Assessing body awareness and autonomic reactivity: Factor structure and psychometric properties of the Body Perception Questionnaire-Short Form (BPQ-SF)

Exploring Individual Differences in Interoception Among Athletes Based on a Three-Dimensional Construct of Interoception

Previous studies demonstrated that sensorimotor training enhances interoceptive abilities. Athletes are highly engaged in performance-driven physical training and often incorporate-to varying degrees-sensorimotor training into their routines. In this study, we investigated the role of individual differences in interoception by comparing professional athletes of different performance levels and both sexes with recreational athletes and controls, applying a three-dimensional model of interoception. Twenty-six elite athletes, 52 recreational athletes, and 50 college students were recruited from national sports teams, local sports training centers, and local universities. We used the Multidimensional Assessment of Interoperative Awareness (MAIA), the Heartbeat Detecting Task (HDT), and a numeric rating scale based on HDT to measure interoceptive sensibility, accuracy, and awareness. At average, athletes showed significantly higher interoceptive sensibility, interoceptive accuracy, and interoceptive awareness than controls. Elite athletes reported significantly higher scores in all measures of interception compared to recreational athletes. Intriguingly, Non-Distracting for interoceptive sensibility was positively correlated with the level of experience in elite athletes. Male athletes had better interoceptive sensibility and interoceptive awareness compared to female athletes in the elite group, while no significant sex differences were detected in the other two groups. These results indicated that level of sport experience and sex are associated with differences in interoceptive accuracy, interoceptive sensibility, and interoceptive awareness. It also suggests that interoceptive ability is possibly an experience-dependent trait for athletic performance, which provides insight for improving sports performance through an approach of enhancing interoceptive ability.

Interoceptive ageing and the impact on psychophysiological processes: A systematic review

Interoception, the perception and response to internal bodily states, significantly influences physical and mental wellbeing. While ageing is associated with interoceptive decline, research has primarily examined selective dimensions of interoception. Understanding these changes is vital as the global population ages, addressing age-related health issues and sustaining psychological wellbeing. This systematic review synthesised findings from 22 studies on age-related interoceptive changes and their impact on psychophysiological processes. Results showed age-related declines (48.4 %), no age differences (32.3 %), an age-related increase (16.13 %), and an inverted U-shaped curvilinear relationship (3.23 %) in interoceptive sensitivity across age groups and interoceptive dimensions. Three patterns emerged regarding psychophysiological processes in older adults: altered mind-body connections with age were associated with reduced high-arousal and increased positive emotional experiences, cognitive protective effects, and improved body representation that correlated with better interoceptive sensitivity. These patterns indicate the complex relationships between interoceptive ageing and psychophysiological processes, showing both, aspects of decline and compensatory mechanisms. We propose future research avenues to elucidate the functional significance of different interoceptive dimensions across the lifespan for optimised psychological wellbeing and health behaviours in older adults.

Greenspace use and anxiety in young adults: The role of interoception

OBJECTIVE

Greenspace is linked to prevention and management of anxiety, but the underlying mechanisms remain unclear. This study aims to evaluate the association between greenspace use and anxiety in Chinese young adults, focusing on the mediating role of interoception.

METHODS

This population-based study was conducted between September and October 2023 in four local universities in China. A total of 27,755 young adults were included. Greenspace use was assessed by self-report, anxiety by the Generalized Anxiety Disorder (GAD) assessment, and interoception by the Body Perception Questionnaire (BPQ). Generalized linear mixed models (GLMMs) and mediation models were utilized to analyze associations.

RESULTS

The mean age of participants was 19.39 ± 1.64 years, with 10,944 (39.4%) being female. A total of 10,273 (37.01%) participants suffered from anxiety. GLMMs indicated that compared to their counterparts who did not visit green spaces at all in the past four weeks, those who visited once or twice, once a week, or several times a week had lower odds of anxiety. A lower level of interoception was associated with reduced odds of anxiety. Furthermore, interoception mediated much of the association between greenspace use and anxiety. These associations were robust in a series of sensitivity analyses.

CONCLUSIONS

These results suggest the crucial role of green spaces on interoception and anxiety and point to the importance of promoting student well-being through interaction with greenspace and nature. Further research is needed to better understand how interoception mediates the connection of greenspace and other aspects of the built environment with anxiety.

