101
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Palaniyappan L, Venkatasubramanian G. The Bayesian brain and cooperative communication in schizophrenia. J Psychiatry Neurosci 2022; 47:E48-E54. [PMID: 35135834 PMCID: PMC8834248 DOI: 10.1503/jpn.210231] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Lena Palaniyappan
- From the Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, Ont., Canada (Palaniyappan); the Robart Research Institute & Lawson Health Research Institute, London, Ont., Canada (Palaniyappan); and the InSTAR Program, Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, India (Venkatasubramanian)
| | - Ganesan Venkatasubramanian
- From the Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, Ont., Canada (Palaniyappan); the Robart Research Institute & Lawson Health Research Institute, London, Ont., Canada (Palaniyappan); and the InSTAR Program, Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, India (Venkatasubramanian)
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102
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Suksasilp C, Garfinkel SN. Towards a comprehensive assessment of interoception in a multi-dimensional framework. Biol Psychol 2022; 168:108262. [DOI: 10.1016/j.biopsycho.2022.108262] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 01/05/2022] [Accepted: 01/08/2022] [Indexed: 12/25/2022]
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103
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Villiger D. How Psychedelic-Assisted Treatment Works in the Bayesian Brain. Front Psychiatry 2022; 13:812180. [PMID: 35360137 PMCID: PMC8963812 DOI: 10.3389/fpsyt.2022.812180] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/11/2022] [Indexed: 11/25/2022] Open
Abstract
Psychedelics are experiencing a renaissance in clinical research. In recent years, an increasing number of studies on psychedelic-assisted treatment have been conducted. So far, the results are promising, suggesting that this new (or rather, rediscovered) form of therapy has great potential. One particular reason for that appears to be the synergistic combination of the pharmacological and psychotherapeutic interventions in psychedelic-assisted treatment. But how exactly do these two interventions complement each other? This paper provides the first account of the interaction between pharmacological and psychological effects in psychedelic-assisted treatment. Building on the relaxed beliefs under psychedelics (REBUS) hypothesis of Carhart-Harris and Friston and the contextual model of Wampold, it argues that psychedelics amplify the common factors and thereby the remedial effects of psychotherapy. More precisely, psychedelics are assumed to attenuate the precision of high-level predictions, making them more revisable by bottom-up input. Psychotherapy constitutes an important source of such input. At best, it signalizes a safe and supportive environment (cf. setting) and induces remedial expectations (cf. set). During treatment, these signals should become incorporated when high-level predictions are revised: a process that is hypothesized to occur as a matter of course in psychotherapy but to get reinforced and accelerated under psychedelics. Ultimately, these revisions should lead to a relief of symptoms.
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Affiliation(s)
- Daniel Villiger
- Department of Psychosomatics and Psychotherapy, Psychiatric University Hospital Basel, University of Basel, Basel, Switzerland.,Institute of Philosophy, University of Zurich, Zurich, Switzerland
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104
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Harrison OK, Köchli L, Marino S, Luechinger R, Hennel F, Brand K, Hess AJ, Frässle S, Iglesias S, Vinckier F, Petzschner FH, Harrison SJ, Stephan KE. Interoception of breathing and its relationship with anxiety. Neuron 2021; 109:4080-4093.e8. [PMID: 34672986 PMCID: PMC8691949 DOI: 10.1016/j.neuron.2021.09.045] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 09/01/2021] [Accepted: 09/23/2021] [Indexed: 01/22/2023]
Abstract
Interoception, the perception of internal bodily states, is thought to be inextricably linked to affective qualities such as anxiety. Although interoception spans sensory to metacognitive processing, it is not clear whether anxiety is differentially related to these processing levels. Here we investigated this question in the domain of breathing, using computational modeling and high-field (7 T) fMRI to assess brain activity relating to dynamic changes in inspiratory resistance of varying predictability. Notably, the anterior insula was associated with both breathing-related prediction certainty and prediction errors, suggesting an important role in representing and updating models of the body. Individuals with low versus moderate anxiety traits showed differential anterior insula activity for prediction certainty. Multi-modal analyses of data from fMRI, computational assessments of breathing-related metacognition, and questionnaires demonstrated that anxiety-interoception links span all levels from perceptual sensitivity to metacognition, with strong effects seen at higher levels of interoceptive processes.
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Affiliation(s)
- Olivia K Harrison
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland; Department of Psychology, University of Otago, Dunedin, New Zealand; Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
| | - Laura Köchli
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Stephanie Marino
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Roger Luechinger
- Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Franciszek Hennel
- Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Katja Brand
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Alexander J Hess
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Stefan Frässle
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Sandra Iglesias
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Fabien Vinckier
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland; Université de Paris, Paris, France; Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie & Neurosciences, Paris, France
| | - Frederike H Petzschner
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Samuel J Harrison
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland; Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Klaas E Stephan
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland; Max Planck Institute for Metabolism Research, Cologne, Germany
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105
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Riva G, Serino S, Di Lernia D, Pagnini F. Regenerative Virtual Therapy: The Use of Multisensory Technologies and Mindful Attention for Updating the Altered Representations of the Bodily Self. Front Syst Neurosci 2021; 15:749268. [PMID: 34803617 PMCID: PMC8595209 DOI: 10.3389/fnsys.2021.749268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/04/2021] [Indexed: 12/25/2022] Open
Abstract
The term “regenerative medicine” (RM) indicates an emerging trend in biomedical sciences that aims at replacing, engineering, or regenerating human cells, tissues, or organs to restore or establish normal function. So far, the focus of RM has been the physical body. Neuroscience, however, is now suggesting that mental disorders can be broadly characterized by a dysfunction in the way the brain computes and integrates the representations of the inner and outer body across time [bodily self-consciousness (BSC)]. In this perspective, we proposed a new kind of clinical intervention, i.e., “Regenerative Virtual Therapy” (RVT), which integrates knowledge from different disciplines, from neuroscience to computational psychiatry, to regenerate a distorted or faulty BSC. The main goal of RVT was to use technology-based somatic modification techniques to restructure the maladaptive bodily representations behind a pathological condition. Specifically, starting from a Bayesian model of our BSC (i.e., body matrix), we suggested the use of mindful attention, cognitive reappraisal, and brain stimulation techniques merged with high-rewarding and novel synthetic multisensory bodily experience (i.e., a virtual reality full-body illusion in sync with a low predictabIlity interoceptive modulation) to rewrite a faulty experience of the body and to regenerate the wellbeing of an individual. The use of RVT will also offer an unprecedented experimental overview of the dynamics of our bodily representations, allowing the reverse-engineering of their functioning for hacking them using advanced technologies.
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Affiliation(s)
- Giuseppe Riva
- Applied Technology for Neuro-Psychology Laboratory, Istituto Auxologico Italiano, Milan, Italy.,Humane Technology Laboratory, Università Cattolica del Sacro Cuore, Milan, Italy.,Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Silvia Serino
- Humane Technology Laboratory, Università Cattolica del Sacro Cuore, Milan, Italy.,Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Daniele Di Lernia
- Humane Technology Laboratory, Università Cattolica del Sacro Cuore, Milan, Italy.,Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Francesco Pagnini
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.,Department of Psychology, Harvard University, Cambridge, MA, United States
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106
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Interoception abnormalities in schizophrenia: A review of preliminary evidence and an integration with Bayesian accounts of psychosis. Neurosci Biobehav Rev 2021; 132:757-773. [PMID: 34823914 DOI: 10.1016/j.neubiorev.2021.11.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/31/2021] [Accepted: 11/13/2021] [Indexed: 01/07/2023]
Abstract
Schizophrenia research has traditionally focused almost exclusively on how the brain interprets the outside world. However, our internal bodily milieu is also central to how we interpret the world and construct our reality: signals from within the body are critical for not only basic survival, but also a wide range of brain functions from basic perception, emotion, and motivation, to sense of self. In this article, we propose that interoception-the processing of bodily signals-may have implications for a wide range of clinical symptoms in schizophrenia and may thus provide key insights into illness mechanisms. We start with an overview of interoception pathways. Then we provide a review of direct and indirect findings in various interoceptive systems in schizophrenia and interpret these findings in the context of computational frameworks that model interoception as hierarchical Bayesian inference. Finally, we propose a conceptual model of how altered interoceptive inference may contribute to specific schizophrenia symptoms-negative symptoms in particular-and suggest directions for future research, including potential new avenues of treatment.
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107
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Hausteiner-Wiehle C, Henningsen P. [Body Experience and Body Interaction in Psychotherapeutic Diagnostics]. Psychother Psychosom Med Psychol 2021; 72:216-224. [PMID: 34781383 DOI: 10.1055/a-1641-0400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Since they are core features of many mental and psychosomatic disorders, disturbances of body experience and body interaction are relevant to understand and treat a particular patient. There are several body-related constructs, standardized psychometric instruments and experiments, focusing on single facets and following categorized evaluation. However, there is a lack of terminology and methods to individually and situationally understand and use body experience and body interaction in everyday clinical psychotherapeutic diagnostics. Based on clinical experience and a broad, topic-focused literature research, this discussion agenda delineates their core dimensions - bodily perception, body language, bodily changes, body-related narratives and actions, bodily resonance - and how to approach them by observation, mentalization, and relatedness.
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Affiliation(s)
- Constanze Hausteiner-Wiehle
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, Deutschland.,Psychosomatischer Konsil- und Liaisondienst, Neurologie, Klinische Neurophysiologie und Stroke Unit, Berufsgenossenschaftliche Unfallklinik Murnau, Deutschland
| | - Peter Henningsen
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, Deutschland
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108
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Joshi V, Graziani P, Del-Monte J. The Role of Interoceptive Attention and Appraisal in Interoceptive Regulation. Front Psychol 2021; 12:714641. [PMID: 34759862 PMCID: PMC8573205 DOI: 10.3389/fpsyg.2021.714641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/01/2021] [Indexed: 12/29/2022] Open
Abstract
Interoception, i.e., the processing and integration of sensory information has gained research interest due to its relevance in the psychopathological context. In the present review, we focus upon interoceptive regulation or one’s capacity to match bodily signals to his/her desired state by altering the signal or the desired state. More specifically, we discuss attention toward and appraisal of interoceptive stimuli as regulatory mechanisms of interoception. We review findings in the emerging research area of interoceptive attention. Studies suggest that the quality of attention and the nature of appraisal regarding interoceptive information influence interoceptive regulation and subsequent adaptive or maladaptive behavioral strategies among healthy controls as well as clinical populations. We discuss the clinical implications and the need to promote further research as well as to target interoceptive attention and appraisal mechanisms in psychotherapy.
