An Active Inference Approach to Interoceptive Psychopathology

Interoceptive accuracy and its impact on neuronal responses to olfactory stimulation in the insular cortex

The insular cortex plays a key role in the integration of multimodal information and in interoceptive and exteroceptive processing. For instance, neurons in the central dorsal insula that are active during interoceptive tasks, also show an adaptation to gustatory stimulation. We tested the link between interoception and exteroception for the olfactory system (i.e., the second domain of chemosensation). In a sample of 31 participants, olfactory function was assessed in a two dimensional approach while the Heartbeat Perception Task served as a measurement for cardiac interoceptive accuracy. Subsequent fMRI sessions were performed on a 3‐Tesla MR scanner containing 12–15 olfactory stimulation trials with a mildly pleasant food‐related odor (coffee). Persons scoring high in the cardiac interoceptive accuracy task presented stronger smelling abilities as well as enhanced BOLD responses following olfactory stimulation. The olfactory stimulation triggered enhanced insular activation patterns in the central dorsal insular cortex. Consistent with prior findings on the coherence of gustatory and interoceptive processing in the central dorsal insula, these results base the insula as a common region for the integration of interoception and exteroception. We propose an explanatory model of how exteroception triggers the integration of intero‐ and exteroceptive sensations in the central dorsal insular cortex.

Estimation of Current and Future Physiological States in Insular Cortex

Interoception, the sense of internal bodily signals, is essential for physiological homeostasis, cognition, and emotions. While human insular cortex (InsCtx) is implicated in interoception, the cellular and circuit mechanisms remain unclear. We imaged mouse InsCtx neurons during two physiological deficiency states: hunger and thirst. InsCtx ongoing activity patterns reliably tracked the gradual return to homeostasis but not changes in behavior. Accordingly, while artificial induction of hunger or thirst in sated mice via activation of specific hypothalamic neurons (AgRP or SFOGLUT) restored cue-evoked food- or water-seeking, InsCtx ongoing activity continued to reflect physiological satiety. During natural hunger or thirst, food or water cues rapidly and transiently shifted InsCtx population activity to the future satiety-related pattern. During artificial hunger or thirst, food or water cues further shifted activity beyond the current satiety-related pattern. Together with circuit-mapping experiments, these findings suggest that InsCtx integrates visceral-sensory signals of current physiological state with hypothalamus-gated amygdala inputs that signal upcoming ingestion of food or water to compute a prediction of future physiological state.

Understanding persistent physical symptoms: Conceptual integration of psychological expectation models and predictive processing accounts

Persistent physical symptoms (PPS) are distressing, difficult to treat, and pose a major challenge to health care providers and systems. In this article, we review two disparate bodies of literature on PPS to provide a novel integrative model of this elusive condition. First, we draw on the clinical-psychological literature on the role of expectations to suggest that people with PPS develop dysfunctional expectations about health and disease that become increasingly immune to disconfirmatory information (such as medical reassurance) through cognitive reappraisal. Second, we invoke neuroscientific predictive processing accounts and propose that the psychological process of 'cognitive immunization' against disconfirmatory evidence corresponds, at the neurobiological and computational level, to too much confidence (i.e. precision) afforded to prior predictions. This can lead to an attenuation of disconfirming sensory information so that strong priors override benign bodily signals and make people believe that something serious is wrong with the body. Combining these distinct accounts provides a unifying framework for persistent physical symptoms and shifts the focus away from their causes to the sustaining mechanisms that prevent symptoms from subsiding spontaneously. Based on this integrative model, we derive new avenues for future research and discuss implications for treating people with PPS in clinical practice.

A Computational Theory of Mindfulness Based Cognitive Therapy from the "Bayesian Brain" Perspective

Mindfulness Based Cognitive Therapy (MBCT) was developed to combine methods from cognitive behavioral therapy and meditative techniques, with the specific goal of preventing relapse in recurrent depression. While supported by empirical evidence from multiple clinical trials, the cognitive mechanisms behind the effectiveness of MBCT are not well understood in computational (information processing) or biological terms. This article introduces a testable theory about the computational mechanisms behind MBCT that is grounded in "Bayesian brain" concepts of perception from cognitive neuroscience, such as predictive coding. These concepts regard the brain as embodying a model of its environment (including the external world and the body) which predicts future sensory inputs and is updated by prediction errors, depending on how precise these error signals are. This article offers a concrete proposal how core concepts of MBCT-(i) the being mode (accepting whatever sensations arise, without judging or changing them), (ii) decentering (experiencing thoughts and percepts simply as events in the mind that arise and pass), and (iii) cognitive reactivity (changes in mood reactivate negative beliefs)-could be understood in terms of perceptual and metacognitive processes that draw on specific computational mechanisms of the "Bayesian brain." Importantly, the proposed theory can be tested experimentally, using a combination of behavioral paradigms, computational modelling, and neuroimaging. The novel theoretical perspective on MBCT described in this paper may offer opportunities for finessing the conceptual and practical aspects of MBCT.

