Enhanced cardiac perception predicts impaired performance in the Iowa Gambling Task in patients with panic disorder

Reflection impulsivity in patients with panic disorder

BACKGROUND

Individuals with panic disorder (PD) often exhibit a proclivity to conclude that an imminent catastrophe looms, drawing such conclusions from limited physical information. Reflection impulsivity, characterized by decision-making without adequate information, likely affects this bias. This study examines the relationship between reflection impulsivity and self-report impulsive features in individuals with PD.

METHODS

Fifty patients with PD and 50 healthy controls (HC) participated to this study. Reflection impulsivity was assessed using the Information Sampling Task (IST), while trait impulsivity was measured using the Barratt Impulsiveness Scale (BIS). Participants also completed the Beck Anxiety Inventory, Panic and Agoraphobia Scale (P&A), and Anxiety Sensitivity Index-3 (ASI-3).

RESULTS

Individuals with PD exhibited higher reflection impulsivity compared to HC. Increased reflection impulsivity correlated positively with PD severity as assessed by the P&A and cognitive concerns measured by ASI-3. No significant correlations were found with physical or social concerns. PD patients had higher BIS scores than HC. Higher trait impulsivity was linked to recurrent emergency department visits among PD patients.

DISCUSSION

The findings of this study reveal the notion of increased impulsivity among individuals with PD and its relationship with cognitive concerns, as well as recurrent visits to the emergency department stemming from panic attacks.

Heart rate variability, interoceptive accuracy and functional connectivity in middle-aged and older patients with depression

BACKGROUND AND OBJECTIVE

Major depressive disorder (MDD) is associated with increased cardiac morbidity. Reduced heart rate variability (HRV) as well as lower interoceptive accuracy (IAc) have been observed in MDD as possible sympathomimetic mechanisms related to insula activity. The salience network (SN) anchored by the insula has been posited as a crucial functional network for cardiac sensations and the default mode network (DMN) for MDD. This study aimed to investigate the relation between insula-centered and depression-related brain networks, IAc and HRV in patients with depression as a possible mechanism by which MDD increases cardiac morbidity.

METHODS

30 depressed inpatients and 30 healthy subjects (derived from the population-based "Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression" cohort study, STAAB) all over 50 years were examined. HRV and IAc were assessed via electrocardiogram and a heartbeat perception task prior to a 3 T resting-state functional magnetic resonance imaging. Seed-to-voxel resting-state functional connectivity (FC) analysis was conducted with six seeds in the insula and two seeds in the DMN.

RESULTS

Depressed patients on the one hand showed decreased FC between insula cortex and frontal as well occipital cortical brain regions compared to controls. Depressed patients on the other hand exhibited higher FC between the medial prefrontal cortex and the insula cortex compared to controls. However, depressed patients did not differ in HRV nor in IAc compared to controls.

CONCLUSION

Thus, differences in insula-related brain networks in depression in our study were not mirrored by differences in HRV and IAc. Future research is needed to define the mechanism by which depression increases cardiac morbidity.

The Role of Emotion Regulation for General Self-Efficacy in Adolescents Assessed Through Both Neurophysiological and Self-Reported Measures

Background

Self-efficacy, the belief in one's ability and capacity to organize and execute actions required to achieve desired results, is associated with adolescent academic achievement and reduced risk for psychopathology. Adolescent emotion regulation represents an important component in the relationship between self-efficacy and developmental outcomes, but the underlying neurophysiological mechanisms are poorly understood. It is unclear how emotion regulation strategies, which change with experience, and emotion regulation capacity, which is largely determined by genetics, contribute to the development of self-efficacy.

Aim

The present study aims to explore the relationship between emotion regulation and self-efficacy in adolescents. We hypothesize that neurophysiological emotion regulation capacity moderates the relationship between emotion regulation strategies and self-efficacy.

Methods

The present study applied a cross-sectional design. A sample of high-school students (N = 45, nfemale = 31, age = 17-18) provided answers on the General Self-Efficacy Questionnaire and the Emotion Regulation Questionnaire. Vagal tone was used as an indicator for emotion regulation capacity.

Results

In the initial correlational analysis, reappraisal, but not expressive suppression nor vagal tone was associated with self-efficacy. Vagal tone was not associated with any self-report measures of emotion regulation or self-efficacy. Contrary to our hypothesis, vagal tone did not moderate the relationship between emotion regulation and self-efficacy.

Conclusion

This is the first study assessing the relationship between neurophysiological indicators of emotion regulation and self-efficacy. Our results do not indicate that vagal tone moderates the relationship between emotion regulation strategies and general self-efficacy. Future studies should also assess the possible influence of metacognition and interoception on relationships.