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Affiliation(s)
- Vrutti Joshi
- Department of Psychology, University of Nîmes, Nîmes, France.,Social Psychology Laboratory EA 849, Aix-Marseille University, Marseille, France
| | - Pierluigi Graziani
- Department of Psychology, University of Nîmes, Nîmes, France.,Social Psychology Laboratory EA 849, Aix-Marseille University, Marseille, France
| | - Jonathan Del-Monte
- Department of Psychology, University of Nîmes, Nîmes, France.,Social Psychology Laboratory EA 849, Aix-Marseille University, Marseille, France
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109
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Bohlen L, Shaw R, Cerritelli F, Esteves JE. Osteopathy and Mental Health: An Embodied, Predictive, and Interoceptive Framework. Front Psychol 2021; 12:767005. [PMID: 34777176 PMCID: PMC8578726 DOI: 10.3389/fpsyg.2021.767005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/06/2021] [Indexed: 11/13/2022] Open
Abstract
Globally, mental and musculoskeletal disorders present with high prevalence, disease burden, and comorbidity. In order to improve the quality of care for patients with persistent physical and comorbid mental health conditions, person-centered care approaches addressing psychosocial factors are currently advocated. Central to successful person-centered care is a multidisciplinary collaboration between mental health and musculoskeletal specialists underpinned by a robust therapeutic alliance. Such a collaborative approach might be found in osteopathy, which is typically utilized to treat patients with musculoskeletal disorders but may arguably also benefit mental health outcomes. However, research and practice exploring the reputed effect of osteopathy on patients with mental health problems lack a robust framework. In this hypothesis and theory article, we build upon research from embodied cognition, predictive coding, interoception, and osteopathy to propose an embodied, predictive and interoceptive framework that underpins osteopathic person-centered care for individuals with persistent physical and comorbid mental health problems. Based on the premise that, for example, chronic pain and comorbid depression are underlined by overly precise predictions or imprecise sensory information, we hypothesize that osteopathic treatment may generate strong interoceptive prediction errors that update the generative model underpinning the experience of pain and depression. Thus, physical and mental symptoms may be reduced through active and perceptual inference. We discuss how these theoretical perspectives can inform future research into osteopathy and mental health to reduce the burden of comorbid psychological factors in patients with persistent physical symptoms and support person-centered multidisciplinary care in mental health.
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Affiliation(s)
- Lucas Bohlen
- Osteopathic Research Institute, Osteopathie Schule Deutschland, Hamburg, Germany
| | - Robert Shaw
- Scandinavian College of Osteopathy, Gothenburg, Sweden
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Ultimo, NSW, Australia
| | - Francesco Cerritelli
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Ultimo, NSW, Australia
- Clinical-based Human Research Department, Foundation COME Collaboration, Pescara, Italy
| | - Jorge E. Esteves
- Clinical-based Human Research Department, Foundation COME Collaboration, Pescara, Italy
- Research Department, University College of Osteopathy, London, United Kingdom
- International College of Osteopathic Medicine, Malta, Italy
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110
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Hodossy L, Ainley V, Tsakiris M. How do we relate to our heart? Neurobehavioral differences across three types of engagement with cardiac interoception. Biol Psychol 2021; 165:108198. [PMID: 34624402 DOI: 10.1016/j.biopsycho.2021.108198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 11/30/2022]
Abstract
Standard measures of interoception are typically limited to the conscious perception of heartbeats. However, the fundamental purpose of interoceptive signaling, is to regulate the body. We present a novel biofeedback paradigm to explore the neurobehavioral consequences of three different types of engagement with cardiac interoception (Attend, Feel, Regulate) while participants perform a 'cardiac recognition' task. For both the Feel and Regulate conditions, participants displayed enhanced recognition of their own heartbeat, accompanied by larger heartbeat-evoked potentials (HEPs), suggesting that these approaches could be used interchangeably. Importantly, meta-cognitive interoceptive insight was highest in the Regulate condition, indicative of stronger engagement with interoceptive signals in addition to greater ecological validity. Only in the passive interoception condition (Feel) was a significant association found between accuracy in recognising one's own heartbeat and the amplitude of HEPs. Overall, our results imply that active conditions have an important role to play in future investigation of interoception.
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Affiliation(s)
- Lilla Hodossy
- Lab of Action and Body, Department of Psychology, Royal Holloway, University of London, United Kingdom
| | - Vivien Ainley
- Lab of Action and Body, Department of Psychology, Royal Holloway, University of London, United Kingdom
| | - Manos Tsakiris
- Lab of Action and Body, Department of Psychology, Royal Holloway, University of London, United Kingdom; Centre for the Politics of Feelings, School of Advanced Study, University of London, United Kingdom; Department of Behavioural and Cognitive Sciences, Faculty of Humanities, Education and Social Sciences, University of Luxembourg, Luxembourg.
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111
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Harrison OK, Marlow L, Finnegan SL, Ainsworth B, Pattinson KTS. Dissociating breathlessness symptoms from mood in asthma. Biol Psychol 2021; 165:108193. [PMID: 34560173 PMCID: PMC9355895 DOI: 10.1016/j.biopsycho.2021.108193] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 09/09/2021] [Accepted: 09/16/2021] [Indexed: 12/21/2022]
Abstract
It is poorly understood why asthma symptoms are often discordant with objective medical tests. Differences in interoception (perception of internal bodily processes) may help explain symptom discordance, which may be further influenced by mood and attention. We explored inter-relationships between interoception, mood and attention in 63 individuals with asthma and 30 controls. Questionnaires, a breathing-related interoception task, two attention tasks, and standard clinical assessments were performed. Questionnaires were analysed using exploratory factor analysis, and linear regression examined relationships between measures. K-means clustering also defined asthma subgroups. Two concordant asthma subgroups (symptoms related appropriately to pathophysiology, normal mood) and one discordant subgroup (moderate symptoms, minor pathophysiology, low mood) were found. In all participants, negative mood correlated with decreased interoceptive ability and faster reaction times in an attention task. Our findings suggest that interpreting bodily sensations relates to mood, and this effect may be heightened in subgroups of individuals with asthma.
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Affiliation(s)
- Olivia K Harrison
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Switzerland; Department of Psychology, University of Otago, Dunedin, New Zealand; Wellcome Centre for Integrative Neuroimaging, and Nuffield Division of Anaesthetics, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom
| | - Lucy Marlow
- Wellcome Centre for Integrative Neuroimaging, and Nuffield Division of Anaesthetics, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Sarah L Finnegan
- Wellcome Centre for Integrative Neuroimaging, and Nuffield Division of Anaesthetics, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom
| | - Ben Ainsworth
- Department of Psychology, University of Bath, United Kingdom
| | - Kyle T S Pattinson
- Wellcome Centre for Integrative Neuroimaging, and Nuffield Division of Anaesthetics, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom.
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112
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Unal O, Eren OC, Alkan G, Petzschner FH, Yao Y, Stephan KE. Inference on homeostatic belief precision. Biol Psychol 2021; 165:108190. [PMID: 34547398 DOI: 10.1016/j.biopsycho.2021.108190] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 09/07/2021] [Accepted: 09/10/2021] [Indexed: 01/19/2023]
Abstract
Interoception and homeostatic/allostatic control are intertwined branches of closed-loop brain-body interactions (BBI). Given their importance in mental and psychosomatic disorders, establishing computational assays of BBI represents a clinically important but methodologically challenging endeavor. This technical note presents a novel approach, derived from a generic computational model of homeostatic/allostatic control that underpins (meta)cognitive theories of affective and psychosomatic disorders. This model views homeostatic setpoints as probability distributions ("homeostatic beliefs") whose parameters determine regulatory efforts and change dynamically under allostatic predictions. In particular, changes in homeostatic belief precision, triggered by anticipated threats to homeostasis, are thought to alter cerebral regulation of bodily states. Here, we present statistical procedures for inferring homeostatic belief precision from measured bodily states and/or regulatory (action) signals. We analyze the inference problem, derive two alternative estimators of homeostatic belief precision, and apply our method to simulated data. Our proposed approach may prove useful for assessing BBI in individual subjects.
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Affiliation(s)
- Ozan Unal
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich & ETH Zurich, 8032 Zurich, Switzerland; Computer Vision Lab (CVL), ETH Zurich, 8092 Zürich, Switzerland.
| | - Orhun Caner Eren
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich & ETH Zurich, 8032 Zurich, Switzerland
| | - Göktuğ Alkan
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich & ETH Zurich, 8032 Zurich, Switzerland
| | - Frederike Hermi Petzschner
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich & ETH Zurich, 8032 Zurich, Switzerland
| | - Yu Yao
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich & ETH Zurich, 8032 Zurich, Switzerland
| | - Klaas Enno Stephan
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich & ETH Zurich, 8032 Zurich, Switzerland; Max Planck Institute for Metabolism Research, 50931 Cologne, Germany
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113
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Leganes-Fonteneau M, Bates ME, Muzumdar N, Pawlak A, Islam S, Vaschillo E, Buckman JF. Cardiovascular mechanisms of interoceptive awareness: Effects of resonance breathing. Int J Psychophysiol 2021; 169:71-87. [PMID: 34534600 DOI: 10.1016/j.ijpsycho.2021.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 08/24/2021] [Accepted: 09/08/2021] [Indexed: 12/14/2022]
Abstract
Interoception, the ability to perceive internal bodily sensations, and heart rate variability (HRV) share common physiological pathways, including the baroreflex feedback loop. The baroreflex can be activated by resonance breathing, wherein respiration is paced at 6 times per minute (0.1 Hz), eliciting immediate physiological changes and longer-term therapeutic responses. This registered report characterizes baroreflex functioning as a cardiac mechanism of interoception in a two-session study (n = 67). The heartbeat discrimination task was used to obtain indices of interoceptive accuracy, sensibility and metacognition. Baroreflex functioning was measured as HRV at 0.1 Hz and baroreflex sensitivity (BRS); high frequency (HF) HRV was calculated as a control. Cardiovascular indices were measured at baseline and during active and control paced breathing after which changes in interoception were measured. The first hypothesis was that baseline baroreflex functioning would predict individual differences in interoceptive awareness. The second hypothesis was that resonance breathing would increase participants' ability to detect their own heartbeats, and that this effect would be mediated by increases in 0.1 Hz HRV and BRS. Data were collected upon in principle acceptance of the manuscript. We found a negative relationship of interoceptive accuracy with baseline HF HRV and BRS, and a positive relationship between metacognitive interoception and 0.1HZ HRV, BRS and HF HRV. We found that changes in 0.1 Hz HRV and BRS during resonance breathing positively correlate with increases in interoceptive accuracy. Our results show that the extent to which breathing recruits the resonant properties of the cardiovascular system can facilitate the conscious perception of participants' heartbeats. We interpret this as an increase in vagal afferent signaling and baroreflex functioning following resonance breathing. We put forward an alternative explanation that HRV modulation can reduce interoceptive prediction errors, facilitating the conscious perception of interoceptive signals, and consider the role of resonance breathing on mental health from an interoceptive inference perspective.
