials among individuals with migraine that compared structured ACT or mindfulness-based interventions to control treatment. Random-effects meta-analyses were performed using RevMan 5.4 meta-analytic software, and standardized mean differences (SMD) with 95% confidence intervals (CIs) quantified effect sizes on outcomes of disability, medication use, and headache frequency. Heterogeneity was quantified via I2 index and explored via subgroup analyses.

RESULTS

Acceptance-based interventions yielded significant improvements in disability (SMD = -0.38, 95% CI = -0.56 to -0.20; I2  = 25%, p = 0.20) but not in medication use (SMD = -0.25, 95% CI: -0.57 to 0.06; I2  = 0%, p = 0.82) or headache frequency (SMD = -0.16, 95% CI = -0.37 to 0.05; I2  = 0%, p = 0.73).

CONCLUSION

Results suggest that acceptance-based interventions are effective in improving disability among adults with migraine and are a viable non-pharmacological treatment option, in addition to well-established behavioral migraine management approaches, for patients seeking functional improvement.

Do contemplative practices make us more moral?

Contemplative practices are a staple of modern life and have historically been intertwined with morality. However, do these practices in fact improve our morality? The answer remains unclear because the science of contemplative practices has focused on unidimensional aspects of morality, which do not align with the type of interdependent moral functioning these practices aspire to cultivate. Here, we appeal to a multifactor construct, which allows the assessment of outcomes from a contemplative intervention across multiple dimensions of moral cognition and behavior. This offers an open-minded and empirically rigorous investigation into the impact of contemplative practices on moral actions. Using this framework, we gain insight into the effect of mindfulness meditation on morality, which we show does indeed have positive influences, but also some negative influences, distributed across our moral functioning.

Relationship between body awareness level and musculoskeletal pain complaints, physical activity level and emotional status in healthy people

INTRODUCTıON/AIM: Defining the physical, psycho-social effects of body awareness may help to explain the functional effects. It was aimed to examine the relationship between the body awareness level and musculoskeletal pain complaints, physical activity level, and emotional state in healthy people.

MATERIALS AND METHODS

A total of 289 healthy individuals between the ages of 18 and 25 were included in the study. Body awareness level was using Body Awareness Questionnaire (BAQ), musculoskeletal pain complaint using The Nordic Musculoskeletal Questionnaire (NMQ), physical activity levels using International Physical Activity Questionnaire (IPAQ-short form) and emotional status using Beck Depression Inventory (BDI) were assessed.

RESULTS

The mean age of the participants was 19.50 ± 1.55 years. The mean pain intensity was 2.48 ± 1.99. The BAQ score average was 91.87 ± 15.55. Thirty percent of the participants had a mild level and 14.9% had a moderate level of depression risk. While there was a weak positive relationship between the Disease Startup sub-dimension of BAQ and the moderate-level IPAQ score (r = 0.135, p = 0.022). Also there was a weak negative relationship between Disease Startup sub-dimension and the level of depression risk. A weak positive relationship was found between the changes in the body process and attention to subjects sub-dimension and the level of depression risk (r = 0.127, p = 0.030). There was a positive correlation between level of depression risk and pain intensity (r = 0.237, p = 0.000). Body awareness levels of individuals who had back pain in the last 1 month were higher than those who did not experience pain (p = 0.029).

CONCLUSION

The results of the study showed that physical activity positively affected body awareness level. The body awareness level was directly related to the pain associated with the musculoskeletal system and emotional state. There is a need more studies examining the relationship between body awareness and pain, physical activity and emotional status with subdimensions of the BAQ.

Psychological interventions for interoception in mental health disorders: A systematic review of randomized-controlled trials

Disturbed interoception (i.e., the sensing, awareness, and regulation of internal body signals) has been found across several mental disorders, leading to the development of interoception-based interventions (IBIs). Searching PubMed and PsycINFO, we conducted the first systematic review of randomized-controlled trials (RCTs) investigating the efficacy of behavioral IBIs at improving interoception and target symptoms of mental disorders in comparison to a non-interoception-based control condition [CRD42021297993]. Thirty-one RCTs fulfilled inclusion criteria. Across all studies, a pattern emerged with 20 (64.5%) RCTs demonstrating IBIs to be more efficacious at improving interoception compared to control conditions. The most promising results were found for post-traumatic stress disorder, irritable bowel syndrome, fibromyalgia and substance use disorders. Regarding symptom improvement, the evidence was inconclusive. The IBIs were heterogenous in their approach to improving interoception. The quality of RCTs was moderate to good. In conclusion, IBIs are potentially efficacious at improving interoception for some mental disorders. In terms of symptom reduction, the evidence is less promising. Future research on the efficacy of IBIs is needed.

Within-Person Modulation of Neural Networks following Interoceptive Awareness Training through Mindful Awareness in Body-Oriented Therapy (MABT): A Pilot Study

Interoception, the representation of the body's internal state, is increasingly recognized for informing subjective wellbeing and promoting regulatory behavior. However, few empirical reports characterize interoceptive neural networks, and fewer demonstrate changes to these networks in response to an efficacious intervention. Using a two-group randomized controlled trial, this pilot study explored within-participant neural plasticity in interoceptive networks following Mindful Awareness in Body-oriented Therapy (MABT). Participants (N = 22) were assigned to either 8 weeks of MABT or to a no-treatment control and completed baseline and post-intervention assessments that included subjective interoceptive awareness (MAIA) and neuroimaging of an interoceptive awareness task. MABT was uniquely associated with insula deactivation, increased functional connectivity between the dorsal attention network and the somatomotor cortex, and connectivity changes correlated positively with changes in subjective interoception. Within the MABT group, changes in subjective interoception interacted with changes in a predefined anterior cingulate seed region to predict changes in right middle insula activity, a putative primary interoceptive representation region. While the small sample size requires the replication of findings, results suggest that interoceptive training enhances sensory-prefrontal connectivity, and that such changes are commensurate with enhanced interoceptive awareness.

Intensity of repetitive negative thinking in depression is associated with greater functional connectivity between semantic processing and emotion regulation areas

BACKGROUND

Repetitive negative thinking (RNT), a cognitive process that encompasses past (rumination) and future (worry) directed thoughts focusing on negative experiences and the self, is a transdiagnostic construct that is especially relevant for major depressive disorder (MDD). Severe RNT often occurs in individuals with severe levels of MDD, which makes it challenging to disambiguate the neural circuitry underlying RNT from depression severity.

METHODS

We used a propensity score, i.e., a conditional probability of having high RNT given observed covariates to match high and low RNT individuals who are similar in the severity of depression, anxiety, and demographic characteristics. Of 148 MDD individuals, we matched high and low RNT groups (n = 50/group) and used a data-driven whole-brain voxel-to-voxel connectivity pattern analysis to investigate the resting-state functional connectivity differences between the groups.

RESULTS

There was an association between RNT and connectivity in the bilateral superior temporal sulcus (STS), an important region for speech processing including inner speech. High relative to low RNT individuals showed greater connectivity between right STS and bilateral anterior insular cortex (AI), and between bilateral STS and left dorsolateral prefrontal cortex (DLPFC). Greater connectivity in those regions was specifically related to RNT but not to depression severity.

CONCLUSIONS

RNT intensity is directly related to connectivity between STS and AI/DLPFC. This might be a mechanism underlying the role of RNT in perceptive, cognitive, speech, and emotional processing. Future investigations will need to determine whether modifying these connectivities could be a treatment target to reduce RNT.

Self-reported interoception, worries and protective behaviors during the COVID-19 pandemic: a longitudinal study

BACKGROUND

Protective behaviors were essential for minimizing the spread of the virus during the coronavirus disease 2019 (COVID-19) pandemic. It is often assumed that awareness of bodily sensations (interoception) can improve decision-making and facilitate adaptive behavior.