Interoceptive accuracy is associated with benefits in decision making in children

Introduction

Decision making results not only from logical analyses, but seems to be further guided by the ability to perceive somatic information (interoceptive accuracy). Relations between interoceptive accuracy and decision making have been exclusively studied in adults and with regard to complex, uncertain situations (as measured by the Iowa Gambling Task, IGT).

Methods

In the present study, 1454 children (6-11 years) were examined at two time points (approximately 1 year apart) using an IGT as well as a delay-of-gratification task for sweets-items and toy-items. Interoceptive accuracy was measured using a child-adapted version of the Heartbeat Perception Task.

Results

The present results revealed that children with higher, as compared to lower, interoceptive accuracy showed more advantageous choices in the IGT and delayed more sweets-items, but not toy-items, in a delay-of-gratification task at time point 2 but not at time point 1. However, no longitudinal relation between interoceptive accuracy and decision making 1 year later could be shown.

Discussion

Results indicate that interoceptive accuracy relates to decision-making abilities in situations of varying complexity already in middle childhood, and that this link might consolidate across the examined 1-year period. Furthermore, the association of interoceptive accuracy and the delay of sweets-items might have implications for the regulation of body weight at a later age.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Spatial-topographic nestedness of interoceptive regions within the networks of decision making and emotion regulation: Combining ALE meta-analysis and MACM analysis

Prominent theories propose that interoception modulates our behavioral and emotional responses involving decision-making and emotion regulation. Are the regions implicated in interoception also spatially related to and possibly nested within the networks of decision making and emotion regulation? Addressing this question, we performed three meta-analyses of functional magnetic resonance imaging studies to identify the regions that are commonly activated by the three domains using activation likelihood estimation (ALE). Additionally, we assessed the coactivation pattern of identified common regions using meta-analytic connectivity modeling (MACM). The results showed major overlaps of interoception with both decision making and emotion regulation in specifically the right dorsal anterior insula. The pairwise contrast analyses confirmed this finding and revealed conjunction-based activities in decision making and emotion regulation in the dorsal anterior cingulate cortex (dACC). MACM based on the identified insula revealed a widespread convergent coactivation pattern with the left anterior insula, dACC, and bilateral thalamus which, together, constitute the salience network. Among these co-activated regions, bilateral insula and the dACC were shared among all three domains. These results suggest that the regions mediating interoception including intero-exteroceptive integration and salience attribution are contained and thus spatially nested within the more extensive networks recruited during decision making and emotion regulation.

Reanalyzing the Maia and McClelland (2004) Empirical Data: How Do Participants Really Behave in the Iowa Gambling Task?

Background

Since 2007, the Iowa Gambling Task (IGT) has been a standardized clinical assessment tool for assessing decision behavior in 13 psychiatric/neurological conditions. After the publication of Maia and McClelland's (1) article, there were two responses in 2005 from Bechara et al. and Maia and McClelland, respectively, discussing whether implicit emotion or explicit knowledge influences the development of foresighted decision strategies under uncertain circumstances (e.g., as simulated in the IGT).

Methods and Results

We reanalyze and verify the data obtained by Maia and McClelland (1) in their study "What participants really know in the Iowa Gambling Task" and find that decision-makers were lured into shortsighted decisions by the prospect of immediate gains and losses.

Conclusion

Although the findings of this reanalysis cannot support any arguments concerning the effect of either implicit emotion or explicit knowledge, we find evidence that, based on the gain-loss frequency in the IGT, participants behave myopically. This is consistent with most IGT-related articles (58 out of 86) in Lee et al.'s (2) cross-cultural review. Alternatively, under uncertain circumstances, there is probably no such thing as foresighted decision strategy irrespective of the proposed mechanisms of implicit emotion or explicit knowledge.

Sex differences in interoceptive accuracy: A meta-analysis

Interoceptive accuracy, the ability to correctly perceive internal signals arising from the body, is thought to be disrupted in numerous mental and physical health conditions. Whilst evidence suggests poorer interoceptive accuracy in females compared to males, raising the possibility that interoceptive differences may relate to sex differences in mental and physical health, results concerning sex differences in interoceptive accuracy are mixed. Given such ambiguity, this meta-analysis aimed to establish the presence or absence of sex differences in interoceptive accuracy across cardiac, respiratory, and gastric domains. A review of 7956 abstracts resulted in 93 eligible studies. Results demonstrated superior accuracy in males across cardiac, but not gastric, tasks, while findings on respiratory tasks were mixed. Effect sizes were consistent across cardiac tasks, but instability and/or moderate heterogeneity was observed across other domains, likely due to the small number of eligible studies. Despite such limitations, results indicate the possibility of sex differences across interoception tasks and domains. Methodological limitations concerning the influence of physiological factors, and directions for future research are discussed.