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Affiliation(s)
- Mateo Leganes-Fonteneau
- Department of Kinesiology and Health, Rutgers University, New Brunswick, United States of America; Cardiac Neuroscience Laboratory, Center of Alcohol Studies, Rutgers University, New Brunswick, United States of America.
| | - Marsha E Bates
- Department of Kinesiology and Health, Rutgers University, New Brunswick, United States of America; Cardiac Neuroscience Laboratory, Center of Alcohol Studies, Rutgers University, New Brunswick, United States of America
| | - Neel Muzumdar
- Department of Kinesiology and Health, Rutgers University, New Brunswick, United States of America; Cardiac Neuroscience Laboratory, Center of Alcohol Studies, Rutgers University, New Brunswick, United States of America
| | - Anthony Pawlak
- Department of Kinesiology and Health, Rutgers University, New Brunswick, United States of America; Cardiac Neuroscience Laboratory, Center of Alcohol Studies, Rutgers University, New Brunswick, United States of America
| | - Shahriar Islam
- Department of Kinesiology and Health, Rutgers University, New Brunswick, United States of America
| | - Evgeny Vaschillo
- Department of Kinesiology and Health, Rutgers University, New Brunswick, United States of America; Cardiac Neuroscience Laboratory, Center of Alcohol Studies, Rutgers University, New Brunswick, United States of America
| | - Jennifer F Buckman
- Department of Kinesiology and Health, Rutgers University, New Brunswick, United States of America; Cardiac Neuroscience Laboratory, Center of Alcohol Studies, Rutgers University, New Brunswick, United States of America
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114
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Martini M, Marzola E, Brustolin A, Abbate-Daga G. Feeling imperfect and imperfectly feeling: A network analysis on perfectionism, interoceptive sensibility, and eating symptomatology in anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2021; 29:893-909. [PMID: 34510651 DOI: 10.1002/erv.2863] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/13/2021] [Accepted: 08/20/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE In recent years, the network analysis (NA) methodology has been applied to identify the central features of the psychopathology of anorexia nervosa (AN) and specific connections to previously recognized vulnerabilities. However, an NA investigating both multidimensional perfectionism and interoceptive sensibility in connection to eating symptomatology is currently missing. METHOD A total of 260 individuals (139 patients with AN, 121 healthy control individuals) completed the Frost Multidimensional Perfectionism Scale, the Multidimensional Assessment of Interoceptive Awareness and the Eating Disorders Inventory-2. Using state-of-the-art techniques, we estimated a main network with data from all participants and then compared the two separated networks. We checked the variables for empirical overlap through goldbricker, combined as suggested and implemented the empirical measure of the bridge nodes. RESULTS Ineffectiveness and need for control over self and body (resulting from combining Asceticism and Drive for Thinness) were the most central nodes, whereas perfectionistic evaluative concerns (resulting from combining Doubts about Actions and Concern over Mistakes) and mistrust in body sensations were the bridge nodes. No significant differences between the patient and control networks emerged. CONCLUSIONS Perfectionistic evaluative concerns and mistrust in body sensations could be key components in the relationships among perfectionism, interoceptive sensibility and eating symptomatology.
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Affiliation(s)
- Matteo Martini
- Department of Neuroscience "Rita Levi Montalcini", Eating Disorders Center, University of Turin, Turin, Italy
| | - Enrica Marzola
- Department of Neuroscience "Rita Levi Montalcini", Eating Disorders Center, University of Turin, Turin, Italy
| | - Annalisa Brustolin
- Department of Neuroscience "Rita Levi Montalcini", Eating Disorders Center, University of Turin, Turin, Italy
| | - Giovanni Abbate-Daga
- Department of Neuroscience "Rita Levi Montalcini", Eating Disorders Center, University of Turin, Turin, Italy
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115
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Smith AR, Forrest LN, Perkins NM, Kinkel-Ram S, Bernstein MJ, Witte TK. Reconnecting to Internal Sensation and Experiences: A Pilot Feasibility Study of an Online Intervention to Improve Interoception and Reduce Suicidal Ideation. Behav Ther 2021; 52:1145-1157. [PMID: 34452669 DOI: 10.1016/j.beth.2021.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 02/04/2021] [Accepted: 02/04/2021] [Indexed: 02/03/2023]
Abstract
Risk factors that are strongly associated with suicide and are amenable to intervention are in need of discovery. This three-study investigation demonstrates that an intervention designed to improve interoception-one potential suicide risk factor-may reduce suicide-related outcomes. Study 1 included 136 undergraduate participants and found that relative to a control condition, participating in a progressive muscle relaxation exercise was associated with reduced implicit identification with suicide through greater body trust, which is one domain of interoception that is consistently linked to suicide-related outcomes. Study 2 included 97 MTurk participants and found that relative to a control condition, participating in a body functionality writing exercise was associated with greater awareness of the body as a whole. Study 3 was a pilot study of a four-session online intervention designed to increase interoception. Study 3 included a sample of 22 clinical participants who completed pre- and postintervention assessments. Participants rated the intervention as highly acceptable and moderately effective. Moreover, the intervention was associated with improvements in interoception and reductions in suicidal ideation, general psychological symptoms, and disordered-eating symptoms. Overall, these findings indicate that our online interoceptive awareness training is acceptable and may be associated with improvements in clinical outcomes. Randomized controlled trials are needed to explore whether the intervention's purported mechanism-improved interoception-leads to changes in clinical outcomes.
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116
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Rogers ML, Duffy ME, Dougherty SP, Joiner TE. Interoception, Pain Tolerance, and Self-Injurious Behaviors: A Multidimensional Assessment. Behav Ther 2021; 52:1055-1066. [PMID: 34452661 DOI: 10.1016/j.beth.2021.02.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 02/22/2021] [Accepted: 02/22/2021] [Indexed: 10/22/2022]
Abstract
Impairments in interoception have been linked to self-injurious behaviors, and capability for suicide may account for this relationship. However, past studies have relied primarily on self-report and unidimensional measures. The present study aimed to replicate and extend previous findings by examining the relationship between interoceptive dysfunction, pain tolerance, and self-injurious behaviors using a multidimensional and multi-method approach. A sample of 245 undergraduate students (Mage = 19.27 years, SD = 2.81; 73.7% female, 72.% White/European American), who reported lifetime suicidal ideation on a screening survey completed a battery of self-report measures, four counterbalanced pain tolerance tasks, and a clinical interview assessing their self-injurious behaviors. A tendency to stay attuned to bodily sensations was significantly related to decreased pain tolerance. Only trust in one's body was significantly related to decreased presence of lifetime suicide attempts. No other facets of interoception or pain tolerance were significantly associated with self-injurious behaviors. Overall, these findings contrast with previous findings that capability for suicide may account for relations between interoceptive dysfunction and self-injurious behaviors. Nonetheless, the results of this study provide important information on the factor structure of interoceptive dysfunction and pain tolerance, and highlight the importance of careful selection of measures and operationalization of key constructs, particularly interoceptive dysfunction and pain tolerance.
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117
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Smith R, Mayeli A, Taylor S, Al Zoubi O, Naegele J, Khalsa SS. Gut inference: A computational modelling approach. Biol Psychol 2021; 164:108152. [PMID: 34311031 PMCID: PMC8429276 DOI: 10.1016/j.biopsycho.2021.108152] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 12/22/2022]
Abstract
Neurocomputational theories have hypothesized that Bayesian inference underlies interoception, which has become a topic of recent experimental work in heartbeat perception. To extend this approach beyond cardiac interoception, we describe the application of a Bayesian computational model to a recently developed gastrointestinal interoception task completed by 40 healthy individuals undergoing simultaneous electroencephalogram (EEG) and peripheral physiological recording. We first present results that support the validity of this modelling approach. Second, we provide a test of, and confirmatory evidence supporting, the neural process theory associated with a particular Bayesian framework (active inference) that predicts specific relationships between computational parameters and event-related potentials in EEG. We also offer some exploratory evidence suggesting that computational parameters may influence the regulation of peripheral physiological states. We conclude that this computational approach offers promise as a tool for studying individual differences in gastrointestinal interoception.
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Affiliation(s)
- Ryan Smith
- Laureate Institute for Brain Research, Tulsa, OK, United States.
| | - Ahmad Mayeli
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | - Samuel Taylor
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | - Obada Al Zoubi
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | - Jessyca Naegele
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | - Sahib S Khalsa
- Laureate Institute for Brain Research, Tulsa, OK, United States; Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, United States.
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118
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Galvez-Pol A, Nadal M, Kilner JM. Emotional representations of space vary as a function of peoples' affect and interoceptive sensibility. Sci Rep 2021; 11:16150. [PMID: 34373488 PMCID: PMC8352937 DOI: 10.1038/s41598-021-95081-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/20/2021] [Indexed: 02/07/2023] Open
Abstract
Most research on people's representation of space has focused on spatial appraisal and navigation. But there is more to space besides navigation and assessment: people have different emotional experiences at different places, which create emotionally tinged representations of space. Little is known about the emotional representation of space and the factors that shape it. The purpose of this study was to develop a graphic methodology to study the emotional representation of space and some of the environmental features (non-natural vs. natural) and personal features (affective state and interoceptive sensibility) that modulate it. We gave participants blank maps of the region where they lived and asked them to apply shade where they had happy/sad memories, and where they wanted to go after Covid-19 lockdown. Participants also completed self-reports on affective state and interoceptive sensibility. By adapting methods for analyzing neuroimaging data, we examined shaded pixels to quantify where and how strong emotions are represented in space. The results revealed that happy memories were consistently associated with similar spatial locations. Yet, this mapping response varied as a function of participants' affective state and interoceptive sensibility. Certain regions were associated with happier memories in participants whose affective state was more positive and interoceptive sensibility was higher. The maps of happy memories, desired locations to visit after lockdown, and regions where participants recalled happier memories as a function of positive affect and interoceptive sensibility overlayed significantly with natural environments. These results suggest that people's emotional representations of their environment are shaped by the naturalness of places, and by their affective state and interoceptive sensibility.
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Affiliation(s)
- Alejandro Galvez-Pol
- grid.507093.8Balearic Islands Health Research Institute (IdISBa) and Research Institute of Health Sciences (IUNICS)
, Palma de Mallorca, Spain ,grid.9563.90000 0001 1940 4767Human Evolution and Cognition Research Group (EvoCog), Psychology Dept. University of the Balearic Islands, Palma de Mallorca, 07122 Spain ,grid.83440.3b0000000121901201Dept. of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, WC1N 3BG UK
| | - Marcos Nadal
- grid.9563.90000 0001 1940 4767Human Evolution and Cognition Research Group (EvoCog), Psychology Dept. University of the Balearic Islands, Palma de Mallorca, 07122 Spain
| | - James M. Kilner
- grid.83440.3b0000000121901201Dept. of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, WC1N 3BG UK
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119
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Dynamics of amygdala connectivity in bipolar disorders: a longitudinal study across mood states. Neuropsychopharmacology 2021; 46:1693-1701. [PMID: 34099869 PMCID: PMC8280117 DOI: 10.1038/s41386-021-01038-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 11/25/2022]
Abstract
Alterations in activity and connectivity of brain circuits implicated in emotion processing and emotion regulation have been observed during resting-state for different clinical phases of bipolar disorders (BD), but longitudinal investigations across different mood states in the same patients are still rare. Furthermore, measuring dynamics of functional connectivity patterns offers a powerful method to explore changes in the brain's intrinsic functional organization across mood states. We used a novel co-activation pattern (CAP) analysis to explore the dynamics of amygdala connectivity at rest in a cohort of 20 BD patients prospectively followed-up and scanned across distinct mood states: euthymia (20 patients; 39 sessions), depression (12 patients; 18 sessions), or mania/hypomania (14 patients; 18 sessions). We compared them to 41 healthy controls scanned once or twice (55 sessions). We characterized temporal aspects of dynamic fluctuations in amygdala connectivity over the whole brain as a function of current mood. We identified six distinct networks describing amygdala connectivity, among which an interoceptive-sensorimotor CAP exhibited more frequent occurrences during hypomania compared to other mood states, and predicted more severe symptoms of irritability and motor agitation. In contrast, a default-mode CAP exhibited more frequent occurrences during depression compared to other mood states and compared to controls, with a positive association with depression severity. Our results reveal distinctive interactions between amygdala and distributed brain networks in different mood states, and foster research on interoception and default-mode systems especially during the manic and depressive phase, respectively. Our study also demonstrates the benefits of assessing brain dynamics in BD.