OBJECTIVE

This paper investigates cross-sectional and longitudinal relationships between different aspects of self-reported interoception, trait anxiety, COVID-related worry, and health protective behaviors.

METHODS

The study was conducted on a community sample of 265 adults. The two data collection phases took place online, before (baseline) and during the second wave of the COVID-19 pandemic in Hungary.

RESULTS

Contrary to our expectations, neither cross-sectional nor longitudinal associations were found between protective behaviors and indicators of self-reported interoception. However, worry at baseline predicted protective behaviors during the second wave, even after controlling for socio-economical characteristics and protective behaviors at baseline.

CONCLUSION

Our results highlight the adaptivity of health-related worry when behavioral steps to avoid threats are known and available. Also, higher level of perceived interoception did not appear to be health protective under these circumstances.

Psychometric properties of an Arabic translation of the multidimensional assessment of interoceptive awareness (MAIA-2) questionnaire in a non-clinical sample of Arabic-speaking adults

BACKGROUND

Interoception refers to processes through which the nervous system identifies, analyzes, and integrates the information generated by the physiological state of the body (e.g., from internal organs such as the stomach, heart, or lungs). Despite its potential interest for clinical research and its wide use globally, no Arabic adaptation and validation of the Multidimensional Assessment of Interoceptive Awareness (MAIA-2) questionnaire exists to date. The goal of this study was to examine the psychometric properties of an Arabic translation of the MAIA-2 in a sample of Arabic-speaking community adults from Lebanon. We hypothesized that the Arabic version of the MAIA-2 would yield adequate internal consistency coefficients; the 8-factor structure model would show a good fit to our data, with measurement invariance and good convergent validity.

METHOD

The Arabic adaptation of the MAIA-2 was developed using the forward-backward translation method. A non-clinical sample of Arabic-speaking adults (n = 359, 59.9% females, mean age = 22.75 years (SD = 7.04)) took part of this validation study. To check if the model was adequate, several fit indices were calculated: the normed model chi-square (χ²/df), the Steiger-Lind root mean square error of approximation (RMSEA), the Tucker-Lewis Index (TLI) and the comparative fit index (CFI). Values ≤ 3 for χ²/df, and ≤ 0.08 for RMSEA, and 0.90 for CFI and TLI indicate good fit of the model to the data.

RESULTS

Confirmatory Factor Analyses corroborated the validity of the original 8-factor structure of the MAIA-2 [χ2/df = 1603.86/601 = 2.67, RMSEA = 0.068 (90% CI 0.064, 0.072), SRMR = 0.058, CFI = 0.903, TLI = 0.892]. Reliability estimates in our sample revealed good internal consistency, with McDonald's ω coefficients for the subscales ranging from 0.86 to 0.93. Our analyses also revealed measurement invariance of the Arabic MAIA-2 for gender. No statistically significant difference between men and women in all dimensions, except for the not worrying and attention regulation subscales where men scored significantly higher than women. Finally, the Arabic MAIA-2 dimensions showed positive correlations with the intuitive eating dimension "Reliance on Hunger and Satiety Cues", thus providing support for convergent validity.

CONCLUSION

We contribute the literature by providing the first Arabic adaptation and validation of a measure assessing the multidimensional construct of self-reported interoception. The Arabic MAIA-2 demonstrated good psychometric properties. We thus preliminarily recommend its use to measure the interoceptive awareness construct among Arabic-speaking communities worldwide.

A machine learning approach towards the differentiation between interoceptive and exteroceptive attention

Interoception, the representation of the body's internal state, plays a central role in emotion, motivation and wellbeing. Interoceptive sensibility, the ability to engage in sustained interoceptive awareness, is particularly relevant for mental health but is exclusively measured via self-report, without methods for objective measurement. We used machine learning to classify interoceptive sensibility by contrasting using data from a randomized control trial of interoceptive training, with functional magnetic resonance imaging assessment before and after an 8-week intervention (N = 44 scans). The neuroimaging paradigm manipulated attention targets (breath vs. visual stimuli) and reporting demands (active reporting vs. passive monitoring). Machine learning achieved high accuracy in distinguishing between interoceptive and exteroceptive attention, both for within-session classification (~80% accuracy) and out-of-sample classification (~70% accuracy), revealing the reliability of the predictions. We then explored the classifier potential for 'reading out' mental states in a 3-min sustained interoceptive attention task. Participants were classified as actively engaged about half of the time, during which interoceptive training enhanced their ability to sustain interoceptive attention. These findings demonstrate that interoceptive and exteroceptive attention is distinguishable at the neural level; these classifiers may help to demarcate periods of interoceptive focus, with implications for developing an objective marker for interoceptive sensibility in mental health research.

Preliminary Rasch analysis of the multidimensional assessment of interoceptive awareness in adults with stroke

PURPOSE

The Multidimensional Assessment of Interoceptive Awareness (MAIA) measures interoceptive body awareness, which includes aspects such as attention regulation, self-regulation, and body listening. Our purpose was to perform a preliminary validation of the MAIA in adults with stroke using Rasch Measurement Theory.

METHODS

The original MAIA has 32 items that measure interoceptive sensibility, which is an aspect of body awareness. We performed a preliminary analysis with Rasch Measurement Theory to evaluate the unidimensionality and structural validity of the scale. We investigated overall fit to assess unidimensionality, person and item fit, person separation reliability, targeting, local item dependence, and principal components analysis of residuals.

RESULTS

Forty-one adults with chronic stroke (average 3.8 years post-stroke, 13 women, average age 57±13 years) participated in the study. Overall fit (χ 2 = 62.26, p = 0.26) and item fit were obtained after deleting 3 items and rescoring 26 items. One participant did not fit the model (2.44%). There were no floor (0.00%) or ceiling effects (0.00%). Local item dependence was found in 42 pairs. The person separation reliability was 0.91, and the person mean location was 0.06±1.12 logits.

CONCLUSIONS

The preliminary structural validity of the MAIA demonstrated good targeting and reliability, as well as unidimensionality, and good item and person fit in adults with chronic stroke. A study with a larger sample size is needed to validate our findings.

Functional connectivity between interoceptive brain regions is associated with distinct health-related domains: A population-based neuroimaging study

Interoception is the sensation, perception, and integration of signals from within the body. It has been associated with a broad range of physiological and psychological processes. Further, interoceptive variables are related to specific regions and networks in the human brain. However, it is not clear whether or how these networks relate empirically to different domains of physiological and psychological health at the population level. We analysed a data set of 19,020 individuals (10,055 females, 8965 males; mean age: 63 years, age range: 45-81 years), who have participated in the UK Biobank Study, a very large-scale prospective epidemiological health study. Using canonical correlation analysis (CCA), allowing for the examination of associations between two sets of variables, we related the functional connectome of brain regions implicated in interoception to a selection of nonimaging health and lifestyle related phenotypes, exploring their relationship within modes of population co-variation. In one integrated and data driven analysis, we obtained four statistically significant modes. Modes could be categorised into domains of arousal and affect and cardiovascular health, respiratory health, body mass, and subjective health (all p < .0001) and were meaningfully associated with distinct neural circuits. Circuits represent specific neural "fingerprints" of functional domains and set the scope for future studies on the neurobiology of interoceptive involvement in different lifestyle and health-related phenotypes. Therefore, our research contributes to the conceptualisation of interoception and may lead to a better understanding of co-morbid conditions in the light of shared interoceptive structures.