Introduction to the special issue on physics of mind

In recent years, both fields of physics and psychology have made important scientific advances. The emergence of new instruments gave rise to a data-driven neuroscience allowing us to learn about the state of the brain supporting known mental functions and conversely. In parallel, the appearance of new mathematics allowed the development of computational models describing fundamental brain functions and implementing them in technological applications. While emphasizing the methodology of physics, the special issue aims to bring together these trends in both the experimental and theoretical sciences in order to explain some of the most basic mental processes such as perception, cognition, emotion, consciousness, and learning. In this editorial, we define unsolved problems for brain and psychological sciences, discuss possible means toward their respective solutions, and outline some collaborative initiatives aiming toward these goals. The following problems are defined in gradual order of difficulty: what are the universal properties of human behavior across conditions and cultures? What have each culture learned over historical times and why should specific elements of knowledge be accumulated over cultural evolution? Can computational psychiatry help predict, understand, and cure mental disorders? What is the function of art and cultural artifacts such as music, fiction, or poetry for the cognitive system? How to explain the relation between first-person subjective experience and third-person objective physiological data? What neural mechanisms operate on which mental content at the highest levels of organization of the hierarchical brain? How do abstract ideas emerge from sensory-motor contingencies and what are the conditions for the birth of a new concept? Could symmetry play a role in psychogenesis and support the emergence of new hierarchical layers in cognition? How can we start addressing the question of meaning scientifically, and what does it entail for the physical sciences?

The practice of meditation is not associated with improved interoceptive awareness of the heartbeat

Meditation is commonly assumed to be associated with enhanced interoceptive accuracy. We previously found that experienced meditators did not exhibit a greater ability than nonmeditators to detect heartbeat sensations at rest, despite the meditators' reported subjective ratings of higher accuracy and lower difficulty. Here, attempting to overcome previous methodological limitations, we assessed interoceptive awareness of heartbeat and breathing sensations across physiological arousal levels using infusions of isoproterenol, a beta-adrenergic agonist similar to adrenaline. We hypothesized that meditators would display greater interoceptive awareness than nonmeditators, as evidenced by higher interoceptive detection rates, increased interoceptive accuracy, and differences in localization of heartbeat sensations. We studied 15 meditators and 15 nonmeditators, individually matched on age, gender, and body mass index, using randomized, double-blinded, and placebo-controlled bolus infusions of isoproterenol. Participants reported their experience of heartbeat and breathing sensations using a dial during infusions and the location of heartbeat sensations on a two-dimensional manikin afterward. There was no evidence of higher detection rates or increased accuracy across any dose, although meditators showed a tendency to report cardiorespiratory sensation changes sooner at higher doses. Relative to nonmeditators, meditators exhibited prominent geographical differences in heartbeat localization, disproportionally reporting sensations throughout central regions of the chest, abdomen, neck, back, and head. To further assess indications of potential differences in cardiac interoceptive accuracy between meditators and nonmeditators, we conducted a meta-analysis including 724 participants and found little evidence for such differences. We conclude that the practice of meditation is not associated with improved cardiac interoceptive awareness.

A Roadmap for Integrating Neuroscience Into Addiction Treatment: A Consensus of the Neuroscience Interest Group of the International Society of Addiction Medicine

Although there is general consensus that altered brain structure and function underpins addictive disorders, clinicians working in addiction treatment rarely incorporate neuroscience-informed approaches into their practice. We recently launched the Neuroscience Interest Group within the International Society of Addiction Medicine (ISAM-NIG) to promote initiatives to bridge this gap. This article summarizes the ISAM-NIG key priorities and strategies to achieve implementation of addiction neuroscience knowledge and tools for the assessment and treatment of substance use disorders. We cover two assessment areas: cognitive assessment and neuroimaging, and two interventional areas: cognitive training/remediation and neuromodulation, where we identify key challenges and proposed solutions. We reason that incorporating cognitive assessment into clinical settings requires the identification of constructs that predict meaningful clinical outcomes. Other requirements are the development of measures that are easily-administered, reliable, and ecologically-valid. Translation of neuroimaging techniques requires the development of diagnostic and prognostic biomarkers and testing the cost-effectiveness of these biomarkers in individualized prediction algorithms for relapse prevention and treatment selection. Integration of cognitive assessments with neuroimaging can provide multilevel targets including neural, cognitive, and behavioral outcomes for neuroscience-informed interventions. Application of neuroscience-informed interventions including cognitive training/remediation and neuromodulation requires clear pathways to design treatments based on multilevel targets, additional evidence from randomized trials and subsequent clinical implementation, including evaluation of cost-effectiveness. We propose to address these challenges by promoting international collaboration between researchers and clinicians, developing harmonized protocols and data management systems, and prioritizing multi-site research that focuses on improving clinical outcomes.