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120
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Liyanage-Don NA, Cornelius T, Sanchez JE, Trainor A, Moise N, Wainberg M, Kronish IM. Psychological Distress, Persistent Physical Symptoms, and Perceived Recovery After COVID-19 Illness. J Gen Intern Med 2021; 36:2525-2527. [PMID: 33987793 PMCID: PMC8118366 DOI: 10.1007/s11606-021-06855-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/22/2021] [Indexed: 01/12/2023]
Affiliation(s)
- Nadia A Liyanage-Don
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Talea Cornelius
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Jose E Sanchez
- Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Alison Trainor
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Nathalie Moise
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Milton Wainberg
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA.,New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA.
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121
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Paulus MP, Khalsa SS. When You Don't Feel Right Inside: Homeostatic Dysregulation and the Mid-Insular Cortex in Psychiatric Disorders. Am J Psychiatry 2021; 178:683-685. [PMID: 34383566 DOI: 10.1176/appi.ajp.2021.21060622] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Martin P Paulus
- Laureate Institute for Brain Research, Tulsa, Okla.; and Faculty of Community Medicine, University of Tulsa, Okla
| | - Sahib S Khalsa
- Laureate Institute for Brain Research, Tulsa, Okla.; and Faculty of Community Medicine, University of Tulsa, Okla
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122
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Krupnik V. Depression as a Failed Anxiety: The Continuum of Precision-Weighting Dysregulation in Affective Disorders. Front Psychol 2021; 12:657738. [PMID: 34366974 PMCID: PMC8339201 DOI: 10.3389/fpsyg.2021.657738] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 06/28/2021] [Indexed: 12/16/2022] Open
Abstract
Depressive, anxiety, and trauma-related disorders have many symptoms in common such as unstable mood, high anxiety, sleep disturbance, impaired concentration among others. This degeneracy creates ambiguity in classifying psychiatric disorders and raises the question of their categorical vs. dimensional nature. Consequently, such ambiguity presents a dilemma for choosing diagnosis-specific vs. trans-diagnostic therapies. In this paper, I build on a theory that considers affective disorders on the continuum of stress response from normative to traumatic. Using an integrative evolutionary-stress response-predictive processing (iESP) model, I arrange affective disorders on a continuum of precision-weighting dysregulation, where depressive, anxiety and trauma-induced disorders have a characteristic pattern of precision-weighting dysregulation. I specifically address the relationship between anxiety and depressive stress responses, exploring the role of anxiety in the dynamics of depressive stress response and the resulting high co-occurrence of anxiety and depression symptoms. Finally, I discuss the model's relevance for therapy of depression.
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Affiliation(s)
- Valery Krupnik
- Naval Hospital Camp Pendleton, Camp Pendleton, CA, United States
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123
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Shalev I. Theory of Motivated Cue-Integration and COVID-19: Between Interoception, Somatization, and Radicalization. Front Psychiatry 2021; 12:631758. [PMID: 34177640 PMCID: PMC8226015 DOI: 10.3389/fpsyt.2021.631758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 05/03/2021] [Indexed: 12/22/2022] Open
Abstract
The global dissemination of COVID-19 creates confusion and ambiguity in nearly every aspect of life, including fear of contagion, heightened awareness of the mortality of self and family members, lack of power, and distrust of experts and decision-makers. In this stressful situation, the question arises as to what mechanisms distinguish between adaptive and maladaptive self-regulation. The theory of Motivated Cue-Integration (MCI) is a novel theory of self-regulation that provides a new perspective on the effect of COVID-19 on self-regulation deficiency as an example of psychological distress. Inspired by predictive coding, social cognition, embodied cognition, and experiential approach, MCI suggests that self-regulation is based on interaction between (1) high-level values and goals, (2) low-level interoceptive and exteroceptive signals, and (3) trust in epistemic authority or a significant other. Motivated Cue-Integration posits that individuals create meaning by making moment-to-moment predictions that affect their interpretation of the experience of ambiguity influenced by their relationship with epistemic authority. According to MCI, deficiency in self-regulation during COVID-19 could result either from over-sensitivity or under-sensitivity to low-level interoceptive and exteroceptive cues; rigidity or ambiguity of high-level goals, poor integration between the two levels of processing as well as distrust in epistemic authority. According to MCI, variations of these deficiencies may occur in various clinical phenomena such as alexithymia and somatization, as well as in social phenomena such as goal radicalization. Based on this reasoning, MCI claims that the mentalization of the relationship between interoceptive cues, exteroceptive cues, goals, and psychological needs of the person, as well as the improvement of confidence in epistemic authority, can promote adaptive self-regulation. Psychological intervention can foster trust in epistemic authority, increase the mentalization of interoceptive and exteroceptive cues, and their association with adaptive goals. As such, the integration of these elements in a way that facilitates incentives pathways and insight fosters a more integrated subjective experience, higher clarity of emotion, and positive internal dialogue which promotes action tendency.
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Affiliation(s)
- Idit Shalev
- Laboratory for Embodiment and Self-Regulation, Department of Psychology, Ariel University, Ariel, Israel
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124
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Yu ANC, Iodice P, Pezzulo G, Barca L. Bodily Information and Top-Down Affective Priming Jointly Affect the Processing of Fearful Faces. Front Psychol 2021; 12:625986. [PMID: 34149514 PMCID: PMC8206275 DOI: 10.3389/fpsyg.2021.625986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/20/2021] [Indexed: 12/12/2022] Open
Abstract
According to embodied theories, the processing of emotions such as happiness or fear is grounded in emotion-specific perceptual, bodily, and physiological processes. Under these views, perceiving an emotional stimulus (e.g., a fearful face) re-enacts interoceptive and bodily states congruent with that emotion (e.g., increases heart rate); and in turn, interoceptive and bodily changes (e.g., increases of heart rate) influence the processing of congruent emotional content. A previous study by Pezzulo et al. (2018) provided evidence for this embodied congruence, reporting that experimentally increasing heart rate with physical exercise facilitated the processing of facial expressions congruent with that interoception (fear), but not those conveying incongruent states (disgust or neutrality). Here, we investigated whether the above (bottom-up) interoceptive manipulation and the (top-down) priming of affective content may jointly influence the processing of happy and fearful faces. The fact that happiness and fear are both associated with high heart rate but have different (positive and negative) valence permits testing the hypothesis that their processing might be facilitated by the same interoceptive manipulation (the increase of heart rate) but two opposite (positive and negative) affective primes. To test this hypothesis, we asked participants to perform a gender-categorization task of happy, fearful, and neutral faces, which were preceded by positive, negative, and neutral primes. Participants performed the same task in two sessions (after rest, with normal heart rate, or exercise, with faster heart rate) and we recorded their response times and mouse movements during the choices. We replicated the finding that when participants were in the exercise condition, they processed fearful faces faster than when they were in the rest condition. However, we did not find the same reduction in response time for happy (or neutral) faces. Furthermore, we found that when participants were in the exercise condition, they processed fearful faces faster in the presence of negative compared to positive or neutral primes; but we found no equivalent facilitation of positive (or neutral) primes during the processing of happy (or neutral) faces. While the asymmetries between the processing of fearful and happy faces require further investigation, our findings promisingly indicate that the processing of fearful faces is jointly influenced by both bottom-up interoceptive states and top-down affective primes that are congruent with the emotion.
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Affiliation(s)
- Alessandra Nicoletta Cruz Yu
- Department of Psychological Science, Pomona College, Lincoln Hall, Claremont, CA, United States.,Institute of Cognitive Neuroscience, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Pierpaolo Iodice
- Centre d'Etude des Transformations des Activités Physiques et Sportives (CETAPS), EA 3832, Faculty of Sports Sciences, University of Rouen, Mont Saint Aignan, France
| | - Giovanni Pezzulo
- Institute of Cognitive Sciences and Technologies, National Research Council, Rome, Italy
| | - Laura Barca
- Institute of Cognitive Sciences and Technologies, National Research Council, Rome, Italy
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125
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Out-of-step: brain-heart desynchronization in anxiety disorders. Mol Psychiatry 2021; 26:1726-1737. [PMID: 33504952 DOI: 10.1038/s41380-021-01029-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 12/30/2020] [Accepted: 01/12/2021] [Indexed: 12/11/2022]
Abstract
Imaging studies in anxiety disorders (AD) show abnormal functional connectivity primarily in the salience network (SN), somatomotor network (SMN), and default mode network (DMN). However, it is not clear how precisely these network changes occur including their relation to psychopathological symptoms. Here, we show that the functional networks affected in AD overlap with cortical regions that receive visceral inputs (the so-called central/visceral autonomic network). Focusing on cardiac afferents, we suggest that network changes in AD may be due to reduced phase synchronization between ongoing neural and cardiac activity. This neuro-cardiac desynchronization occurs due to the abnormal phase resetting of neural activity at the onset of each heartbeat, as measured by a lower intertrial coherence and heartbeat-evoked potential. Biochemically, cardiac afferents reach subcortical serotonergic raphe nuclei and noradrenergic locus coeruleus (among others) which, in turn, are known to reciprocally modulate the DMN and SMN/SN on the cortical level. Consistent with the network changes in AD, decreases in serotonergic and noradrenergic activity are known to increase connectivity in both SMN and SN while, at the same time, they decrease DMN connectivity. SMN and SN increases, in turn, lead to increased emotional arousal/anxiety and bodily awareness whereas decreased DMN connectivity leads to an unstable sense-of-self in AD. Finally, we integrate our proposal with interoceptive predictive processing models suggesting neuro-cardiac desynchronization as a mechanism for "noisy" bottom-up information leading to a persistently uncertain bodily state in top-down models. In sum, integrating theories on active interference and hyperarousal, we propose a precise neuro-cardiac and biochemically -driven mechanisms for key psychopathological symptoms of AD.