Interoceptive Awareness of the Breath Preserves Attention and Language Networks amidst Widespread Cortical Deactivation: A Within-Participant Neuroimaging Study

Interoception, the representation of the body's internal state, serves as a foundation for emotion, motivation, and wellbeing. Yet despite its centrality in human experience, the neural mechanisms of interoceptive attention are poorly understood. The Interoceptive/Exteroceptive Attention Task (IEAT) is a novel neuroimaging paradigm that compares behavioral tracking of the respiratory cycle (Active Interoception) to tracking of a visual stimulus (Active Exteroception). Twenty-two healthy participants completed the IEAT during two separate scanning sessions (N = 44) as part of a randomized control trial of mindful awareness in body-oriented therapy (MABT). Compared with Active Exteroception, Active Interoception deactivated somatomotor and prefrontal regions. Greater self-reported interoceptive sensibility (MAIA scale) predicted sparing from deactivation within the anterior cingulate cortex (ACC) and left-lateralized language regions. The right insula, typically described as a primary interoceptive cortex, was only specifically implicated by its deactivation during an exogenously paced respiration condition (Active Matching) relative to self-paced Active Interoception. Psychophysiological interaction (PPI) analysis characterized Active Interoception as promoting greater ACC connectivity with lateral prefrontal and parietal regions commonly referred to as the dorsal attention network (DAN). In contrast to evidence relating accurate detection of liminal interoceptive signals such as the heartbeat to anterior insula activity, interoceptive attention toward salient signals such as the respiratory cycle may involve reduced cortical activity but greater ACC-DAN connectivity, with greater sensibility linked to reduced deactivation within the ACC and language-processing regions.

A Primer on Interoception and its Importance in Psychiatry

Interoception is the perception of signals from inside the body. It plays a significant role in the nervous, cardiovascular, respiratory, gastrointestinal, genitourinary, and endocrine systems. It is also closely related to the autonomic nervous system and inflammatory pathways and plays a significant role in our optimal functioning. Recently, interoception has gained more attention in neuropsychiatric research. Anatomical and physiological aspects of interoception like relevant brain areas, the role of the vagus nerve, and the autonomic nervous system are gradually being understood. Different facets of interoception like interoceptive attention, detection, magnitude, discrimination, accuracy, awareness, and appraisal have been proposed and their assessments and importance are being evaluated. Further, interoception is often dysregulated or abnormal in psychiatric disorders. It has been implicated in the psychopathology, etiopathogenesis, clinical features and treatment of mood, anxiety, psychotic, personality and addiction-related disorders. This narrative review attempts to provide a nuanced understanding of the pathway(s), components, functions, assessments, and problems of interoception and will help us to detect its disturbances and evaluate its impact on psychiatric disorders, leading to a better perspective and management. This will also advance interoception-related research.

Trauma-related disorders and the bodily self: current perspectives and future directions

Trauma-related disorders are debilitating psychiatric conditions that influence people who have directly or indirectly witnessed adversities. Dramatic brain/body transformations and altered person's relationship with self, others, and the world occur when experiencing multiple types of traumas. In turn, these unfortunate modifications may contribute to predisposition to trauma-related vulnerability conditions, such as externalizing (aggression, delinquency, and conduct disorders) problems. This mini-review analyzes the relations between traumatic experiences (encoded as implicit and embodied procedural memories) and bodily self, sense of safety for the own body, and relationship with others, also in the presence of externalizing conducts. Furthermore, an emerging research area is also considered, highlighting principles and techniques of body-oriented and sensorimotor therapies designed to remodel bodily self-aspects in the presence of trauma, discussing their potential application with individuals showing externalizing problems.

The Role of Perfectionistic Self-Presentation and Problematic Instagram Use in the Relationship Between Self-Concept Clarity and Body Disconnection: A Serial Mediation Model

By combining authors who hypothesized that modern technology has greatly increased people's ability and people's possibility to distance themselves from their embodied awareness and those who have shown that communication through social media is more congenial to people with a tendency towards perfectionistic self-presentation (PSP), this study analyses the influence of self-concept clarity (SCC) in bodily dissociation (BD) and hypothesizes that people with a low SCC are more prone to BD and that PSP and problematic Instagram use (PIU) may play a serial mediating role in this relationship. Two hundred and 19 women (M_age = 31.8 ± 11.25) completed an online survey that included the Italian-validated versions of the Perfectionistic Self-Presentation Scale, the Scale of Body Connection and the Bergen Facebook Scale modified for Instagram use. A Serial Mediation Model (Hayes's PROCESS Model 6) shows that both PSP and PIU significantly serially mediate the association between SCC and BD (β = -.025 SE = .011, 95% CI = [-.0498, -.0070]) and that there is a mediating effect of PIU between SCC and BD (β = -.04 SE = .020, 95% CI = [-.0865, -.0098]), but no mediating effect of PSP between SCC and BD was found (β = -.052 SE = .031, 95% CI = [-.1184, +.0039]). A possible explanation is that people with low SCC try to avoid others noticing their imperfections because they fail to integrate it into their self-concept and tend to use Instagram in a problematic way because this tool allows them to largely control the information they share. This use, in turn, alters their state of mind-body connection and this increases the disconnection from one's bodily sensations. The absence of mediation by the PSP between SCC and BD and the presence of PIU mediation between SCC and BD underlines the importance of technology in this relationship. The implications and limitations of this study will be discussed.

Effectiveness of a Brief Online Mindfulness-Based Intervention for University Students

Objectives

The COVID-19 pandemic resulted in a dramatic increase in Web-based education, lacking face-to-face student-teacher and student-student interaction, and consequently impairing students' sense of belonging to a community, interoceptive awareness, and academic self-efficacy. This study examined how a brief mindfulness-based intervention in an online university course can be effective in enhancing attention resources, developing a stronger sense of academic self-efficacy, and improving the sense of belonging to a community, which represent critical factors affecting students' participation in online and blended courses.

Method

Four-hundred and eighty-six participants (Mage 22.88) completed a battery of measures at pre- and post-treatment. One class (experimental group) participated in a brief online mindfulness-based intervention (42%), whereas the other one (control group) did not take part in the intervention (58%). The intervention included breathing meditation at the beginning of class, sharing of experiences, mini-lectures on mindfulness, and daily practice, and lasted for 28 consecutive days.

Results

Participants in the experimental group when compared to controls showed a significant increase in the feeling of influencing the course activities (F = 9.628; p < 0.005), in the self-regulation of attention (F = 19.133; p < 0.001), in academic self-efficacy (F = 9.220; p < 0.005), and, particularly, in their self-efficacy in regulating learning (F = 12.942; p < 0.001). The students' adherence to the assigned practice could partially explain the effectiveness of the intervention.

Conclusions

This study offers useful clues about the effectiveness of mindfulness interventions in the classroom in enhancing sense of belonging to a community, attention grounded in bodily sensations, and academic self-efficacy.

Preregistration

This study is not preregistered.

Menstrual cycle symptomatology during the COVID-19 pandemic: The role of interoceptive sensibility and psychological health

The literature on the COVID-19 pandemic has shown the importance of investigating its impact on mental health during this sensitive period, also in relation to the female menstrual cycle. To this end, interceptive sensibility has emerged as a fundamental construct for studying the mind-body interaction among psychosomatic and pain symptoms, particularly through the distinction between two attentional styles (namely, a "mindful" and a "non-mindful" sensibility). The aim of the following study is to verify the role of mental health and interoceptive sensibility on menstrual symptoms in women of childbearing age, during the pandemic, as well as to identify the specific contribution of the existing dimensions of interoceptive sensibility in the prediction of symptoms' severity. Data were collected through an online survey, for which 5294 women responded on demographic information, menstrual history, symptoms' disturbance, and completed the Italian versions of the GHQ-12 and the MAIA. The analyses showed that symptoms were strongly correlated to either the GHQ-12 and the MAIA subscales Noticing, Emotional Awareness, Trusting and Not-Worrying. This result was further verified via a hierarchical regression, which revealed that the same interoceptive dimensions and mental health strongly predicted the intensity of menstrual symptoms (R² = 0.177, ΔR² = 0.143) compared to other considered dimensions (R² = 0.180, ΔR² = 0.002). Results are partially in line with the premises but suggest that mental health has a strong impact on the experience of the menstrual cycle and that only a few interoceptive dimensions may be relevant in explaining the severity of menstrual symptoms. It is here suggested that noticing internal bodily signals and being aware of emotional states might become dysfunctional if not reconciled with a good ability to self-regulate internal states, but may rather contribute to the perpetuation of the 'vicious cycle' of heightened affective and attentional reactions to interoceptive sensations.