Atypical interoception as a common risk factor for psychopathology: A review

The inadequacy of a categorial approach to mental health diagnosis is now well-recognised, with many authors, diagnostic manuals and funding bodies advocating a dimensional, trans-diagnostic approach to mental health research. Variance in interoception, the ability to perceive one's internal bodily state, is reported across diagnostic boundaries, and is associated with atypical functioning across symptom categories. Drawing on behavioural and neuroscientific evidence, we outline current research on the contribution of interoception to numerous cognitive and affective abilities (in both typical and clinical populations), and describe the interoceptive atypicalities seen in a range of psychiatric conditions. We discuss the role that interoception may play in the development and maintenance of psychopathology, as well as the ways in which interoception may differ across clinical presentations. A number of important areas for further research on the role of interoception in psychopathology are highlighted.

Effects of Interoceptive Sensibility on Mental Health during the Coronavirus Disease 2019 Pandemic

The current coronavirus disease 2019 pandemic has been reported to influence interoceptive sensibility. This study focused on adaptive and maladaptive aspects of interoceptive sensibility and examined how each aspect of interoceptive sensibility affects depression, anxiety, and somatization symptoms under the mild lockdown in Japan, which was not enforceable and a non-punitive lockdown. We used data from 10,672 participants who lived in prefectures where the emergency declaration was first applied in Japan. Interoceptive sensibility was measured by the Multidimensional Assessment of Interoceptive Awareness (MAIA). The findings show that Noticing, a subscale of the MAIA, significantly contributed to the worsening of psychological and somatic symptoms (all ps < 0.001). Conversely, Not-Distracting, Not-Worrying, Self-Regulation, and Trusting significantly contributed to the decrease of these symptoms (all ps < 0.05). The findings suggest that two aspects of interoceptive sensibility affected mental health in different ways during the mild lockdown. Mindfulness and mindfulness-based interventions would be effective in terms of enhancing adaptive aspects of interoceptive sensibility.

Evaluating a Hybrid Web-Based Training Program for Panic Disorder and Agoraphobia: Randomized Controlled Trial

BACKGROUND

Previous studies provide evidence for the effectiveness of web-based interventions for panic disorder with and without agoraphobia. Smartphone-based technologies hold significant potential for further enhancing the accessibility and efficacy of such interventions.

OBJECTIVE

This randomized controlled trial aims to evaluate the efficacy of a guided, hybrid web-based training program based on cognitive behavioral therapy for adults with symptoms of panic disorder.

METHODS

Participants (N=92) with total scores in the Panic and Agoraphobia Scale ranging from 9 to 28 were recruited from the general population and allocated either to a hybrid intervention (GET.ON Panic) or to a wait-list control group. The primary outcome was the reduction in panic symptoms, as self-assessed using a web-based version of the Panic and Agoraphobia Scale.

RESULTS

Analysis of covariance-based intention-to-treat analyses revealed a significantly stronger decrease in panic symptoms posttreatment (F=9.77; P=.002; Cohen d=0.66; 95% CI 0.24-1.08) in the intervention group than in the wait-list control group. Comparisons between groups of the follow-up measures at 3 and 6 months yielded even stronger effects (3-month follow-up: F=17.40, P<.001, Cohen d=0.89, 95% CI 0.46-1.31; 6-month follow-up: F=14.63, P<.001, Cohen d=0.81, 95% CI 0.38-1.24).

CONCLUSIONS

Hybrid web-based training programs may help reduce the symptoms of panic disorder and hence play an important role in improving health care for patients with this debilitating disorder.

TRIAL REGISTRATION

German Clinical Trial Register DRKS00005223; https://tinyurl.com/f4zt5ran.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/1745-6215-15-427.

A Practice-Inspired Mindset for Researching the Psychophysiological and Medical Health Effects of Recreational Dance (Dance Sport)