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126
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Forrest LN, Smith AR. A multi-measure examination of interoception in people with recent nonsuicidal self-injury. Suicide Life Threat Behav 2021; 51:492-503. [PMID: 33486793 DOI: 10.1111/sltb.12732] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/02/2020] [Accepted: 09/11/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Self-injurious behaviors (SIB) are highly dangerous, yet prediction remains weak. Novel SIB correlates must be identified, such as impaired interoception. This study examined whether two forms of interoceptive processing (accuracy and sensibility) for multiple sensations (general, cardiac, and pain) differed between people with and without recent nonsuicidal self-injury (NSSI). METHOD Participants were adults with recent (n = 48) NSSI and with no history of SIBs (n = 55). Interoceptive sensibility was assessed with self-reports. Interoceptive accuracy for cardiac sensations was assessed using the heartbeat tracking task. Interoceptive accuracy for pain was assessed with a novel metric that mirrored the heartbeat tracking test. RESULTS Participants with recent NSSI reported significantly lower interoceptive sensibility for general sensations relative to people without SIBs. Groups did not differ on interoceptive sensibility for cardiac sensations or pain. Groups also did not differ on interoceptive accuracy for cardiac sensations. The NSSI group exhibited significantly lower interoceptive accuracy for pain compared with the No SIB group. CONCLUSIONS Interoceptive impairment in people with NSSI may vary by interoceptive domain and sensation type. Diminished interoceptive accuracy for sensations relevant to the pathophysiology of self-injury may be a novel SIB correlate.
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Affiliation(s)
| | - April R Smith
- Department of Psychology, Miami University, Oxford, Ohio, USA
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127
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Koenen LR, Pawlik RJ, Icenhour A, Petrakova L, Forkmann K, Theysohn N, Engler H, Elsenbruch S. Associative learning and extinction of conditioned threat predictors across sensory modalities. Commun Biol 2021; 4:553. [PMID: 33976383 PMCID: PMC8113515 DOI: 10.1038/s42003-021-02008-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 03/18/2021] [Indexed: 12/19/2022] Open
Abstract
The formation and persistence of negative pain-related expectations by classical conditioning remain incompletely understood. We elucidated behavioural and neural correlates involved in the acquisition and extinction of negative expectations towards different threats across sensory modalities. In two complementary functional magnetic resonance imaging studies in healthy humans, differential conditioning paradigms combined interoceptive visceral pain with somatic pain (study 1) and aversive tone (study 2) as exteroceptive threats. Conditioned responses to interoceptive threat predictors were enhanced in both studies, consistently involving the insula and cingulate cortex. Interoceptive threats had a greater impact on extinction efficacy, resulting in disruption of ongoing extinction (study 1), and selective resurgence of interoceptive CS-US associations after complete extinction (study 2). In the face of multiple threats, we preferentially learn, store, and remember interoceptive danger signals. As key mediators of nocebo effects, conditioned responses may be particularly relevant to clinical conditions involving disturbed interoception and chronic visceral pain.
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Affiliation(s)
- Laura R Koenen
- Institute of Medical Psychology and Behavioral Immunobiology, Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Robert J Pawlik
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr University Bochum, Bochum, Germany
| | - Adriane Icenhour
- Translational Pain Research Unit, Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Liubov Petrakova
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr University Bochum, Bochum, Germany
| | - Katarina Forkmann
- Translational Pain Research Unit, Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Nina Theysohn
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Harald Engler
- Institute of Medical Psychology and Behavioral Immunobiology, Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sigrid Elsenbruch
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr University Bochum, Bochum, Germany.
- Translational Pain Research Unit, Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
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Höller I, Stenzel JS, Rath D, Forkmann T. Listen to Your Heart-Ecological Momentary Assessment of Interoceptive Accuracy, Awareness and Sensibility: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4893. [PMID: 34064438 PMCID: PMC8124337 DOI: 10.3390/ijerph18094893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/29/2021] [Accepted: 04/29/2021] [Indexed: 02/07/2023]
Abstract
Background: Interoception is a multi-facetted phenomenon including interoceptive accuracy, awareness and sensibility. Deficits in interoception have been associated with psychological distress. However, little is known about the course of interoception over time. The present study aimed at examining interoception in an ecological momentary assessment (EMA)-setting. Methods: A seven-day smartphone-based EMA was conducted in a community sample of sixty-one participants (age: M = 24.1, SD = 7.00, n = 54 female (88.5%)). To control for potential practice effects of repeated assessments during the EMA phase, participants were randomly assigned to a control (n = 30) and an interoception (n = 31) group. The latter was assessed for interoceptive accuracy, awareness and sensibility. Before and after the EMA phase, all participants were assessed for interoception in the laboratory. Results: Multilevel analyses revealed significant fluctuations for all three interoceptive facets, around 50% of variance was due to within-person variability. There were only practice effects for the subscale "Attention Regulation", measuring interoceptive sensibility. Conclusion: The facets of interoception can be assessed in an EMA-setting. Repeated interoceptive assessments do not necessarily lead to an improvement of participants' interoceptive abilities. It could be shown that all interoceptive facets fluctuate, which should be considered in future research.
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Affiliation(s)
- Inken Höller
- Department of Clinical Psychology, University of Duisburg-Essen, 45141 Essen, Germany; (J.-S.S.); (D.R.); (T.F.)
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129
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Abstract
Introduction: The effectiveness of treatment for PTSD is limited, which is especially true for war veterans, of whom 30-50% do not respond to therapy. Hyperarousal is central to the maintenance of trauma pathology. The mainstream trauma-focused therapies traditionally target the cognitive processing of traumatic experience. In this article, we propose that these therapies may be enhanced by the inclusion of interventions specifically targeting hyperarousal.Method: We review an earlier formulated model of trauma supporting our proposal. This model is based on a theory of trauma that integrates the concept of allostasis with the predictive processing framework. In this view, trauma is considered a maladaptive stress response guided by false inference.Results: The reviewed model is in agreement with the central role of hyperarousal in the maintenance of trauma-induced disorders. It also demonstrates the importance of targeting hyperarousal at the same time as maladaptive cognitions and behaviours associated with trauma. A treatment for PTSD is proposed that combines exposure to trauma-related cues with neurofeedback-mediated regulation of arousal.Conclusions: Our analysis argues for the integration of hyperarousal-targeting interventions into existing therapies. Accordingly, we offer methodological considerations based on the nested hierarchy principle that can guide such integration.
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Affiliation(s)
- Valery Krupnik
- Department of Mental Health, Naval Hospital Camp Pendleton
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130
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Hechler T. Altered interoception and its role for the co-occurrence of chronic primary pain and mental health problems in children. Pain 2021; 162:665-671. [PMID: 33021565 DOI: 10.1097/j.pain.0000000000002099] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 09/23/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Tanja Hechler
- Department of Clinical Psychology and Psychotherapy in Children and Adolescents, University of Trier, Trier, Germany
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131
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Smith R, Feinstein JS, Kuplicki R, Forthman KL, Stewart JL, Paulus MP, Khalsa SS. Perceptual insensitivity to the modulation of interoceptive signals in depression, anxiety, and substance use disorders. Sci Rep 2021; 11:2108. [PMID: 33483527 PMCID: PMC7822872 DOI: 10.1038/s41598-021-81307-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 12/28/2020] [Indexed: 01/18/2023] Open
Abstract
This study employed a series of heartbeat perception tasks to assess the hypothesis that cardiac interoceptive processing in individuals with depression/anxiety (N = 221), and substance use disorders (N = 136) is less flexible than that of healthy individuals (N = 53) in the context of physiological perturbation. Cardiac interoception was assessed via heartbeat tapping when: (1) guessing was allowed; (2) guessing was not allowed; and (3) experiencing an interoceptive perturbation (inspiratory breath hold) expected to amplify cardiac sensation. Healthy participants showed performance improvements across the three conditions, whereas those with depression/anxiety and/or substance use disorder showed minimal improvement. Machine learning analyses suggested that individual differences in these improvements were negatively related to anxiety sensitivity, but explained relatively little variance in performance. These results reveal a perceptual insensitivity to the modulation of interoceptive signals that was evident across several common psychiatric disorders, suggesting that interoceptive deficits in the realm of psychopathology manifest most prominently during states of homeostatic perturbation.
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Affiliation(s)
- Ryan Smith
- Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK, 74136, USA
| | - Justin S Feinstein
- Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK, 74136, USA
- Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, USA
| | - Rayus Kuplicki
- Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK, 74136, USA
| | | | - Jennifer L Stewart
- Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK, 74136, USA
- Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, USA
| | - Martin P Paulus
- Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK, 74136, USA
- Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, USA
| | - Sahib S Khalsa
- Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK, 74136, USA.
- Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, USA.
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132
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Lawson RP, Bisby J, Nord CL, Burgess N, Rees G. The Computational, Pharmacological, and Physiological Determinants of Sensory Learning under Uncertainty. Curr Biol 2021; 31:163-172.e4. [PMID: 33188745 PMCID: PMC7808754 DOI: 10.1016/j.cub.2020.10.043] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 09/01/2020] [Accepted: 10/14/2020] [Indexed: 02/02/2023]
Abstract
The ability to represent and respond to uncertainty is fundamental to human cognition and decision-making. Noradrenaline (NA) is hypothesized to play a key role in coordinating the sensory, learning, and physiological states necessary to adapt to a changing world, but direct evidence for this is lacking in humans. Here, we tested the effects of attenuating noradrenergic neurotransmission on learning under uncertainty. We probed the effects of the β-adrenergic receptor antagonist propranolol (40 mg) using a between-subjects, double-blind, placebo-controlled design. Participants performed a probabilistic associative learning task, and we employed a hierarchical learning model to formally quantify prediction errors about cue-outcome contingencies and changes in these associations over time (volatility). Both unexpectedness and noise slowed down reaction times, but propranolol augmented the interaction between these main effects such that behavior was influenced more by prior expectations when uncertainty was high. Computationally, this was driven by a reduction in learning rates, with people slower to update their beliefs in the face of new information. Attenuating the global effects of NA also eliminated the phasic effects of prediction error and volatility on pupil size, consistent with slower belief updating. Finally, estimates of environmental volatility were predicted by baseline cardiac measures in all participants. Our results demonstrate that NA underpins behavioral and computational responses to uncertainty. These findings have important implications for understanding the impact of uncertainty on human biology and cognition.