Embodying Consciousness through Interoception and a Balanced Time Perspective

This review presents current research and scientific knowledge in body mind sciences through the lens of interoception, as a representative of the body; and time perspective, as the representative of the mind. This intertwining dichotomy has been a subject of discourse in many fields, all having the common denominator of consciousness. Our aim is to expand on the congruities of these seemingly deconstructed worlds-of science and philosophy, of the body and the mind, to show that the place of consciousness lies in the zone between these two. Being aware of the body in the present moment. We introduce interoception and time perspective, focusing on how interoceptive signals are depicted in autonomic nervous system (ANS) regulation, and how this relates to the concept of a balanced time perspective (BTP), a highly adaptive psychological characteristic. Time perspective and interoception are also reviewed in the case of clinical conditions. We assess findings on interoceptive pathways in the body, finding convergence with balanced time perspective through the neuroanatomical lens. We conclude with findings that both dysregulated interoceptive states and a time perspective disbalance are recognized as defining features of mental disorders, proposing prospective practical therapeutic approaches, as well as implications for further research in the field.

What is the role of interoception in the symptom experience of people with a chronic condition? A systematic review

BACKGROUND

Interoception, the ability of the organism to sense, interpret, and regulate signals originating from within the body, plays an important role in how individuals perceive and respond to symptoms. However, there is scarce evidence on the role of interoception in the symptom experience of people with chronic conditions.

AIM

To synthesize the role of interoception in the symptom experience of adults with a chronic condition.

METHODS

Systematic review. We searched PubMed, Psychinfo, Embase, CINAHL, and Science Citation Index-Expanded. We included primary research (all study designs) addressing our study aim, published between 2013-2021, and measuring at least one dimension of interoception. Any chronic condition and any symptom were included. No language limits were applied. Only the adult population was included.

RESULTS

We included 18 quantitative studies investigating the relationship between three interoceptive dimensions (i.e., accuracy, sensibility, awareness) and condition-specific symptoms in 10 chronic conditions. People with chronic conditions had lower interoceptive accuracy than healthy controls. Higher interoceptive sensibility was associated with lower symptom severity/frequency. Higher interoceptive accuracy was associated with lower symptom severity/frequency in half of the studies, while the other half reported the opposite. Only one study explored interoceptive awareness.

CONCLUSION

Interoceptive abilities are lower in patients with chronic conditions. Higher interoceptive sensibility is associated with lower symptom severity/frequency, but this relationship is unclear when it comes to interoceptive accuracy and awareness.

Dyadic inter-brain EEG coherence induced by interoceptive hyperscanning

Previous single-brain studies suggested interoception plays a role in interpersonal synchronization. The aim of the present study was to assess the electrophysiological intersubject coherence through electrophysiological (EEG) hyperscanning recording during simple dyadic synchronization tasks when the participants focused on their breath. To this aim, the neural activity of 15 dyads of participants was collected during the execution of a cognitive and motor synchronization task in two distinct IA conditions: focus and no focus on the breath condition. Individuals' EEG frequency bands were recorded through EEG hyperscanning and coherence analysis was performed. Results showed greater EEG coherence was observed for the alpha band in frontopolar brain regions (Fp1, Fp2) and also in central brain regions (C3, C4) within the dyads, during the focus on the breath condition for the motor compared to the cognitive synchronization task; during the same experimental condition, delta and theta band showed augmented inter-individual coherence in the frontal region (Fz) and central areas (C3, C4). To conclude, the current hyperscanning study highlights how the manipulation of the interoceptive focus (obtained through the focus on the breath) strengthens the manifestation of the EEG markers of interpersonal tuning during a motor synchronization task in specific brain areas.

Pilot Study About the Effects of the Soma Experiencing Motion (Soma e-Motion) Program on Interoceptive Awareness and Self-Compassion

OBJECTIVE

The purpose of this study was to examine the effects of the Soma experiencing motion (Soma e-motion) program on interoceptive awareness and self-compassion among novices.

METHODS

A total of 19 adults (clinical group=9, non-clinical group=10) participated in the intervention. Psychological and physical changes after program were qualitatively analyzed using in-depth interviews. The Korean Multidimensional Assessment of Interoceptive Awareness (K-MAIA) and the Korean version of the Self-Compassion Scale (K-SCS) were used as quantitative measures.

RESULTS

The non-clinical group showed statistically significant differences in the K-MAIA scores (z=-2.805, p<0.01) and K-SCS scores (z=-2.191, p<0.05); however, the clinical group showed no significant differences (K-MAIA: z=-0.652, p>0.05; K-SCS: z=-0.178, p>0.05). According to the in-depth interviews, the results of the qualitative analysis were categorized into five dimensions (psychological and emotional, physical, cognitive, behavioral, and aspects participants found challenging and needs improvement).

CONCLUSION

The Soma e-motion program was feasible for improving interoceptive awareness and self-compassion in the non-clinical group. However, further research is needed to investigate the clinical efficacy of the Soma e-motion program for clinical group.

Making the Financial Case for Surgical Resident Well-being: A Scoping Review

OBJECTIVE

To conduct a scoping review of literature on financial implications of surgical resident well-being.

BACKGROUND

Surgeon well-being affects clinical outcomes, patient experience, and health care economics. However, our understanding of the relationship between surgical resident well-being and organizational finances is limited.

METHODS

Authors searched PubMed, Web of Science, and Embase with no date or language restrictions. Searches of the gray literature included hand references of articles selected for data extraction and reviewing conference abstracts from Embase. Two reviewers screened articles for eligibility based on title and abstract then reviewed eligible articles in their entirety. Data were extracted and analyzed using conventional content analysis.

RESULTS

Twenty-five articles were included, 5 (20%) published between 2003 and 2010, 12 (48%) between 2011 and 2018, and 8 (32%) between 2019 and 2021. One (4%) had an aim directly related to the research question, but financial implications were not considered from the institutional perspective. All others explored factors impacting well-being or workplace sequelae of well-being, but the economics of these elements were not the primary focus. Analysis of content surrounding financial considerations of resident well-being revealed 5 categories; however, no articles provided a comprehensive business case for investing in resident well-being from the institutional perspective.

CONCLUSIONS

Although the number of publications identified through the present scoping review is relatively small, the emergence of publications referencing economic issues associated with surgical resident well-being may suggest a growing recognition of this area's importance. This scoping review highlights a gap in the literature, which should be addressed to drive the system-level change needed to improve surgical resident well-being.

Conscious connected breathing with breath retention intervention in adults with chronic low back pain: protocol for a randomized controlled pilot study

BACKGROUND

Chronic pain is a major source of human suffering, and chronic low back pain (cLBP) is among the most prevalent, costly, and disabling of pain conditions. Due to the significant personal and societal burden and the complex and recurring nature of cLBP, self-management approaches that can be practiced at home are highly relevant to develop and test. The respiratory system is one of the most integrated systems of the body, and breathing is bidirectionally related with stress, emotion, and pain. Thus, the widespread physiological and psychological impact of breathing practices and breathwork interventions hold substantial promise as possible self-management strategies for chronic pain. The primary aim of the current randomized pilot study is to test the feasibility and acceptability of a conscious connected breathing with breath retention intervention compared to a sham control condition.