“Dance” has been associated with many psychophysiological and medical health effects. However, varying definitions of what constitute “dance” have led to a rather heterogenous body of evidence about such potential effects, leaving the picture piecemeal at best. It remains unclear what exact parameters may be driving positive effects. We believe that this heterogeneity of evidence is partly due to a lack of a clear definition of dance for such empirical purposes. A differentiation is needed between (a) the effects on the individual when the activity of “dancing” is enjoyed as a dancer within different dance domains (e.g., professional/”high-art” type of dance, erotic dance, religious dance, club dancing, Dance Movement Therapy (DMT), and what is commonly known as hobby, recreational or social dance), and (b) the effects on the individual within these different domains, as a dancer of the different dance styles (solo dance, partnering dance, group dance; and all the different styles within these). Another separate category of dance engagement is, not as a dancer, but as a spectator of all of the above. “Watching dance” as part of an audience has its own set of psychophysiological and neurocognitive effects on the individual, and depends on the context where dance is witnessed. With the help of dance professionals, we first outline some different dance domains and dance styles, and outline aspects that differentiate them, and that may, therefore, cause differential empirical findings when compared regardless (e.g., amount of interpersonal contact, physical exertion, context, cognitive demand, type of movements, complexity of technique and ratio of choreography/improvisation). Then, we outline commonalities between all dance styles. We identify six basic components that are part of any dance practice, as part of a continuum, and review and discuss available research for each of them concerning the possible health and wellbeing effects of each of these components, and how they may relate to the psychophysiological and health effects that are reported for “dancing”: (1) rhythm and music, (2) sociality, (3) technique and fitness, (4) connection and connectedness (self-intimation), (5) flow and mindfulness, (6) aesthetic emotions and imagination. Future research efforts might take into account the important differences between types of dance activities, as well as the six components, for a more targeted assessment of how “dancing” affects the human body.

Recollecting Cross-Cultural Evidences: Are Decision Makers Really Foresighted in Iowa Gambling Task?

The Iowa Gambling Task (IGT) has become a remarkable experimental paradigm of dynamic emotion decision making. In recent years, research has emphasized the "prominent deck B (PDB) phenomenon" among normal (control group) participants, in which they favor "bad" deck B with its high-frequency gain structure-a finding that is incongruent with the original IGT hypothesis concerning foresightedness. Some studies have attributed such performance inconsistencies to cultural differences. In the present review, 86 studies featuring data on individual deck selections were drawn from an initial sample of 958 IGT-related studies published from 1994 to 2017 for further investigation. The PDB phenomenon was found in 67.44% of the studies (58 of 86), and most participants were recorded as having adopted the "gain-stay loss-randomize" strategy to cope with uncertainty. Notably, participants in our sample of studies originated from 16 areas across North America, South America, Europe, Oceania, and Asia, and the findings suggest that the PDB phenomenon may be cross-cultural.

Altered Function of Superior Parietal Lobule Associated with Perceptive Awareness in First-Episode Drug-Naïve Panic Disorders: A Preliminary fMRI Study

BACKGROUND

Biased fear-related perception is one main characteristic in patients with panic disorder (PD) and their prominent cardiovascular symptoms associated with enhanced heartbeat perception.

PATIENTS AND METHODS

We investigated interoceptive perception in 18 first-onset drug-naïve PD patients and 21 age- and gender-matched healthy controls (HC). Moreover, we compared blood oxygen level-dependent (BOLD) responses between the two groups during a heartbeat perception (interoception) task to assess task-evoked activity and its relationship with heartbeat perception scores (HPSs).

RESULTS

We found that patients with PD compared to HCs revealed a trend higher but insignificant HPSs. Higher activity in the bilateral superior parietal lobule (SPL) was observed in PD patients compared to HCs during the perception of both heartbeats and pure tones compared to rest. Furthermore, patients with PD exhibited a significant positive correlation between BOLD activity in the left SPL during heartbeat > resting-state and HPS.

CONCLUSION

Using a sample of first-episode drug-naïve patients, our study reports that patients with PD show altered activation in the bilateral SPL during both interoceptive and exteroceptive perception. The increased activation during interoceptive stimuli might render PD patients more engaged in processing information associated with their internal states.

Functional neuroanatomy of interoceptive processing in children and adolescents: a pilot study

In adults, interoception - the sense of the physiological condition of the body - appears to influence emotion processing, cognition, behavior and various somatic and mental health disorders. Adults demonstrate frontal-insula-parietal-anterior cingulate cortex activation during the heartbeat detection task, a common interoceptive measure. Little, however, is known about the functional neuroanatomy underlying interoception in children. The current pilot study examined interoceptive processing in children and adolescents with fMRI while using the heartbeat detection task. Our main findings demonstrate that children as young as the age of six activate the left insula, cuneus, inferior parietal lobule and prefrontal regions. These findings are similar to those in adults when comparing heartbeat and tone detection conditions. Age was associated with increased activation within the dACC, orbital frontal cortex and the mid-inferior frontal gyri. Thus, our pilot study may provide important information about the neurodevelopment of interoceptive processing abilities in children and a task for future interoception neuroimaging studies in children.