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Affiliation(s)
- Rebecca P Lawson
- Department of Psychology, Downing Street, University of Cambridge, Cambridge CB2 3EB, UK; MRC Cognition & Brain Sciences Unit, Chaucer Road, University of Cambridge, Cambridge CB2 7EF, UK.
| | - James Bisby
- Institute of Cognitive Neuroscience, Queen Square, University College London, London WC1N 3AZ, UK; Division of Psychiatry, Tottenham Court Road, University College London, London W1T 7NF, UK
| | - Camilla L Nord
- MRC Cognition & Brain Sciences Unit, Chaucer Road, University of Cambridge, Cambridge CB2 7EF, UK
| | - Neil Burgess
- Institute of Cognitive Neuroscience, Queen Square, University College London, London WC1N 3AZ, UK; Institute of Neurology, Queen Square, University College London, London WC1N 3BG, UK
| | - Geraint Rees
- Institute of Cognitive Neuroscience, Queen Square, University College London, London WC1N 3AZ, UK; Wellcome Centre for Human Neuroimaging, Queen Square, University College London, London WC1N 3AR, UK
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133
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Wolters C, Harzem J, Witthöft M, Gerlach AL, Pohl A. Somatosensory Illusions Elicited by Sham Electromagnetic Field Exposure: Experimental Evidence for a Predictive Processing Account of Somatic Symptom Perception. Psychosom Med 2021; 83:94-100. [PMID: 33141791 DOI: 10.1097/psy.0000000000000884] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE According to the predictive processing theory of somatic symptom generation, body sensations are determined by somatosensory input and central nervous predictions about this input. We examined how expectations shape predictions and consequently bodily perceptions in a task eliciting illusory sensations as laboratory analogue of medically unexplained symptoms. METHODS Using the framework of signal detection theory, the influence of sham Wi-Fi on response bias (c) and somatosensory sensitivity (d') for tactile stimuli was examined using the somatic signal detection task (SSDT). A healthy student sample (n = 83) completed the SSDT twice (sham Wi-Fi on/off) in a randomized order after watching a film that promoted adverse health effects of electromagnetic fields. RESULTS When expecting a Wi-Fi signal to be present, participants showed a significantly more liberal response bias c (p = .010, ηp2 = 0.08) for tactile stimuli in the SSDT as evidence of a higher propensity to experience somatosensory illusions. No significant alteration of somatosensory sensitivity d' (p = .76, ηp2 < 0.002) was observed. CONCLUSIONS Negative expectations about the harmfulness of electromagnetic fields may foster the occurrence of illusory symptom perceptions via alterations in the somatosensory decision criterion. The findings are in line with central tenets of the predictive processing account of somatic symptom generation. This account proposes a decoupling of percept and somatosensory input so that perception becomes increasingly dependent on predictions. This biased perception is regarded as a risk factor for somatic symptom disorders.
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Affiliation(s)
- Carolin Wolters
- From the Institute of Clinical Psychology and Psychotherapy (Wolters, Harzem, Gerlach, Pohl), University of Cologne, Cologne; and Institute of Clinical Psychology, Psychotherapy, and Experimental Psychopathology (Witthöft), Johannes Gutenberg University Mainz, Mainz, Germany
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134
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Petzschner FH, Garfinkel SN, Paulus MP, Koch C, Khalsa SS. Computational Models of Interoception and Body Regulation. Trends Neurosci 2021; 44:63-76. [PMID: 33378658 PMCID: PMC8109616 DOI: 10.1016/j.tins.2020.09.012] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 08/01/2020] [Accepted: 09/30/2020] [Indexed: 02/07/2023]
Abstract
To survive, organisms must effectively respond to the challenge of maintaining their physiological integrity in the face of an ever-changing environment. Preserving this homeostasis critically relies on adaptive behavior. In this review, we consider recent frameworks that extend classical homeostatic control via reflex arcs to include more flexible forms of adaptive behavior that take interoceptive context, experiences, and expectations into account. Specifically, we define a landscape for computational models of interoception, body regulation, and forecasting, address these models' unique challenges in relation to translational research efforts, and discuss what they can teach us about cognition as well as physical and mental health.
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Affiliation(s)
- Frederike H Petzschner
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich, ETH Zurich, Switzerland.
| | - Sarah N Garfinkel
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Falmer, UK; Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Martin P Paulus
- Laureate Institute for Brain Research, Tulsa, OK, USA; Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, USA
| | | | - Sahib S Khalsa
- Laureate Institute for Brain Research, Tulsa, OK, USA; Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, USA
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135
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Sojka P, Diez I, Bareš M, Perez DL. Individual differences in interoceptive accuracy and prediction error in motor functional neurological disorders: A DTI study. Hum Brain Mapp 2020; 42:1434-1445. [PMID: 33615622 PMCID: PMC7927304 DOI: 10.1002/hbm.25304] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/12/2020] [Accepted: 11/22/2020] [Indexed: 12/16/2022] Open
Abstract
In motor functional neurological disorders (mFND), relationships between interoception (a construct of high theoretical relevance to its pathophysiology) and neuroanatomy have not been previously investigated. This study characterized white matter in mFND patients compared to healthy controls (HCs), and investigated associations between fiber bundle integrity and cardiac interoception. Voxel‐based analysis and tractography quantified fractional anisotropy (FA) in 38 mFND patients compared to 38 HCs. Secondary analyses compared functional seizures (FND‐seiz; n = 21) or functional movement disorders (n = 17) to HCs. Network lesion mapping identified gray matter origins of implicated fiber bundles. Within‐group mFND analyses investigated relationships between FA, heartbeat tracking accuracy and interoceptive trait prediction error (discrepancies between interoceptive accuracy and self‐reported bodily awareness). Results were corrected for multiple comparisons, and all findings were adjusted for depression and trait anxiety. mFND and HCs did not show any between‐group interoceptive accuracy or FA differences. However, the FND‐seiz subgroup compared to HCs showed decreased integrity in right‐lateralized tracts: extreme capsule/inferior fronto‐occipital fasciculus, arcuate fasciculus, inferior longitudinal fasciculus, and thalamic/striatum to occipital cortex projections. These alterations originated predominantly from the right temporoparietal junction and inferior temporal gyrus. In mFND patients, individual differences in interoceptive accuracy and interoceptive trait prediction error correlated with fiber bundle integrity originating from the insula, temporoparietal junction, putamen and thalamus among other regions. In this first study investigating brain‐interoception relationships in mFND, individual differences in interoceptive accuracy and trait prediction error mapped onto multimodal integration‐related fiber bundles. Right‐lateralized limbic and associative tract disruptions distinguished FND‐seiz from HCs.
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Affiliation(s)
- Petr Sojka
- Department of Psychiatry, Faculty of Medicine, Masaryk University Brno and University Hospital, Brno, Brno, Czech Republic.,Department of Psychology and Psychosomatics, Faculty of Medicine, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - Ibai Diez
- Department of Neurology, Functional Neurological Disorder Research Program, Behavioral Neurology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.,Gordon Center, Department of Nuclear Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Martin Bareš
- First Department of Neurology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital, Brno, Czech Republic.,Department of Neurology, School of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - David L Perez
- Department of Neurology, Functional Neurological Disorder Research Program, Behavioral Neurology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.,Department of Psychiatry, Neuropsychiatry Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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136
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Smith R, Kuplicki R, Feinstein J, Forthman KL, Stewart JL, Paulus MP, Khalsa SS. A Bayesian computational model reveals a failure to adapt interoceptive precision estimates across depression, anxiety, eating, and substance use disorders. PLoS Comput Biol 2020; 16:e1008484. [PMID: 33315893 PMCID: PMC7769623 DOI: 10.1371/journal.pcbi.1008484] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/28/2020] [Accepted: 10/31/2020] [Indexed: 12/16/2022] Open
Abstract
Recent neurocomputational theories have hypothesized that abnormalities in prior beliefs and/or the precision-weighting of afferent interoceptive signals may facilitate the transdiagnostic emergence of psychopathology. Specifically, it has been suggested that, in certain psychiatric disorders, interoceptive processing mechanisms either over-weight prior beliefs or under-weight signals from the viscera (or both), leading to a failure to accurately update beliefs about the body. However, this has not been directly tested empirically. To evaluate the potential roles of prior beliefs and interoceptive precision in this context, we fit a Bayesian computational model to behavior in a transdiagnostic patient sample during an interoceptive awareness (heartbeat tapping) task. Modelling revealed that, during an interoceptive perturbation condition (inspiratory breath-holding during heartbeat tapping), healthy individuals (N = 52) assigned greater precision to ascending cardiac signals than individuals with symptoms of anxiety (N = 15), depression (N = 69), co-morbid depression/anxiety (N = 153), substance use disorders (N = 131), and eating disorders (N = 14)-who failed to increase their precision estimates from resting levels. In contrast, we did not find strong evidence for differences in prior beliefs. These results provide the first empirical computational modeling evidence of a selective dysfunction in adaptive interoceptive processing in psychiatric conditions, and lay the groundwork for future studies examining how reduced interoceptive precision influences visceral regulation and interoceptively-guided decision-making.
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Affiliation(s)
- Ryan Smith
- Laureate Institute for Brain Research, Tulsa, Oklahoma, United States of America
| | - Rayus Kuplicki
- Laureate Institute for Brain Research, Tulsa, Oklahoma, United States of America
| | - Justin Feinstein
- Laureate Institute for Brain Research, Tulsa, Oklahoma, United States of America
- Oxley College of Health Sciences, The University of Tulsa, Tulsa, Oklahoma, United States of America
| | | | - Jennifer L. Stewart
- Laureate Institute for Brain Research, Tulsa, Oklahoma, United States of America
- Oxley College of Health Sciences, The University of Tulsa, Tulsa, Oklahoma, United States of America
| | - Martin P. Paulus
- Laureate Institute for Brain Research, Tulsa, Oklahoma, United States of America
- Oxley College of Health Sciences, The University of Tulsa, Tulsa, Oklahoma, United States of America
| | | | - Sahib S. Khalsa
- Laureate Institute for Brain Research, Tulsa, Oklahoma, United States of America
- Oxley College of Health Sciences, The University of Tulsa, Tulsa, Oklahoma, United States of America
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137
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Kube T, Hildebrandt A. “Ich denke, also sage ich vorher”: Wie “Predictive Processing-Modelle den Einsatz von Verhaltensexperimenten bei Depressionen optimieren können. VERHALTENSTHERAPIE 2020. [DOI: 10.1159/000510610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Verhaltensexperimente stellen eine wichtige Interventionsform bei depressiven Störungen dar, um dysfunktionale Annahmen zu modifizieren. Häufig ist jedoch zu beobachten, dass Patient*innen trotz einer fachgerechten Durchführung von Verhaltensexperimenten weiter an negativen Annahmen festhalten. Vor diesem Hintergrund diskutieren wir in diesem Artikel, wie der Einsatz von Verhaltensexperimenten bei Depressionen optimiert werden kann und beziehen uns dabei auf ein neues Störungsmodell, das interessante Implikationen hierzu liefern könnte. Dieses Störungsmodell aus der neurowissenschaftlichen Forschung zu “Predictive Processing” geht davon aus, dass depressive Störungen durch zwei Kernaspekte gekennzeichnet sind: (1) stark negative Erwartungen, die im Sinne von selbsterfüllenden Prophezeiungen zu negativen Erlebnissen führen und zunehmend “immun” gegen gegenteilige Erfahrungen machen; (2) das Fehlen von positiven Erwartungen, wodurch die Wahrscheinlichkeit von positiven Erlebnissen reduziert wird. Darauf aufbauend beschreiben wir zunächst, dass zur Modifikation negativer Erwartungen in einer ausführlichen Vorbesprechung erarbeitet werden sollte, welche möglichen positiven Erfahrungen aus dem Verhaltensexperiment die Patient*innen als glaubwürdig betrachten und zur Veränderung ihrer negativen Erwartungen nutzen würden. Auf diese sollte bei der Durchführung besonders geachtet werden, damit positive Erwartungsverletzungen auch als solche wahrgenommen werden. Zum anderen stellen wir dar, dass es nicht ausreichend ist, nur negative Erwartungen zu reduzieren, sondern auch explizit positive Erwartungen durch weitere Verhaltensexperimente gefördert werden sollten.