METHODS

The rationale and procedures for testing a 5-day conscious connected breathing with breath retention intervention, compared to a deep breathing sham control intervention, in 24 adults (18-65 years) with cLBP is described. Both interventions will be delivered using standardized audio recordings and practiced over 5 days (two times in-person and three times at-home), and both are described as Breathing and Attention Training to reduce possible expectancy and placebo effects common in pain research. The primary outcomes for this study are feasibility and acceptability. Feasibility will be evaluated by determining rates of participant recruitment, adherence, retention, and study assessment completion, and acceptability will be evaluated by assessing participants' satisfaction and helpfulness of the intervention. We will also measure other clinical pain, psychological, behavioral, and physiological variables that are planned to be included in a follow-up randomized controlled trial.

DISCUSSION

This will be the first study to examine the effects of a conscious connected breathing with breath retention intervention for individuals with chronic pain. The successful completion of this smaller-scale pilot study will provide data regarding the feasibility and acceptability to conduct a subsequent trial testing the efficacy of this breathing self-management practice for adults with cLBP.

TRIAL REGISTRATION

Clinicaltrials.gov, identifier NCT04740710 . Registered on 5 February 2021.

Injury, illness, and emotion: A review of the motivational continuum from trauma through recovery from an ecological perspective

Image 1.

Hair cortisol reduction and social integration enhancement after a mindfulness-based intervention in children

BACKGROUND

Over recent decades, chronic stress at an early age has become a worrying health problem in children. We seek to evaluate an intervention involving mindfulness-based practices and prosocial activities in 7- to 8-year-old children.

METHODS

Stress levels were determined using hair cortisol concentration (HCC), and social integration was measured by means of a sociogram. The program had previously proven to be effective in decreasing salivary cortisol levels and in favouring social integration in children. A total of 35 children participated in the study: 18 constituted the intervention group and 17 the wait-list group. In both groups, HCC and social integration were evaluated before and after the intervention conducted throughout an entire school year.

RESULTS

The experimental group showed a significant reduction in HCC, as well as significant enhancement of social integration levels, whereas no changes were observed in the wait-list group.

CONCLUSIONS

This is the first research to show that HCC, a reliable neuroendocrine indicator, decreased as a result of a mindfulness-based program. This successful outcome adds new evidence to previous findings regarding the reduction of chronic stress in children following participation in this program.

'My words become my hands': Yoga instructors' experiences of adapting teleyoga in the SAGE fall prevention trial-A qualitative analysis

Objective

This research identifies practical lessons regarding the delivery of teleyoga. Our objectives are to (1) describe challenges and opportunities experienced by yoga instructors when moving the Successful AGEing (SAGE) yoga programme online, and (2) describe how yoga instructors adapted to manage the challenges and leverage opportunities presented by teleyoga.

Methods

This study is a secondary analysis of the data from a previous realist process evaluation of the SAGE yoga trial. The SAGE yoga trial is testing the effect of a yoga-based exercise programme on falls among 700 community-dwelling people aged 60+ years. We draw on focus groups and interviews with four SAGE yoga instructors which we analysed using previously developed programme theories combined with inductive coding and an analytical workshop.

Results

The concerns of the yoga instructors about teleyoga can be characterised into four broad issues: threats to safety, altered interpersonal dynamics, facilitating mind-body connection and difficulties with technology. The SAGE instructors identified eight modifications they used to manage these challenges: a 1:1 participant interview prior to programme commencement, more descriptive verbal instructions, increased focus on interoception, increased attention and support, slower more structured class flow, simplifying poses, adapting the studio environment and IT support.

Conclusions

We have created a typology of strategies for addressing challenges in the delivery of teleyoga for older people. As well as maximising engagement with teleyoga, these manageable strategies could be applied by other instructors to a wide range of telehealth classes, improving the uptake and adherence of beneficial online programmes and services.

Does the practice of mindfulness reduce somatic symptoms and COVID-19-related anxiety? A community-based survey

Objective

Since the beginning of COVID-19 pandemic, several studies have shown an increase of psychological distress in the general population. Previous research demonstrated that high levels of anxiety are associated with reporting more somatic symptoms. The ability to adaptively regulate emotions is essential to deal with stressful situations, and it is one of the main components of mindfulness practice. The aim of the present study was to document the effect of mindfulness practice on somatic symptoms and psychological distress in the context of COVID-19 pandemic.

Methods

The study has a descriptive cross-sectional design. During the second wave of COVID-19 pandemic, between November 2020 and January 2021 participants living in France responded to an online survey on the impact of COVID-19 on psychological distress and physical health. The questionnaire included the assessment of COVID-19-related anxiety, mindfulness practice and experience, dispositional mindfulness, somatization, depression, generalized anxiety, and emotion regulation.

Results

A total of 569 people (mean age = 39.8 years, 90% women) were included in the study. COVID-19 related anxiety was associated with higher levels of somatic symptoms, generalized anxiety, and depression. About half of the sample (n = 318, 56%) reported moderate to severe somatic symptoms that were associated with higher levels of depression and anxiety, lower levels of dispositional mindfulness and to the use of maladaptive emotion regulation strategies. Overall, 164 subjects (28.8%) reported practicing meditation. No differences were found in dispositional mindfulness (MAAS score) between beginners and advanced practitioners, regardless of the type, years, frequency, and length of practice. Participants with less experience in mindfulness practice reported a significant higher number of somatic symptoms than non-practitioners and a higher use of rumination. Moreover, mindfulness experience was associated with the use of more adaptive emotion regulation strategies.

Conclusion

Mindfulness meditation has been promoted as a practice enhancing well-being and helping to cope with the psychological impact of stressful events. However, in a distressing situation as COVID-19 pandemic, a limited experience in mindfulness practices might result in the development or endurance of somatic symptoms. Adequate training and a focus on mindful acceptance, may contribute to enhance the effectiveness of mindfulness practice.

Mechanical Affective Touch Therapy for Anxiety Disorders: Effects on Resting State Functional Connectivity

OBJECTIVES

Mechanical Affective Touch Therapy (MATT) is a safe, novel form of noninvasive peripheral nerve stimulation. Although mechanical stimulation activates nerves, we know little about its impact on psychiatric symptoms and their underlying cortical mechanisms. We examined the effects of open-label MATT on resting state functional connectivity (RSFC) and its relationship with anxiety and affective symptomatology (clinical results in separate report).

MATERIALS AND METHODS

A total of 22 adults with an Axis I anxiety disorder were recruited from the community. After two initial sessions assisted by research staff, participants self-administered 20-minute sessions of MATT at home at least twice daily for four weeks. Self-report measures of mood and anxiety severity were collected at baseline, two weeks, and four weeks. Resting state functional magnetic resonance imaging was collected before the initial MATT session (n = 20), immediately after the first session (n = 18), and following four weeks of MATT (n = 14). Seed-based whole-brain functional connectivity analyses identified brain connectivity patterns correlated with responsiveness to MATT. Seeds were based on Neurosynth meta-analytic maps for "anxiety" and "pain" given MATT's hypothesized role in anxiety symptom amelioration and potential mechanism of action through C-tactile afferents, which play an important role in detecting pain and its affective components. Connectivity results were corrected for multiple comparisons (voxel p < 0.005, cluster p-FDR < 0.05).

RESULTS

Baseline RSFC is predictive of symptom improvement with chronic MATT. Acute increases in insula connectivity were observed between mid-cingulate cortex and postcentral motor regions following the first MATT session. Chronic MATT was associated with increased connectivity between pain and anxiety regions of interest (ROIs) and posterior default mode network (DMN) regions involved in memory and self-reflection; the connectivity changes correlated with decreases in stress and depression symptoms.

CONCLUSIONS

MATT is associated with alterations in RSFC in the DMN of anxiety disorder patients both acutely and after long-term administration, and baseline RSFC is predictive of post-treatment symptom improvement.