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

Interoception is impaired in different psychiatric disorders and is also associated with emotions. Only one study could show a higher interoceptive accuracy (IAcc) in patients with obsessive-compulsive disorder (OCD). Based on the predictive coding system we assume contrary results, indicating a decreased IAcc in patients with OCD. So far, there is no study investigating the effect of cognitive-behavioral therapy on IAcc in patients with OCD. Therefore, we hypothesize that patients with OCD improve their IAcc during the time course of therapy compared to healthy controls. Twenty-six patients with OCD from the Psychosomatic Clinic in Windach were examined in the time course of cognitive-behavioral therapy. They were compared to 26 matched healthy controls. IAcc via the heartbeat perception task as well as questionnaire data (OCD-, depression- and anxiety symptoms) were assessed. Results showed that IAcc, OCD-, depression- and anxiety symptoms were attenuated in patients with OCD. Patients recovered in the time course of therapy regarding OCD-, depression- and anxiety symptoms. Interoceptive deficits did not change in the time course of cognitive-behavioral therapy. We demonstrated that IAcc is affected in patients with OCD and this deficit does not change during the time course of a standardized therapy. Future studies should investigate, whether an inaccuracy in perceiving one's bodily signals constitutes a risk factor for relapse. Further, it could be examined if IAcc can be increased via self- and body focus interventions in patients with OCD.

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

OBJECTIVE

Spider phobia is a common form of anxiety disorder for which exposure therapy is an effective first-line treatment. Motivated by the observed modulation of threat processing by afferent cardiac signals, we tested the hypothesis that interoceptive information concerning cardiovascular arousal can influence the outcomes of computerized exposure therapy for spider phobia.

METHOD

Fifty-three normal healthy participants with high spider phobia scores underwent one of the following three modified computerized exposure protocols, defined by the timing of exposure to brief spider stimuli within the cardiac cycle: systole (during afferent baroreceptor firing); diastole (during baroreceptor-quiescent interbeat interval); random (noncontingent on cardiac cycle). Outcomes were judged on phobic and anxiety measures and physiological data (skin conductance). Individuals were also rated on interoceptive accuracy.

RESULTS

MANCOVA analysis showed that timing group affected the outcome measures (F(10,80) = 2.405, p = .015) and there was a group interaction with interoception ability (F(15,110) = 1.808, p = .045). Subjective symptom reduction was greatest in the systolic group relative to the other two groups (diastolic (t = 3.115, ptukey = .009); random (t = 2.438, ptukey = .048)), with greatest reductions in those participants with lower interoceptive accuracy. Behavioral aversion reduced more in cardiac-contingent groups than the noncontingent (random) group (diastolic (t = 3.295, ptukey = .005); systolic (t = 2.602, ptukey = .032)). Physiological (skin conductance response) responses remained strongest for spider stimuli presented at cardiac systole.

CONCLUSIONS

Interoceptive information influences exposure benefit. The reduction in the subjective expression of fear/phobia is facilitated by "bottom-up" afferent signals, whereas improvement in the behavioral expression is further dependent on "top-down" representation of self-related physiology (heart rhythm). Individual interoceptive differences moderate these effects, suggesting means to personalize therapy.

Does neuropsychological performance in OCD relate to different symptoms? A meta-analysis comparing the symmetry and obsessing dimensions

BACKGROUND

Investigations of neuropsychological functioning in obsessive-compulsive disorder (OCD) have produced mixed results for deficits in executive functioning (EF), attention, and memory. One potential explanation for varied findings may relate to the heterogeneity of symptom presentations, and different clinical or neurobiological characteristics may underlie these different symptoms.

METHODS

We investigated differences in neuropsychological functioning between two symptoms groups, obsessing/checking (O/C) and symmetry/ordering (S/O), based on data suggesting an association with different motivations: harm avoidance and incompleteness, respectively. Ten studies (with 628 patients) were included and each investigation assessed at least one of 14 neuropsychological domains.

RESULTS

The S/O domain demonstrated small, negative correlations with overall neuropsychological functioning, performance in EF, memory, visuospatial ability, cognitive flexibility, and verbal working memory. O/C symptoms demonstrated small, negative correlations with memory and verbal memory performance. A comparison of functioning between symptom groups identified large effect sizes showing that the S/O dimension was more strongly related to poorer neuropsychological performance overall, and in the domains of attention, visuospatial ability, and the subdomain of verbal working memory.

CONCLUSIONS

Findings support existing evidence suggesting that different OCD symptoms, and their associated core motivations, relate to unique patterns of neuropsychological functioning, and, potentially dysfunction in different neural circuits.