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138
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Riva G, Mancuso V, Cavedoni S, Stramba-Badiale C. Virtual reality in neurorehabilitation: a review of its effects on multiple cognitive domains. Expert Rev Med Devices 2020; 17:1035-1061. [PMID: 32962433 DOI: 10.1080/17434440.2020.1825939] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Neurological diseases frequently cause adult-onset disability and have increased the demand for rehabilitative interventions. Neurorehabilitation has been progressively relying on computer-assisted programs and, more recently, on virtual reality (VR). Current reviews explore VR-based neurorehabilitation for assessing and treating the most common neurological pathologies. However, none of them explored specifically the impact of VR on multiple cognitive domains. AREAS COVERED The present work is a review of 6 years of literature (2015-2020) on VR in neurorehabilitation with the purpose of analyzing its effects on memory, attention, executive functions, language, and visuospatial ability. EXPERT OPINION Our review suggests that VR-based neurorehabilitation showed encouraging results for executive functions and visuospatial abilities particularly for both acute and neurodegenerative conditions. Conversely, memory, and attention outcomes are conflicting, and language did not show significant improvements following VR-based rehabilitation. Within five years, it is plausible that VR-based intervention would be provided in standalone and mobile-based platforms that won't need a PC to work, with reduced latency and improved user interaction.
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Affiliation(s)
- Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano , Milan, Italy.,Department of Psychology, Catholic University of the Sacred Heart , Milan, Italy
| | - Valentina Mancuso
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano , Milan, Italy
| | - Silvia Cavedoni
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano , Milan, Italy
| | - Chiara Stramba-Badiale
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano , Milan, Italy
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139
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Affiliation(s)
- Beate M. Herbert
- Clinical Psychology & Psychotherapy, Department of Psychology, Eberhard-Karls-University of Tübingen, Germany
- Psychology School, University of Applied Sciences Fresenius, Munich, Germany
| | - Olga Pollatos
- Health & Clinical Psychology, Institute of Psychology and Education, Ulm University, Germany
| | - Verena Klusmann
- Department of Psychology, Psychological Assessment & Health Psychology, University of Konstanz, Germany
- Department of Psychology and Human Movement Science, University of Hamburg, Germany
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140
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Herbert BM. Interoception and Its Role for Eating, Obesity, and Eating Disorders. EUROPEAN JOURNAL OF HEALTH PSYCHOLOGY 2020. [DOI: 10.1027/2512-8442/a000062] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. The importance of the sense of ourselves from within for understanding adaptive behavior and psychopathology has been increasingly recognized during the last decades. Interoception builds the foundation of our embodied self and dysfunctional interoception lies at the core of many psychosomatic disorders. Eating is fundamental for survival with consequences for health and well-being. It is deeply grounded in homoeostatic and allostatic psychophysiological needs and is driven by interoceptive signals of the body. This narrative review summarizes a selection of empirical findings and draws conclusions on the role of interoception in eating behavior, body weight, and eating disorders. Beyond disordered eating behavior, eating disorders are characterized by impairment of the sense of self, with dysfunctional interoception at its core. Predictive coding accounts are addressed to integrate conclusions and to underline the relevance of interventions to modify interoception.
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Affiliation(s)
- Beate M. Herbert
- Clinical Psychology & Psychotherapy, Department of Psychology, Eberhard Karls University of Tübingen, Germany
- Psychology School, University of Applied Sciences Fresenius, Munich, Germany
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141
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Todd J, Aspell JE, Barron D, Toh EKL, Zahari HS, Mohd Khatib NA, Laughton R, Swami V. Greater gastric interoception is associated with more positive body image: Evidence from adults in Malaysia and the United Kingdom. Body Image 2020; 34:101-111. [PMID: 32512525 DOI: 10.1016/j.bodyim.2020.05.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/25/2020] [Accepted: 05/25/2020] [Indexed: 12/29/2022]
Abstract
Gastric interoception refers to the processing of sensory stimuli originating in the gut. Previous research has found that gastric interoception (measured using a water load task) is associated with drive for thinness in young Western women. However, associations with broader facets of body image and in diverse national groups have not been previously investigated. To address these issues, we asked samples of adults in the United Kingdom (UK; N = 91, women n = 54) and Malaysia (N = 100, women n = 50) to complete a 2-stage water load task (WLT) and measures of positive body image (i.e., body appreciation, functionality appreciation). The results indicated that a greater change in the intensity of self-reported WLT-related sensations was associated with significantly higher body appreciation and functionality appreciation after accounting for gender identity, body mass index, and national group. Behavioural performance on the WLT was significantly associated with body appreciation and functionality appreciation for the Malaysian sample, but not the UK adults, after accounting for gender identity and body mass index. These findings extend previous research by demonstrating that there are significant associations between facets of gastric interoception and previously unexplored facets of body image in both Western and non-Western settings.
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Affiliation(s)
- Jennifer Todd
- School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, UK.
| | - Jane E Aspell
- School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, UK
| | - David Barron
- Centre for Psychological Medicine, Perdana University, Serdang, Malaysia
| | | | - Hanoor Syahirah Zahari
- Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Ryan Laughton
- School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, UK
| | - Viren Swami
- School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, UK; Centre for Psychological Medicine, Perdana University, Serdang, Malaysia
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142
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Kube T, Rozenkrantz L. When Beliefs Face Reality: An Integrative Review of Belief Updating in Mental Health and Illness. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2020; 16:247-274. [DOI: 10.1177/1745691620931496] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Belief updating is a relatively nascent field of research that examines how people adjust their beliefs in light of new evidence. So far, belief updating has been investigated in partly unrelated lines of research from different psychological disciplines. In this article, we aim to integrate these disparate lines of research. After presenting some prominent theoretical frameworks and experimental designs that have been used for the study of belief updating, we review how healthy people and people with mental disorders update their beliefs after receiving new information that supports or challenges their views. Available evidence suggests that both healthy people and people with particular mental disorders are prone to certain biases when updating their beliefs, although the nature of the respective biases varies considerably and depends on several factors. Anomalies in belief updating are discussed in terms of both new insights into the psychopathology of various mental disorders and societal implications, such as irreconcilable political and societal controversies due to the failure to take information into account that disconfirms one’s own view. We conclude by proposing a novel integrative model of belief updating and derive directions for future research.
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Affiliation(s)
- Tobias Kube
- Program in Placebo Studies, Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Koblenz-Landau
| | - Liron Rozenkrantz
- Program in Placebo Studies, Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology
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143
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Increased anticipatory brain response to pleasant touch in women remitted from bulimia nervosa. Transl Psychiatry 2020; 10:236. [PMID: 32669557 PMCID: PMC7363900 DOI: 10.1038/s41398-020-00916-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 06/22/2020] [Accepted: 06/30/2020] [Indexed: 01/24/2023] Open
Abstract
Bulimia nervosa (BN) is characterized by affective instability and dysregulated behaviors (binge eating, fasting, self-induced vomiting) that disrupt bodily homeostasis. Mechanisms underlying dysregulation in BN are unclear, although altered reward responsivity, anticipatory processing of environmental cues, and interoception (detection and integration of body-state signals to regulate behavior) have been implicated in BN pathophysiology. We aimed to determine whether BN is associated with ineffectively predicting body state or integrating predicted experience with actual experience by examining neural response to anticipation and experience of affective touch, a pleasant interoceptive stimulus that acts on sensory and emotional systems to guide behavior. During fMRI, we administered soft strokes to the palm and forearm in women remitted from BN (RBN; N = 23) and control women (CW; N = 25). A Group (RBN/CW) × Condition (anticipation/touch) interaction was found in the right dorsal caudate; both CW and RBN had increased activation during touch compared with anticipation, with RBN demonstrating marginally greater anticipatory response than CW. For RBN, those individuals who showed greater anticipatory response in the dorsal caudate also reported higher levels of harm avoidance. RBN individuals relative to CW showed greater activation in left putamen and insula during the anticipation but not when experiencing an affective touch. This increase during anticipation rather than the actual experience of the affective touch is consistent with a top-down preparatory process which is associated with harm avoidance and is similar to what has been observed in anxious individuals. This aberrant signal integration could disrupt feedback processing, serving to maintain disordered behavior.
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144
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Walter H, Kausch A, Dorfschmidt L, Waller L, Chinichian N, Veer I, Hilbert K, Lüken U, Paulus MP, Goschke T, Kruschwitz JD. Self-control and interoception: Linking the neural substrates of craving regulation and the prediction of aversive interoceptive states induced by inspiratory breathing restriction. Neuroimage 2020; 215:116841. [DOI: 10.1016/j.neuroimage.2020.116841] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 03/31/2020] [Accepted: 04/07/2020] [Indexed: 12/28/2022] Open
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145
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Krupnik V. Trauma or Drama: A Predictive Processing Perspective on the Continuum of Stress. Front Psychol 2020; 11:1248. [PMID: 32714230 PMCID: PMC7344261 DOI: 10.3389/fpsyg.2020.01248] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/13/2020] [Indexed: 02/01/2023] Open
Abstract
The notion of psychological trauma has been liberally used both in clinical literature and general discourse. However, no consensus exists on its exact meaning and definition. Whereas traditionally trauma has been mostly associated with criterion A of acute and posttraumatic stress disorders (PTSDs) as defined in the Diagnostic and Statistical Manual of Mental Disorders, many researchers find this definition too constraining and not accounting for the complexity and many aspects of trauma. This touched off a quest for a broader more accommodating trauma concept, and a dimensional view of trauma with PTSD as its extreme manifestation has been suggested. The dimensional view also has its detractors arguing that "conceptual bracket creep" may undermine the category's utility. Both categorical and dimensional views mostly rely on trauma's clinical phenomenology and lack a unified theoretical basis. In an attempt to reconcile this contradiction, a hybrid categorical-dimensional model of trauma based on the general theory of stress has been recently proposed (Krupnik, 2019). Herein, I explore the categorical boundary of the trauma concept, as posited by the model, within the predictive processing framework (PPF). I integrate the PPF view with the theory of stress. In conclusion, I briefly discuss how the proposed model of trauma may guide clinical practice.
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Affiliation(s)
- Valery Krupnik
- Department of Mental Health, Naval Hospital Camp Pendleton, Camp Pendleton, CA, United States
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146
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Stefanov K, McLean J, McColl A, Basu N, Cavanagh J, Krishnadas R. Mild Inflammation in Healthy Males Induces Fatigue Mediated by Changes in Effective Connectivity Within the Insula. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2020; 5:865-874. [PMID: 32532687 DOI: 10.1016/j.bpsc.2020.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/30/2020] [Accepted: 04/06/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Systemic inflammation is associated with sickness behaviors such as low mood and fatigue. Activity patterns within the insula are suggested to coordinate these behaviors but have not been modeled. We hypothesized that mild systemic inflammation would result in changes in effective connectivity between the viscerosensory and the visceromotor regions of the insula. METHODS We used a double-blind, crossover design to randomize 20 male subjects to receive either a Salmonella typhi vaccine or a placebo saline injection at two separate sessions. All participants underwent a resting-state functional magnetic resonance scan 3 hours after injection. We determined behavioral and inflammatory changes, using the Profile of Mood States questionnaire and interleukin-6 levels. We extracted effective connectivity matrices between bilateral mid/posterior (viscerosensory) and anterior (visceromotor) insular cortices using spectral dynamic causal modeling. We applied parametric empirical Bayes and mediation analysis to determine a vaccination effect on effective connectivity and whether this mediated behavioral changes. RESULTS The vaccine condition was associated with greater interleukin-6 levels and greater fatigue 3 hours after the injection. Activity within the right mid/posterior insula increased the activity within the bilateral anterior insular regions. This connectivity was augmented by vaccination over a 99% posterior confidence threshold. The right mid/posterior insula-to-left anterior insula connectivity was significantly associated with fatigue and mediated the association between inflammation and increased fatigue scores. CONCLUSIONS These results demonstrate that increased effective connectivity between specific nodes of the insula can model and mediate the association between inflammation and fatigue in males.