Transforming adversity into an ally: A qualitative study of “feeding your demons” meditation

Contemplative science has made great strides in the empirical investigation of meditation practices, such as how mindfulness, compassion, and mantra practices impact health and well-being. However, meditation practices from the Vajrayana Buddhist tradition that use mental imagery to transform distressing beliefs and emotions have been little explored. We examined the “Feeding Your Demons” meditation, a secular adaptation of the traditional Tibetan Vajrayana Buddhist meditation practice of Chöd (“Severance”) in a pilot, randomized controlled trial in which 61 community adults from the U.S. with prior meditation experience and moderate levels of depressive and anxiety symptoms (70% female)were randomly assigned to one month (15 meditation sessions) of “Feeding Your Demons” practice or a waitlist control group. Written diary entries were collected immediately after each meditation session. We used an Interpretive Phenomenological Analysis approach to examine qualitative responses to two questions which probed (1) how participants made meaning of each meditation session and (2) how they thought it may impact their future thoughts and intentions for action. Five major themes were identified based on 20 codes developed through an inductive review of written responses across all participants. The themes included an enhanced sense of self-worth and confidence, empathy for the “demon” or rejected parts of oneself, increased self-awareness, an active-oriented “fierce” self-compassion, and an acceptance form of self-compassion. Overall, participants expressed an ability to reframe, or transform, their relationship to distressing thoughts, emotions, and experiences as they gained personal insights, self-compassion, and acceptance through the meditation process which in turn shaped their future intentions for action in the world. This research suggests that a secular form of a Vajrayana Buddhist practice may be beneficial for Western meditation practitioners with no prior training in Vajrayana Buddhism. Future research is warranted to understand its longer-term impacts on health and well-being.

Interoception in Old Age

Emotion regulation in old age was found to be more efficient; seniors seem to focus less on the negative aspects of experiences. Here, we ask, do older individuals regulate their emotions more efficiently or are they numb to the physiological changes that modulate these emotions? Interoception, the perception of physical feelings, influences a person’s mood, emotions, and sense of well-being, and was hardly tested among older adults. We examined the awareness of physiological changes (physiological arousal—blood pressure and heart rate) of 47 older adults, compared to 18 young adults, and their subjective reports of emotional experiences while viewing emotional stimuli. Interoception was decreased in old age. Blood pressure medications had a partial role in this reduction. Moreover, interoception mediated emotional experience, such that low interoception led to lower experiences of changes in physiological arousal. These findings may account for the emotional changes in old age, suggesting a decline in sensitivity with age, which leads to a positive interpretation of information.

Relations among parent-reported physical activity and interoception in children

BACKGROUND

Interoception is the sense of one's internal body and emotional state; it plays a critical role in guiding self-regulatory behaviors. Physical activity (PA) can support interoceptive processes, but limited research has examined the association in children. This study explored the relations among parent-reported PA and several interoceptive domains in children aged 3 - 10 years old.

METHODS

Baseline data were analyzed from a cluster-randomized controlled study examining a yoga intervention (N = 122). Parents completed a questionnaire that included the Caregiver Questionnaire for Interoceptive Awareness, Second Edition (CQIA-2) and two measures of PA, the PROMIS Parent-Proxy Short Form (PROMIS-PA) and the adapted Burdette Proxy Report (aBPR-PA). Psychometrics of the CQIA-2 subscales were assessed and then used in subsequent analyses to examine the association between PA and interoceptive sensibility.

RESULTS

Seventy percent of the surveys were completed by mothers (30% by fathers), and their children (56% female, M_age = 5.81 ± 1.7 years) were predominately white. Across all children, PA had a significant positive relationship with interoceptive domains related to emotion and physical energy (p < 0.01). Children who met the PROMIS-PA "good" cutoff had a clearer sense of emotion and physical energy (F(2,115) = 4.30, p = 0.016, R² = 0.070), compared to children who did not. Children's age predicted interoceptive sensibility of illness and toileting needs (F(1,116) = 14.16, p < 0.001, R² = 0.109).

CONCLUSION

Children with higher PA levels were perceived to have better interoceptive sensibility of emotion and physical energy. Children's age was predictive of interoceptive domains representing the awareness of illness and toileting needs. Future work should consider incorporating direct measures of PA and child-reported interoceptive sensibility. A better understanding of their relationship will likely help guide the design of more effective interventions for health behavior development.

How childhood maltreatment alters perception and cognition - the predictive processing account of borderline personality disorder

Borderline personality disorder (BPD) is a severe mental disorder, comprised of heterogeneous psychological and neurobiological pathologies. Here, we propose a predictive processing (PP) account of BPD to integrate these seemingly unrelated pathologies. In particular, we argue that the experience of childhood maltreatment, which is highly prevalent in BPD, leaves a developmental legacy with two facets: first, a coarse-grained, alexithymic model of self and others - leading to a rigidity and inflexibility concerning beliefs about self and others. Second, this developmental legacy leads to a loss of confidence or precision afforded beliefs about the consequences of social behavior. This results in an over reliance on sensory evidence and social feedback, with concomitant lability, impulsivity and hypersensitivity. In terms of PP, people with BPD show a distorted belief updating in response to new information with two opposing manifestations: rapid changes in beliefs and a lack of belief updating despite disconfirmatory evidence. This account of distorted information processing has the potential to explain both the instability (of affect, self-image, and interpersonal relationships) and the rigidity (of beliefs about self and others) which is typical of BPD. At the neurobiological level, we propose that enhanced levels of dopamine are associated with the increased integration of negative social feedback, and we also discuss the hypothesis of an impaired inhibitory control of the prefrontal cortex in the processing of negative social information. Our account may provide a new understanding not only of the clinical aspects of BPD, but also a unifying theory of the corresponding neurobiological pathologies. We conclude by outlining some directions for future research on the behavioral, neurobiological, and computational underpinnings of this model, and point to some clinical implications of it.

Embodied Cognition in Meditation, Yoga, and Ethics-An Experimental Single-Case Study on the Differential Effects of Four Mind-Body Treatments

Yoga is an embodied contemplative practice considered as a path toward long-term well-being, which fosters an integrated processing of bodily and emotional stimuli. However, little is known about how the different components of yoga contribute to these processes. This was the aim of this single-case multiple-baseline study. Herein, we explored how different yoga components affect body awareness, emotion regulation, affectivity, self-compassion, and distress tolerance. Forty-two randomly assigned participants (from initially fifty-seven) completed one of four 8-week treatments: Mantra meditation alone (MA), meditation plus physical yoga (MY), meditation plus ethical education (ME), and meditation plus yoga and ethical education (MYE). Participants had no prior regular yoga or meditation practice. Data were analyzed using visual inspection, effect size estimation, and multilevel modeling. Surprisingly, all four treatments similarly improved body awareness (Tau-UMA = 0.21 to Tau-UMY = 0.49), emotion regulation (Tau-UMYE = -0.43 to Tau-UME = -0.52), self-compassion (η2 = 0.08), and distress tolerance (η2 = 0.13). These effects were maintained until follow-up at 2 and 12 months after the study, even though home practice declined. The MA condition had the least favorable effect on affective experience (Tau-UMA = -0.14 and 0.07), while the ME condition enhanced valence the most (Tau-UME = 0.10) and the MY condition was the most effective in preventing negative affective responses. Although mantra meditation on its own negatively influenced daily affect, it can be assumed as the driving force behind the improvement in the other variables. This points to the central role of meditation in increasing interoception, self-awareness, and embodied processing.