Influence of interoception and body movement on the rubber hand illusion

Rubber hand illusion (RHI) refers to the illusory sense of body ownership of a fake hand, which is induced by synchronous visuotactile stimulation to the real and fake hands. A negative correlation was reported between the cardiac interoception and the strength of RHI, but the subsequent studies have been unsuccessful in replicating it. On the other hand, voluntary action is suggested to link interoception and the sense of body ownership in different situations. If so, moving RHI, induced by the active or the passive finger tapping while observing a fake hand, might reveal the relationship more clearly. The measurement of interoception has been another issue. We, therefore, examined the relationship between the moving RHI and two measures of interoception: interoceptive accuracy (IAcc) measured by the conventional heartbeat counting task and interoceptive sensibility (IS) measured using a questionnaire. For the classical visuotactile RHI, our results supported the lack of association between the interoception measures and RHI. For the moving RHI, a stronger sense of body ownership was induced for participants with higher IS regardless of active or passive movement, and a stronger sense of agency was caused by active than passive movement only for those with lower IAcc. These results reveal the dynamic links between the interoception and the bodily senses. The results also suggest that multiple dimensions of interoception affect the bodily senses differently.

The relationship between self-reported interoception and anxiety: A systematic review and meta-analysis

Interoception, the processing of internal bodily sensations, is associated with various mental health conditions. In particular, anxiety is often considered to be the prototypical interoceptive disorder. However, empirical evidence is mixed, with meta-analytic work reporting no relationship between anxiety and cardiac interoceptive accuracy. Less explored, however, are the mixed results relating to anxiety and self-reported interoception. This meta-analysis of 71 studies explored the relationship between self-report measures of interoception and anxiety. Across 12 measures (20 subscales), anxiety was associated with increased negative evaluations of, frequency of, and sensitivity to, bodily signals. Anxiety was also associated with greater (negative) attention to bodily signals, and difficulties describing bodily signals and emotions. However, anxiety was not associated with the use of bodily signals to inform emotions (e.g., noticing emotionally induced bodily signals). Results are discussed considering the overlap between anxiety and interoception questionnaires, the lack of specificity of certain measures, and the potential confound of individual differences in questionnaire interpretation. We also discuss limitations of anxiety measures and the clinical relevance of findings.

Validation of the Neuroception of Psychological Safety Scale (NPSS) Among Health and Social Care Workers in the UK

Psychological safety is essential for rest, recovery, and fostering social connections, particularly for health and social care workers (HSCWs) who frequently operate in high-pressure environments. These workers are prone to traumatic stress, which can elevate their sense of threat and undermine their psychological safety. This study aimed to validate the Neuroception of Psychological Safety Scale (NPSS) among HSCWs in the UK (n = 443). The NPSS is based on polyvagal theory and assesses the dimensions of compassion, social engagement and bodily sensations. Internal consistency, test-retest reliability, convergent, discriminant, and concurrent validity were examined, along with the scale's dimensionality. A three-factor structure was confirmed, with internal consistencies ranging from acceptable to excellent across subscales. Validity was supported by significant associations with measures of team psychological safety, well-being, post-traumatic stress, burnout, body perception, and personality. The NPSS also demonstrated strong test-retest reliability. These results validate the NPSS as a reliable and multidimensional tool for assessing psychological safety in health and social care settings. The study highlights the importance of psychological safety for HSCWs and provides a valuable measure to support interventions aimed at fostering safer and more supportive work environments.

Altered Neural Processing of Interoception in Patients With Functional Neurological Disorder: A Task-Based fMRI Study

OBJECTIVE

Research suggests that disrupted interoception contributes to the development and maintenance of functional neurological disorder (FND); however, no functional neuroimaging studies have examined the processing of interoceptive signals in patients with FND.

METHODS

The authors examined univariate and multivariate functional MRI neural responses of 38 patients with mixed FND and 38 healthy control individuals (HCs) during a task exploring goal-directed attention to cardiac interoception-versus-control (exteroception or rest) conditions. The relationships between interoception-related neural responses, heartbeat-counting accuracy, and interoceptive trait prediction error (ITPE) were also investigated for FND patients.

RESULTS

When attention was directed to heartbeat signals versus exteroception or rest tasks, FND patients showed decreased neural activations (and reduced coactivations) in the right anterior insula and bilateral dorsal anterior cingulate cortices (among other areas), compared with HCs. For FND patients, heartbeat-counting accuracy was positively correlated with right anterior insula and ventromedial prefrontal activations during interoception versus rest. Cardiac interoceptive accuracy was also correlated with bilateral dorsal anterior cingulate activations in the interoception-versus-exteroception contrast, and neural activations were correlated with ITPE scores, showing inverse relationships to those observed for heartbeat-counting accuracy.

CONCLUSIONS

This study identified state and trait interoceptive disruptions in FND patients. Convergent between- and within-group findings contextualize the pathophysiological role of cingulo-insular (salience network) areas across the spectrum of functional seizures and functional movement disorder. These findings provide a starting point for the future development of comprehensive neurophysiological assessments of interoception for FND patients, features that also warrant research as potential prognostic and monitoring biomarkers.