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Affiliation(s)
- Kristian Stefanov
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom.
| | - John McLean
- Institute for Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Alison McColl
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Neil Basu
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Jonathan Cavanagh
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom; Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
| | - Rajeev Krishnadas
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom.
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147
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Koreki A, Garfkinel SN, Mula M, Agrawal N, Cope S, Eilon T, Gould Van Praag C, Critchley HD, Edwards M, Yogarajah M. Trait and state interoceptive abnormalities are associated with dissociation and seizure frequency in patients with functional seizures. Epilepsia 2020; 61:1156-1165. [PMID: 32501547 PMCID: PMC7737228 DOI: 10.1111/epi.16532] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Dissociative traits represent a disturbance in selfhood that may predispose to, and trigger, functional seizures (FSs). The predictive representation and control of the internal physiological state of the body (interoception) are proposed to underpin the integrity of the sense of self ("minimal selfhood"). Therefore, discrepancies between objective and subjective aspects of interoception may relate to symptom expression in patients with FSs. Here, we tested whether individual differences in trait measures of interoception relate to dissociative symptoms, and whether state interoceptive deficits predict FS occurrence. METHODS Forty-one participants with FSs and 30 controls completed questionnaire ratings of dissociation, and measures of (1) interoceptive accuracy (IA)-objective performance on heartbeat detection tasks; (2) trait interoceptive sensibility-subjective sensitivity to internal sensations (using the Porges Body Perception Questionnaire); and (3) state interoceptive sensibility-subjective trial-by-trial measures of confidence in heartbeat detection. Interoceptive trait prediction error (ITPE) was calculated from the discrepancy between IA and trait sensibility, and interoceptive state prediction error (ISPE) from the discrepancy between IA and state sensibility. RESULTS Patients with FSs had significantly lower IA and greater trait interoceptive sensibility than healthy controls. ITPE was the strongest predictor of dissociation after controlling for trait anxiety and depression in a regression model. ISPE correlated significantly with FS frequency after controlling for state anxiety. SIGNIFICANCE Patients with FSs have disturbances in interoceptive processing that predict both dissociative traits reflecting the disrupted integrity of self-representation, and the expression of FSs. These findings provide insight into the pathophysiology of functional neurological disorder, and could lead to novel diagnostic and therapeutic approaches.
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Affiliation(s)
- Akihiro Koreki
- Neurosciences Research CentreSt George's University of LondonLondonUK
- Department of NeuropsychiatryNational Hospital Organization Shimofusa Psychiatric Medical CenterChibaJapan
| | - Sarah N. Garfkinel
- Brighton and Sussex Medical School and The Sackler Centre for Consciousness ScienceUniversity of SussexSussexUK
| | - Marco Mula
- Atkinson Morley Regional Neuroscience CentreSt George's HospitalLondonUK
| | - Niruj Agrawal
- Atkinson Morley Regional Neuroscience CentreSt George's HospitalLondonUK
- Department of NeuropsychiatrySouth West London and St George's Mental Health TrustLondonUK
| | - Sarah Cope
- Department of NeuropsychiatrySouth West London and St George's Mental Health TrustLondonUK
| | - Talia Eilon
- Department of NeuropsychiatrySouth West London and St George's Mental Health TrustLondonUK
| | - Cassandra Gould Van Praag
- Brighton and Sussex Medical School and The Sackler Centre for Consciousness ScienceUniversity of SussexSussexUK
- Department of PsychiatryUniversity of OxfordOxfordUK
| | - Hugo D. Critchley
- Brighton and Sussex Medical School and The Sackler Centre for Consciousness ScienceUniversity of SussexSussexUK
| | - Mark Edwards
- Neurosciences Research CentreSt George's University of LondonLondonUK
- Atkinson Morley Regional Neuroscience CentreSt George's HospitalLondonUK
| | - Mahinda Yogarajah
- Neurosciences Research CentreSt George's University of LondonLondonUK
- Atkinson Morley Regional Neuroscience CentreSt George's HospitalLondonUK
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148
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Rieger SW, Stephan KE, Harrison OK. Remote, Automated, and MRI-Compatible Administration of Interoceptive Inspiratory Resistive Loading. Front Hum Neurosci 2020; 14:161. [PMID: 32477083 PMCID: PMC7236550 DOI: 10.3389/fnhum.2020.00161] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 04/14/2020] [Indexed: 11/24/2022] Open
Abstract
Research on how humans perceive sensory inputs from their bodies (“interoception”) has been rapidly gaining momentum, with interest across a host of disciplines from physiology through to psychiatry. However, studying interoceptive processes is not without significant challenges, and many methods utilized to access internal states have been largely devoted to capturing and relating naturally occurring variations in interoceptive signals (such as heartbeats) to measures of how the brain processes these signals. An alternative procedure involves the controlled perturbation of specific interoceptive axes. This is challenging because it requires non-invasive interventions that can be repeated many times within a subject and that are potent but safe. Here we present an effective methodology for instigating these perturbations within the breathing domain. We describe a custom-built circuitry that is capable of delivering inspiratory resistive loads automatically and precisely. Importantly, our approach is compatible with magnetic resonance imaging (MRI) environments, allowing for the administration of complicated experimental designs in neuroimaging as increasingly required within developing fields such as computational psychiatry/psychosomatics. We describe the experimental setup for both the control and monitoring of the inspiratory resistive loads, and demonstrate its possible utilities within different study designs. This methodology represents an important step forward from the previously utilized, manually controlled resistive loading setups, which present significant experimental burdens with prolonged and/or complicated sequences of breathing stimuli.
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Affiliation(s)
- Sebastian W Rieger
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,FMRIB Centre, Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Klaas Enno Stephan
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zürich, Zurich, Switzerland.,Wellcome Centre for Human Neuroimaging, University College London, London, United Kingdom.,Max Planck Institute for Metabolism Research, Cologne, Germany
| | - Olivia K Harrison
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zürich, Zurich, Switzerland.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
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149
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Kube T, Berg M, Kleim B, Herzog P. Rethinking post-traumatic stress disorder - A predictive processing perspective. Neurosci Biobehav Rev 2020; 113:448-460. [PMID: 32315695 DOI: 10.1016/j.neubiorev.2020.04.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 12/15/2022]
Abstract
Predictive processing has become a popular framework in neuroscience and computational psychiatry, where it has provided a new understanding of various mental disorders. Here, we apply the predictive processing account to post-traumatic stress disorder (PTSD). We argue that the experience of a traumatic event in Bayesian terms can be understood as a perceptual hypothesis that is subsequently given a very high a-priori likelihood due to its (life-) threatening significance; thus, this hypothesis is re-selected although it does not fit the actual sensory input. Based on this account, we re-conceptualise the symptom clusters of PTSD through the lens of a predictive processing model. We particularly focus on re-experiencing symptoms as the hallmark symptoms of PTSD, and discuss the occurrence of flashbacks in terms of perceptual and interoceptive inference. This account provides not only a new understanding of the clinical profile of PTSD, but also a unifying framework for the corresponding pathologies at the neurobiological level. Finally, we derive directions for future research and discuss implications for psychological and pharmacological interventions.
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Affiliation(s)
- Tobias Kube
- Harvard Medical School, Program in Placebo Studies, Beth Israel Deaconess Medical Center, Brookline Avenue 330, Boston, MA, 02115, USA; University of Koblenz-Landau, Pain and Psychotherapy Research Lab, Ostbahnstr. 10, 76829 Landau, Germany.
| | - Max Berg
- Philipps-University of Marburg, Department of Psychology, Division of Clinical Psychology and Psychological Treatment Gutenbergstraße 18, D-35032, Marburg, Germany
| | - Birgit Kleim
- University of Zurich, Department of Psychology, Binzmühlestrasse 14, Box 8, CH-8050, Zurich, Switzerland; Psychiatric University Hospital (PUK), Lenggstrasse 31, CH-8032, Zurich, Switzerland
| | - Philipp Herzog
- Philipps-University of Marburg, Department of Psychology, Division of Clinical Psychology and Psychological Treatment Gutenbergstraße 18, D-35032, Marburg, Germany; University of Greifswald, Department of Psychology, Clinical Psychology and Psychotherapy, Franz-Mehring-Straße 47, D-17489, Greifswald, Germany; Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, D-23562, Lübeck, Germany
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150
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DeVille DC, Kuplicki R, Stewart JL, Paulus MP, Khalsa SS. Diminished responses to bodily threat and blunted interoception in suicide attempters. eLife 2020; 9:e51593. [PMID: 32254020 PMCID: PMC7138608 DOI: 10.7554/elife.51593] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 03/02/2020] [Indexed: 12/17/2022] Open
Abstract
Psychological theories of suicide suggest that certain traits may reduce aversion to physical threat and increase the probability of transitioning from suicidal ideation to action. Here, we investigated whether blunted sensitivity to bodily signals is associated with suicidal action by comparing individuals with a history of attempted suicide to a matched psychiatric reference sample without suicide attempts. We examined interoceptive processing across a panel of tasks: breath-hold challenge, cold-pressor challenge, and heartbeat perception during and outside of functional magnetic resonance imaging. Suicide attempters tolerated the breath-hold and cold-pressor challenges for significantly longer and displayed lower heartbeat perception accuracy than non-attempters. These differences were mirrored by reduced activation of the mid/posterior insula during attention to heartbeat sensations. Our findings suggest that suicide attempters exhibit an 'interoceptive numbing' characterized by increased tolerance for aversive sensations and decreased awareness of non-aversive sensations. We conclude that blunted interoception may be implicated in suicidal behavior.
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Affiliation(s)
- Danielle C DeVille
- Laureate Institute for Brain ResearchTulsaUnited States
- Department of Psychology, The University of TulsaTulsaUnited States
| | | | - Jennifer L Stewart
- Laureate Institute for Brain ResearchTulsaUnited States
- Oxley College of Health Sciences, The University of TulsaTulsaUnited States
| | - Martin P Paulus
- Laureate Institute for Brain ResearchTulsaUnited States
- Oxley College of Health Sciences, The University of TulsaTulsaUnited States
| | - Sahib S Khalsa
- Laureate Institute for Brain ResearchTulsaUnited States
- Oxley College of Health Sciences, The University of TulsaTulsaUnited States
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