The effects of alcohol on heartbeat perception: Implications for anxiety

INTRODUCTION

It is well established that some individuals self-medicate their anxiety with alcohol. Though much evidence exists that alcohol consumption can be negatively reinforcing, there remains uncertainty regarding what mediates the relationship between alcohol and anxiety. An unexplored possibility is that, for some, alcohol impairs interoceptive sensitivity (the ability to accurately perceive one's physiological state), thereby decreasing state anxiety. Consistent with this, highly accurate heartbeat perception is a risk factor both for elevated trait anxiety and anxiety disorders. However, the direct impact of alcohol on cardioceptive accuracy has not to our knowledge been previously examined.

METHODS

Sixty-one social drinkers came to the lab in groups of 4-6 on two days spaced a week apart. Each participant was randomly assigned to receive alcoholic drinks targeting a BAC of 0.05% on one testing day and placebo drinks on the other, with the order counter-balanced. On both testing days, participants engaged in a Schandry heartbeat perception task on three occasions: at baseline, after an alcohol absorption period, and after physiological arousal was raised via exercise.

RESULTS

For men only, alcohol significantly impaired cardioceptive accuracy relative to a placebo at both low and high levels of arousal, with medium to large effect sizes.

CONCLUSIONS

Though preliminary, this finding is consistent with the proposed hypothesis linking alcohol consumption and anxiety, at least for men. Future studies should directly examine whether, among individuals with anxiety disorders, cardioceptive sensitivity mediates the relationship between alcohol consumption and state anxiety.

Interoceptive sensitivity as a proxy for emotional intensity and its relationship with perseverative cognition

Background

Technical advancement in military cyber defense poses increased cognitive demands on cyber officers. In the cyber domain, the influence of emotion on decision-making is rarely investigated. The purpose of this study was to assess psychophysiological correlation with perseverative cognitions during emotionally intensive/stressful situations in cyber military personnel. In line with parallel research on clinical samples high on perseverative cognition, we expected a decreased interoceptive sensitivity in officers with high levels of perseverative cognition.

Method

We investigated this association in a sample of 27 cyber officer cadets.

Results

Contrary to our hypothesis, there was no relationship between the factors.

Discussion

Cyber officers might display characteristics not otherwise found in general populations. The cyber domain may lead to a selection process that attracts different profiles of cognitive and emotional processing.

Improvement of Interoceptive Processes after an 8-Week Body Scan Intervention

Objective: Interoceptive processes are defined as ability to detect sensations arising within the body. There is a growing body of research investigating ways of improving interoceptive processes. One promising approach increasing the attention to bodily sensations is the body scan (BS), a method stemming from mindfulness-based stress reduction. Research so far revealed only heterogenous findings of meditational practice and mindfulness-based stress reduction on interoceptive processes. Even more importantly, there is no study considering the effect of an 8-week BS intervention on interoceptive processes and the distinguishable subdomains of interoception. Therefore, the main objective of this research is to examine the effects of a BS intervention on different interoceptive subdomains over 8 weeks of training in two different samples.

Methods: In study 1, healthy participants executed a 20 min standardized audiotaped BS in the BS intervention group (n = 25) each day over 8 weeks. The control group (n = 24) listened to an audio book for the same amount of time. In study 2, the BS group (n = 18) was compared to an inactive control group (n = 18). In both studies, three measurement points were realized and interoceptive accuracy (IAc) – using a heartbeat perception task – as well as interoceptive sensibility (IS) – using confidence ratings for the heartbeat perception task and the subscale ‘interoceptive awareness’ of the Eating Disorder Inventory-2 (EDI-2) – were assessed.

Results: In study 1, we found, as a descriptive trend, IAc and confidence ratings to be increased irrespective of the condition. However, post hoc analysis revealed a significant improvement of IAc between T1 and T3 in the BS intervention only. IS revealed to be unaffected by the interventions. In study 2, we observed a significant positive effect of the BS intervention on IAc and confidence ratings compared to the inactive controls. As in study 1, IS (EDI-2) was unaffected by the intervention.

Discussion: The results highlight the fact that interoception can be improved by long-term interventions focusing on bodily signals. Further studies might focus on clinical samples showing deficits in interoceptive processes and could use other bodily systems for measurement (e.g., respiratory signals) as well methods manipulating body ownership.

Impairment of Working Memory, Decision-making, and Executive Function in the First-Degree Relatives of People with Panic Disorder: A Pilot Study

BACKGROUND

Panic disorder (PD) patients present impairments of working memory, decision-making, and executive function. However, whether the first-degree relatives (FDRs) of people with PD present abnormal characteristics, including clinical and neuropsychological aspects, in comparison to the general population, has not been studied. Investigation and understanding of the abnormal neuropsychological characteristics of the FDRs of people with PD will contribute to the prevention and treatment of PD.

OBJECTIVE

The purpose of this paper is to compare the working memory, decision-making, and executive function among people with PD, their FDRs, and controls.