Exploring the relationship between cardiac awareness and balance

Postural balance requires the interplay between several physiological signals. Indirect evidence suggests that the perception of signals arising from the autonomic nervous system might play a role (e.g. cardiac awareness). Here, we tested this hypothesis by investigating the relationship between postural control and cardiac awareness (i.e. interoception) in a sample of N = 70 healthy individuals. Postural control was measured using a medical robotic device, while cardiac awareness was evaluated using the heartbeat counting task. A within-subject design included two platform configurations (static, unstable) and two visual feedback conditions (eyes open, eyes closed). For each condition, we measured the sway area and the range of oscillation of the platform, as well as the range of oscillation and the quantity of movement of participants' trunk. In the "platform unstable, eyes closed" condition, participants with higher cardiac awareness demonstrated a significantly smaller sway area and reduced oscillations of both the platform and their trunk. These findings hint at a potential link between interoception and postural control, suggesting that the perception of internal body signals might sustain balance.

A systematic review and meta-analysis of the relationship between subjective interoception and alexithymia: Implications for construct definitions and measurement

Although research indicates that self-reported interoception is associated with deficits in identifying and describing emotional experience, and externally oriented thinking styles (alexithymia), this relationship appears moderated by how interoception is measured. A systematic review and meta-analyses examined the association between self-reported interoception and alexithymia, investigating how different interoceptive questionnaires relate to alexithymia at global and facet levels. PsychINFO, PubMed, Scopus, and Web of Science databases were searched with predefined terms related to self-reported interoception and alexithymia. Three reviewers independently assessed articles, extracted data, and undertook risk of bias assessment. Thirty-two cross-sectional studies published between 1996 and 2023 were included. Random-effects meta-analyses and narrative synthesis indicated that global alexithymia was positively associated with measures of interoceptive confusion, autonomic nervous system reactivity, and heightened interoceptive attention, and inversely associated with interoceptive accuracy and adaptive interoception, indexed by composite Multidimensional Assessment of Interoceptive Awareness scores, but particularly interoceptive trusting, self-regulation, and attention regulation. These patterns were observed for alexithymic facets and stronger in magnitude for difficulty identifying feelings and difficulty describing feelings, relative to externally oriented thinking. Overall, results suggested that the association between self-reported interoception and alexithymia differs as a function of the interoceptive self-report. The review highlighted issues with construct definition and operationalisation and determined that existing interoceptive self-reports broadly capture maladaptive and adaptive sensing, attention, interpretation, and memory. The findings underscore the importance of specifying interoceptive constructs and using appropriate assessments to improve convergence between constructs and measurements, further suggesting potential clinical utility in using existing self-reports to measure interoception and alexithymia, facilitating interventions targeting mind-body connections.

Autonomic assessment at the intersection of psychosocial and gastrointestinal health

BACKGROUND

Wearable technology is increasingly used in clinical practice and research to monitor functional gastrointestinal symptoms and mental health.

AIMS

This article explores the potential of wearable sensors to enhance the understanding of the autonomic nervous system (ANS), particularly its role in linking psychological and gastrointestinal function. The ANS, facilitates brain-gut communication and is responsive to psychosocial conditions. It is implicated in disorders related to psychological stress and gut-brain interaction. Wearable technology enables tracking of the ANS in daily life, offering complementary and alternative methods from traditional lab-based measures. This review places focus on autonomic metrics such as respiratory sinus arrhythmia, vagal efficiency, and electrodermal activity as well as self-reports of autonomic symptoms.

DISCUSSION

Potential applications include use of wearable sensors for tracking autonomic activity in disorder of gut-brain interaction such as cyclic vomiting syndrome, in which ANS dysregulation may be triggered by psychosocial factors. Considerations for data interpretation and contextualization are addressed, acknowledging challenges such as situational confounders of ANS activity and accuracy of wearable devices.

He Who Seeks Finds (Bodily Signals): German Validation of the Interoceptive Attention Scale (IATS) and its Relationship with Subclinical Psychopathology

Alterations in interoception have been linked to psychopathology. Recent findings suggest that both the attention to and the accuracy of, interoceptive perceptions may be oppositely related to subclinical symptomatology. Thus, providing well-validated tools that tap into these interoceptive processes is crucial for understanding the relation between interoceptive processing and subclinical psychopathology. In the current study (N = 642), we aimed to (1) validate the German version of the Interoceptive Attention Scale (IATS; Gabriele et al., 2022), and (2) test the differential association of self-reported interoceptive attention and accuracy with subclinical symptomatology, including alexithymia, depressive, and anxious symptomatology. We observed that a one-factor solution is a well-fitting model for the IATS. Further, the IATS showed good internal consistency, convergent, and divergent validity, but poor test-retest reliability. Self-reported interoceptive attention and accuracy were unrelated to each other. However, IATS scores were positively related to all measures of psychopathology (except depressive symptomatology), whereas self-reported interoceptive accuracy scores showed negative or nonsignificant relations with these. Our data suggest that the IATS is a good instrument to measure self-report interoceptive attention in the German population. Further, we highlight the need to distinguish between constructs of interoception to better understand the relation between interoception and psychopathology.