Brain-heart interactions are modulated across the respiratory cycle via interoceptive attention

Respiration and heartbeat continuously interact within the living organism at many different levels, representing two of the main oscillatory rhythms of the body and providing major sources of interoceptive information to the brain. Despite the modulatory effect of respiration on exteroception and cognition has been recently established in humans, its role in shaping interoceptive perception has been scarcely investigated so far. In two independent studies, we investigated the effect of spontaneous breathing on cardiac interoception by assessing the Heartbeat Evoked Potential (HEP) in healthy humans. In Study 1, we compared HEP activity for heartbeats occurred during inhalation and exhalation in 40 volunteers at rest. We found higher HEP amplitude during exhalation, compared to inhalation, over fronto-centro-parietal areas. This suggests increased brain-heart interactions and improved cortical processing of the heartbeats during exhalation. Further analyses revealed that this effect was moderated by heart rate changes. In Study 2, we tested the respiratory phase-dependent modulation of HEP activity in 20 volunteers during Exteroceptive and Interoceptive conditions of the Heartbeat Detection (HBD) task. In these conditions, participants were requested to tap at each heartbeat, either listened to or felt, respectively. Results showed higher HEP activity and higher detection accuracy at exhalation than inhalation in the Interoceptive condition only. Direct comparisons of Interoceptive and Exteroceptive conditions confirmed stronger respiratory phase-dependent modulation of HEP and accuracy when attention was directed towards the interoceptive stimuli. Moreover, HEP changes during the Interoceptive condition were independent of heart physiology, but were positively correlated with higher detection accuracy at exhalation than inhalation. This suggests a link between optimization of cortical processing of cardiac signals and detection of heartbeats across the respiratory cycle. Overall, we provide data showing that respiration shapes cardiac interoception at the neurophysiological and behavioural levels. Specifically, exhalation may allow attentional shift towards the internal bodily states.

Interoception Underlies Therapeutic Effects of Mindfulness Meditation for Posttraumatic Stress Disorder: A Randomized Clinical Trial

BACKGROUND

Mindfulness-based interventions have proven efficacy in treating posttraumatic stress disorder (PTSD), but the neurobiological mechanism underlying the therapeutic effects is unknown. As mindfulness meditation cultivates attention to the present moment and bodily sensations, neural functions related to interoception (i.e., central processes of bodily signals) might be such a mechanism.

METHODS

We conducted a clinical trial in which veterans with PTSD were randomly assigned to receive an 8-week mindfulness-based stress reduction (MBSR) intervention (n = 47) or an active control intervention (present-centered group therapy; n = 51). We assessed pre- and postintervention PTSD symptoms and electroencephalography measures of neural outcomes, including spontaneous brain activity, cognitive task-related brain responses, and interoceptive brain responses (heartbeat-evoked brain responses). We conducted statistical causal mediation analyses using treatment type as a predictor, pre- and postintervention measures of symptom severity as treatment response, and the neural outcomes as mediators.

RESULTS

Compared with the control group, the MBSR group had greater improvements in PTSD symptoms and increases in spontaneous alpha power (8-13 Hz), task-related frontal theta power (4-7 Hz in 140-220 ms after stimulus), and frontal theta heartbeat-evoked brain responses (3-5 Hz and 265-336 ms after R peak). The mediation analysis using latent difference score modeling revealed that only changes in frontal theta heartbeat-evoked brain responses mediated the MBSR treatment effect.

CONCLUSIONS

Mindfulness meditation improves brain functions of attentional control and resting brain states reflective of internally oriented relaxation. However, interoceptive neural functions enhanced by MBSR seem to be a primary cerebral mechanism that improves symptoms of PTSD.

Interoceptive awareness and self-regulation contribute to psychosomatic competence as measured by a new inventory

BACKGROUND

The interrelation of interoception, cognitive appraisal of bodily signals and conscious self-regulatory behavior is insufficiently understood although it may be relevant for health and disease. Therefore, it was intended to develop a novel self-report measure targeting this link.

METHODS

Item development was theoretically based on the multidimensional conceptual framework of the psychosomatic intelligence hypothesis and included an iterative process of refinement of items. In a preliminary test a principal components analysis (PROMAX rotation) and item analysis were calculated for item reduction. In the field test an item response theory approach was used for development of final scales and items. For validation purposes, associations with established measures of related constructs were analyzed.

RESULTS

The final 44-item questionnaire consisted of 6 interrelated scales: (1) interoceptive awareness, (2) mentalization, (3) body-related cognitive congruence, (4) body-related health literacy, (5) general self-regulation, and (6) stress experience and stress regulation. Psychometric properties of this instrument demonstrated good model fit, internal consistency and construct validity. According to the validation, the final instrument measures a form of competence rather than intelligence and was termed the psychosomatic competence inventory.

CONCLUSION

Interoceptive awareness and conscious body-related self-regulation seem to jointly contribute to a basic competence which may serve homeostatic/allostatic control; however, further research is needed to confirm the reported preliminary findings in a large-scale test.

Self-Reported Body Awareness: Validation of the Postural Awareness Scale and the Multidimensional Assessment of Interoceptive Awareness (Version 2) in a Non-clinical Adult French-Speaking Sample

Body awareness refers to the individual ability to process signals originating from within the body, which provide a mapping of the body's internal landscape (interoception) and its relation with space and movement (proprioception). The present study aims to evaluate psychometric properties and validate in French two self-report measures of body awareness: the Postural Awareness Scale (PAS), and the last version of the Multidimensional Assessment of Interoceptive Awareness questionnaire (version 2, MAIA-2). We collected data in a non-clinical, adult sample (N = 308; 61% women, mean age 35 ± 12 years) using online survey, and a subset of the original sample (n = 122; 62% women, mean age 44 ± 11 years) also completed the retest control. Factor analyses and reliability analyses were conducted. Construct validity of the PAS and the MAIA-2 were examined by testing their association with each other, and with self-report measures of personality (Big Five Inventory), alexithymia (Toronto Alexithymia Scale) and dispositional trait mindfulness (Freiburg Mindfulness Inventory). Factor analyses of the PAS supported the same two-factor structure as previously published versions (in other languages). For the MAIA-2, factor analyses suggested that a six-factor structure, excluding Not-Worrying and Not-Distracting factors, could successfully account for a common general factor of self-reported interoception. We found satisfactory internal consistency, construct validity, and reliability over time for both the PAS and the MAIA-2. Altogether, our findings suggest that the French version of the PAS and the MAIA-2 are reliable self-report tools to assess both components of body awareness (proprioception and interoception dimension, respectively).

What Next After MBSR/MBCT? An Open Trial of an 8-Week Follow-on Program Exploring Mindfulness of Feeling Tone (vedanā)

Objectives

The effectiveness of mindfulness-based programs (MBPs) has been established in many randomized controlled trials. However, effect sizes are often modest, and there remains ample scope to improve their effectiveness. One approach to this challenge is to offer a “follow-on” course to people who have completed an MBP and are interested in further skill development. We developed and tested a new 8-week course for this purpose based on awareness of feeling tone (vedanā), an understudied aspect of mindfulness in many current MBPs, incorporating new developments in neuroscience and trauma sensitivity. We examined its effectiveness and the frequency and severity of unpleasant experience and harm.

Methods

In an open trial, 83 participants, 78 of whom had previously taken part in an MBP (majority MBSR or MBCT), completed the program in nine groups. Participants completed questionnaires before and after and gave qualitative written feedback at completion.

Results

Participants reported significantly reduced depression (d = 0.56), stress (d = 0.36), and anxiety (d = 0.53) and increased well-being (d = 0.54) and mindfulness (d = 0.65) with 38% meeting criteria for reliable change on anxiety and depression. As expected, about three-quarters of participants reported some unpleasant experiences associated with mindfulness practice during the course, but none reported harm. Five participants showed “reliable deterioration” (an increase) in either depression or anxiety, but four of these five also gave anonymous qualitative feedback describing benefits of the course.

Conclusions

Findings support the added value of a follow-on course based on the exploration of feeling tone for participants who have a range of previous mindfulness experience.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12671-022-01929-0.

Mindfulness, Interoception, and the Body

In recent years, there has been a surge of interest in the topics of interoception and mindfulness from researchers, clinicians, and the general public alike (e [...]