MATERIALS AND METHODS

Neuropsychological functions of 30 people with PD, 30 FDRs of people with PD, and 30 controls were measured with a digit span task, Iowa Gambling Task (IGT), and Wisconsin Card Sorting Test (WCST).

RESULTS

Perseverative errors, failure to maintain set scores, and number of cards chosen from decks A, B, C, and D were higher for People with PD and their FDRs than those of controls. Furthermore, error rates for these tests were higher for people with PD than their FDRs. Forward scores and backward scores, percentage of conceptual level responses, the number of categories completed, choices from advantageous minus disadvantageous decks, and mean amount of money earned of people with PD and their FDRs were all lower than those of controls. Scores for these tests were also lower for people with PD than for their FDRs.

CONCLUSION

People with PD as well as their FDRs present different degrees of impairments of working memory, decision-making, and executive function. Impaired performance on three tasks appears to be associated with the diathesis for PD and may be a valuable indicator of susceptibility for this disorder.

Neural correlates of heart-focused interoception: a functional magnetic resonance imaging meta-analysis

Interoception is the ability to perceive one's internal body state including visceral sensations. Heart-focused interoception has received particular attention, in part due to a readily available task for behavioural assessment, but also due to accumulating evidence for a significant role in emotional experience, decision-making and clinical disorders such as anxiety and depression. Improved understanding of the underlying neural correlates is important to promote development of anatomical-functional models and suitable intervention strategies. In the present meta-analysis, nine studies reporting neural activity associated with interoceptive attentiveness (i.e. focused attention to a particular interoceptive signal for a given time interval) to one's heartbeat were submitted to a multilevel kernel density analysis. The findings corroborated an extended network associated with heart-focused interoceptive attentiveness including the posterior right and left insula, right claustrum, precentral gyrus and medial frontal gyrus. Right-hemispheric dominance emphasizes non-verbal information processing with the posterior insula presumably serving as the major gateway for cardioception. Prefrontal neural activity may reflect both top-down attention deployment and processing of feed-forward cardioceptive information, possibly orchestrated via the claustrum.This article is part of the themed issue 'Interoception beyond homeostasis: affect, cognition and mental health'.

ADORA2A genotype modulates interoceptive and exteroceptive processing in a fronto-insular network

Facilitated processing of interoceptive and exteroceptive information in the salience network is suggested to promote the development of anxiety and anxiety disorders. Here, it was investigated whether the adenosine 2 A receptor gene (ADORA2A) 1976T/C (rs5751876) variant - previously associated with anxiety disorders and anxiety-related phenotypes as well as general attentional efficiency -was involved in the regulation of this network. In detail, fMRI recordings of 65 healthy participants (female=35) were analyzed regarding ADORA2A genotype effects on brain connectivity related to (1) interoceptive processing in terms of functional connectivity resting-state fMRI, and (2) exteroceptive processing using dynamic causal modeling in task-based fMRI. In a subsample, cardiac interoceptive accuracy was furthermore measured via the Mental Tracking Task. ADORA2A genotype was found to modulate a fronto-insular network at rest (interoceptive processing) and while performing an executive control task (exteroceptive processing). Across both modalities, the ADORA2A TT risk genotype was associated with increased connectivity between the insula and the prefrontal cortex. The strength in connectivity correlated with interoceptive accuracy. It is concluded that alterations in fronto-insular connectivity are modulated by both the adenosinergic system and interoceptive accuracy. Thus, fronto-insular connectivity in synopsis with ADORA2A genotypic information could serve as combined biomarkers for personalized treatment approaches in anxiety disorders targeting exteroceptive and interoceptive dysfunction.

Interoception and stress

Afferent neural signals are continuously transmitted from visceral organs to the brain. Interoception refers to the processing of visceral-afferent neural signals by the central nervous system, which can finally result in the conscious perception of bodily processes. Interoception can, therefore, be described as a prominent example of information processing on the ascending branch of the brain–body axis. Stress responses involve a complex neuro-behavioral cascade, which is elicited when the organism is confronted with a potentially harmful stimulus. As this stress cascade comprises a range of neural and endocrine pathways, stress can be conceptualized as a communication process on the descending branch of the brain–body axis. Interoception and stress are, therefore, associated via the bi-directional transmission of information on the brain–body axis. It could be argued that excessive and/or enduring activation (e.g., by acute or chronic stress) of neural circuits, which are responsible for successful communication on the brain–body axis, induces malfunction and dysregulation of these information processes. As a consequence, interoceptive signal processing may be altered, resulting in physical symptoms contributing to the development and/or maintenance of body-related mental disorders, which are associated with stress. In the current paper, we summarize findings on psychobiological processes underlying acute and chronic stress and their interaction with interoception. While focusing on the role of the physiological stress axes (hypothalamic-pituitary-adrenocortical axis and autonomic nervous system), psychological factors in acute and chronic stress are also discussed. We propose a positive feedback model involving stress (in particular early life or chronic stress, as well as major adverse events), the dysregulation of physiological stress axes, altered perception of bodily sensations, and the generation of physical symptoms, which may in turn facilitate stress.

The somatic marker theory in the context of addiction: contributions to understanding development and maintenance

Recent theoretical accounts of addiction have acknowledged that addiction to substances and behaviors share inherent similarities (eg, insensitivity to future consequences and self-regulatory deficits). This recognition is corroborated by inquiries into the neurobiological correlates of addiction, which has indicated that different manifestations of addictive pathology share common neural mechanisms. This review of the literature will explore the feasibility of the somatic marker hypothesis as a unifying explanatory framework of the decision-making deficits that are believed to be involved in addiction development and maintenance. The somatic marker hypothesis provides a neuroanatomical and cognitive framework of decision making, which posits that decisional processes are biased toward long-term prospects by emotional marker signals engendered by a neuronal architecture comprising both cortical and subcortical circuits. Addicts display markedly impulsive and compulsive behavioral patterns that might be understood as manifestations of decision-making processes that fail to take into account the long-term consequences of actions. Evidence demonstrates that substance dependence, pathological gambling, and Internet addiction are characterized by structural and functional abnormalities in neural regions, as outlined by the somatic marker hypothesis. Furthermore, both substance dependents and behavioral addicts show similar impairments on a measure of decision making that is sensitive to somatic marker functioning. The decision-making deficits that characterize addiction might exist a priori to addiction development; however, they may be worsened by ingestion of substances with neurotoxic properties. It is concluded that the somatic marker model of addiction contributes a plausible account of the underlying neurobiology of decision-making deficits in addictive disorders that is supported by the current neuroimaging and behavioral evidence. Implications for future research are outlined.

Neural and sympathetic activity associated with exploration in decision-making: further evidence for involvement of insula

We previously reported that sympathetic activity was associated with exploration in decision-making indexed by entropy, which is a concept in information theory and indexes randomness of choices or the degree of deviation from sticking to recent experiences of gains and losses, and that activation of the anterior insula mediated this association. The current study aims to replicate and to expand these findings in a situation where contingency between options and outcomes is manipulated. Sixteen participants performed a stochastic decision-making task in which we manipulated a condition with low uncertainty of gain/loss (contingent-reward condition) and a condition with high uncertainty of gain/loss (random-reward condition). Regional cerebral blood flow was measured by (15)O-water positron emission tomography (PET), and cardiovascular parameters and catecholamine in the peripheral blood were measured, during the task. In the contingent-reward condition, norepinephrine as an index of sympathetic activity was positively correlated with entropy indicating exploration in decision-making. Norepinephrine was negatively correlated with neural activity in the right posterior insula, rostral anterior cingulate cortex, and dorsal pons, suggesting neural bases for detecting changes of bodily states. Furthermore, right anterior insular activity was negatively correlated with entropy, suggesting influences on exploration in decision-making. By contrast, in the random-reward condition, entropy correlated with activity in the dorsolateral prefrontal and parietal cortices but not with sympathetic activity. These findings suggest that influences of sympathetic activity on exploration in decision-making and its underlying neural mechanisms might be dependent on the degree of uncertainty of situations.

Rumination and interoceptive accuracy predict the occurrence of the thermal grill illusion of pain

Background

While the neurophysiological mechanisms underlying the thermal grill illusion of pain (TGI) have been thoroughly studied, psychological determinants largely remain unknown. The present study aimed to investigate whether cognitive and affective personality traits encompassing rumination, interoception, and suggestibility may be identified as characteristics favouring the elicitation of paradoxical pain experiences.

Methods

The dominant hand of 54 healthy volunteers was stimulated with a water-bath driven thermal grill providing an interlaced temperature combination of 15 and 41°C. Pain intensity and pain unpleasantness perceptions were rated on a combined verbal-numerical scale (NRS). Traits were assessed via questionnaires, the heartbeat-tracking task, and warmth suggestions.

Results

Logistic regression analyses uncovered trait rumination and interoceptive accuracy (IA) as major predictors of the likelihood of the illusive pain occurrence (all p < .05). Rumination and suggestibility had an impact on unpleasant pain perceptions.

Conclusion

Our findings allowed identifying psychological factors substantially involved in the individual pre-disposition to reporting painful sensations in the thermal grill paradigm. These psychological characteristics may also be relevant in the context of central neuropathic pain, which to a large extent incorporates the same neural pathways.