Disentangling the role of interoceptive sensibility in alexithymia, emotion dysregulation, and depression in healthy individuals

Interoception, a multifaceted concept defined as the perception of internal bodily signals, is crucially involved in mental health in general and in emotion regulation in particular, being interoceptive sensibility (IS) one of the most studied interoceptive processes. The main objective of this study was to explore the relationships between IS and emotion regulation processes, analyzing the role of the eight IS dimensions assessed by the Multidimensional Assessment of Interoceptive Awareness-2 (MAIA-2) in alexithymia, emotion dysregulation, and depression. Additionally, this study also aimed to validate the MAIA-2 in a Spanish sample. To do so, 391 healthy adults, native Peninsular Spanish speakers (61.0% women, Mage = 29.00, SDage = 11.40), completed the MAIA-2 and other self-reported questionnaires to measure alexithymia, emotion dysregulation, and depressive symptoms. Results showed that lower scores on the IS dimensions that involve an accepting attitude toward the bodily signals (e.g., not-worrying) were related to alexithymia and emotion dysregulation, which, in turn, predicted depression. Moreover, the eight-factor structure of the MAIA-2 was confirmed with acceptable fit indices. This study highlights the multidimensional nature of the IS and the relevance of IS dimensions that involve a positive appraisal of the body in regulating emotions.

Meditative and Mindfulness-Focused Interventions in Neurology: Principles, Science, and Patient Selection

A growing body of research suggests that meditative- and mindfulness-focused interventions may improve neuropsychiatric symptoms that commonly occur in a range of neurological disorders. In this article, the principles of meditation and mindfulness are first defined, as well as briefly describing the neurobiological mechanisms implicated in these interventions. Thereafter, a range of meditative- and mindfulness-focused interventions are detailed, along with their supporting evidence to treat neuropsychiatric symptoms in neurological conditions (e.g., headache, movement disorders, chronic pain, etc.). Overall, these interventions warrant further investigation among individuals with neurological conditions. When recommending these interventions, health care professionals must consider a combination of structural (e.g., insurance reimbursement) and patient factors (e.g., ability to tolerate a group setting).

Effectiveness of yoga training programs to reduce depression and improve resilience of single mothers

Single mothers are vulnerable to mental health such as depression, but emotional support is insufficient. Yoga is known to be effective in reducing negative emotions and promoting resilience. This study was conducted in order to verify the effectiveness of yoga training programs in reducing depression and improving the resilience of single mothers. Participants in the study included 20 single mothers who belonged to the Single Mothers Association, who were randomly assigned to training (n=10) and nontraining (n=10) groups. The yoga training program for single mothers consisted of Asana yoga, meditation, and mind expression through expert meetings; a total of eight sessions were conducted once a week for 120 min. Testing for depression and resilience was performed before and after the program in order to verify the effectiveness of the program. According to the results of the study, depression in single mothers who participated in the yoga training program was significantly decreased, and resilience was significantly increased. Therefore, the effectiveness of the yoga training program in lowering the depression of single mothers and improving resilience was confirmed. In the future conduct of many studies will be required in order to help the mental health of single mothers.

Flourishing as a guide to intervention: a national multicenter study of general surgery residents

Purpose

Physician wellbeing is critical to maximize patient experience, quality of care, and healthcare value. Objective measures to guide and assess efficacy of interventions in terms of enhanced thriving (as opposed to just decreased pathology) have been limited. Here we provide early data on modifiable targets, potential interventions, and comparative impact.

Methods

In this cross-sectional survey-based study of mixed-level residents at 16 academic General Surgery training programs, gender-identity, race, post-graduate year, and gap years were self-reported. Correlation between our primary outcome variable, flourishing, and measures of resilience (mindfulness, personal accomplishment [PA], workplace support, workplace control) and risk (depression, emotional exhaustion, depersonalization, perceived stress, anxiety, workplace demand) were assessed.

Results

Of 891 recipients, 300 responded (60% non-male, 41% non-white). Flourishing was significantly positively correlated with all measured resilience factors and negatively correlated with all measured risk factors. In multivariable modelling, mindfulness, PA, and workplace support were positively and significantly associated with flourishing, with PA having the strongest resilience effect. Depression and anxiety were negatively and significantly associated with flourishing, with depression having the strongest risk effect.

Conclusions

Our results suggest that interventions that increase mindfulness, workplace support, and PA, as well as those that decrease depression and anxiety may particularly impact flourishing (i.e., global wellbeing) in surgical trainees. These findings provide preliminary guidance on allocation of resources toward wellbeing interventions. In particular, cognitive (i.e., mindfulness) training is a feasible intervention with modest but significant association with flourishing, and potential indirect effects through influence on PA, anxiety and depression.

Supplementary Information

The online version contains supplementary material available at 10.1007/s44186-022-00014-3.

Steady-state visual evoked potentials differentiate between internally and externally directed attention

While attention to external visual stimuli has been extensively studied, attention directed internally towards mental contents (e.g., thoughts, memories) or bodily signals (e.g., breathing, heartbeat) has only recently become a subject of increased interest, due to its relation to interoception, contemplative practices and mental health. The present study aimed at expanding the methodological toolbox for studying internal attention, by examining for the first time whether the steady-state visual evoked potential (ssVEP), a well-established measure of attention, can differentiate between internally and externally directed attention. To this end, we designed a task in which flickering dots were used to generate ssVEPs, and instructed participants to count visual targets (external attention condition) or their heartbeats (internal attention condition). We compared the ssVEP responses between conditions, along with alpha-band activity and the heartbeat evoked potential (HEP) - two electrophysiological measures associated with internally directed attention. Consistent with our hypotheses, we found that both the magnitude and the phase synchronization of the ssVEP decreased when attention was directed internally, suggesting that ssVEP measures are able to differentiate between internal and external attention. Additionally, and in line with previous findings, we found larger suppression of parieto-occipital alpha-band activity and an increase of the HEP amplitude in the internal attention condition. Furthermore, we found a trade-off between changes in ssVEP response and changes in HEP and alpha-band activity: when shifting from internal to external attention, increase in ssVEP response was related to a decrease in parieto-occipital alpha-band activity and HEP amplitudes. These findings suggest that shifting between external and internal directed attention prompts a re-allocation of limited processing resources that are shared between external sensory and interoceptive processing.

Neurofeedback-Augmented Mindfulness Training Elicits Distinct Responses in the Subregions of the Insular Cortex in Healthy Adolescents

Mindfulness training (MT) reduces self-referential processing and promotes interoception, the perception of sensations from inside the body, by increasing one’s awareness of and regulating responses to them. The posterior cingulate cortex (PCC) and the insular cortex (INS) are considered hubs for self-referential processing and interoception, respectively. Although MT has been consistently found to decrease PCC, little is known about how MT relates to INS activity. Understanding links between mindfulness and interoception may be particularly important for informing mental health in adolescence, when neuroplasticity and emergence of psychopathology are heightened. We examined INS activity during real-time functional magnetic resonance imaging neurofeedback-augmented mindfulness training (NAMT) targeting the PCC. Healthy adolescents (N = 37; 16 female) completed the NAMT task, including Focus-on-Breath (MT), Describe (self-referential processing), and Rest conditions, across three neurofeedback runs and two non-neurofeedback runs (Observe, Transfer). Regression coefficients estimated from the generalized linear model were extracted from three INS subregions: anterior (aINS), mid (mINS), and posterior (pINS). Mixed model analyses revealed the main effect of run for Focus-on-Breath vs. Describe contrast in aINS [R2 = 0.39] and pINS [R2 = 0.33], but not mINS [R2 = 0.34]. Post hoc analyses revealed greater aINS activity and reduced pINS activity during neurofeedback runs, and such activities were related to lower self-reported life satisfaction and less pain behavior, respectively. These findings revealed the specific involvement of insula subregions in rtfMRI-nf MT.