A network analysis of body image concern, interoceptive sensibility, self-consciousness, and self-objectification

OBJECTIVE

Disrupted interoception has been found in individuals with body image concerns and related psychiatric conditions (i.e., eating disorders, body dysmorphic disorder). However, few studies have explored the role of interoception in the relationship between body image concern and self-objectification (SO). As components of the bodily self, interoception and body image may also contribute to the fostering of self-consciousness.

METHODS

The current study estimated the network model of body image concern, adaptive and maladaptive interoceptive sensibility (IS), self-consciousness, and SO, with data from 743 neurotypical adults. The centrality of nodes and the robustness of the network were verified.

RESULTS

Our network showed that interoception correlated with certain characteristics of body image concern (BIC) with varying strength and different directions. The most central node described beliefs of BIC, namely, negative evaluation toward appearance. Self-objectification and maladaptive IS presented the highest bridge centrality. Interoception also linked BICs with SO and self-consciousness.

CONCLUSION

Findings suggested that SO, adaptive and maladaptive interoception might be the targets of intervention for individuals with BIC, specifically for those with high levels of appearance-related negative self-evaluations.

First-person thought is associated with body awareness in daily life

Sensations from the body are thought to play a critical role in many aspects of conscious experience, including first-person thought. In the present set of studies, we examined within-person relationships between in-the-moment subjective awareness of sensations from the body and self-reported first-person thought in real-world settings using ecological momentary assessment (EMA) protocols. In Study 1, participants reported experiencing greater first-person thoughts in moments when they also reported heightened awareness of sensations from their body, and this relationship was stable over a 4-week period even with mean-level changes in body awareness and first-person thought. In Study 2, we replicated this association in a 1-week EMA protocol using both self-report measures and measures derived from participants' open-ended descriptions of their ongoing thoughts using a natural language processing approach. Taken together, findings shed light on the role of subjective body awareness in other facets of conscious experience.

Changes in interoception before and after treatment in patients with alcohol use disorder

AIMS

To investigate the factors associated with interoception in patients with alcohol use disorder and determine whether treatment causes changes in their interoception.

METHODS

The Body Perception Questionnaire-Body Awareness ultra-short version Japanese version (BPQ-BAVSF-J) was used to measure interoception in 50 alcohol-dependent participants (27 in the inpatient group and 23 in the outpatient group). The BPQ-BAVSF-J was administered and data on aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (γ-GTP), mean corpuscular volume, platelet count, and Fib-4 index were extracted at admission and immediately before discharge for the inpatient group and at the first outpatient visit and approximately 3 months after the visit for the outpatient group.

RESULTS

The mean age of the 50 participants was 51.0 ± 12.3 years. Significant associations were found between the BPQ-BAVSF-J and Fib-4 index and AST. The BPQ-BAVSF-J score significantly decreased at discharge in the inpatient group. AST, ALT, γ-GTP, and Fib-4 index of liver function were also significantly lower at discharge. In contrast, in the outpatient group, there were no significant changes in the BPQ-BAVSF-J score, AST level, ALT level, γ-GTP level, and Fib-4 index between at the first outpatient visit and approximately 3 months after the visit.

CONCLUSIONS

Interoception in patients with alcohol use disorder increased with worsening liver function and decreased with improvement in liver function owing to treatment. This suggests that the BPQ-BAVSF-J score, an easily accessible scale, may be used to detect early deterioration of liver function through regular administration.

Factor structure and psychometric properties of the Body Perception Questionnaire-Short Form (BPQ-SF); The Persian version

BACKGROUND

Body perception is considered an important physiological marker in physical and mental disorders, therefore, its valid and reliable quantification is indeed necessary. Due to the lack of a Persian version of an instrument with validated psychometric properties for evaluating body perception, this study aimed to investigate the factorial structure, reliability, and validity of body perception questionnaire-Short Form (BPQ-SF) among Iranian adults.

METHODS

A total of 748 participants (mean age = 31.74; 57%female) were included in the analysis. Participants were recruited using the online survey method. Confirmatory factor analysis (CFA) was performed and concurrent validity was determined by computing Pearson's correlation coefficient between BPQ_SF, Depression Anxiety Stress Scale (DASS), and somatization subscale of Symptom-Checklist-90 (SOM). Internal consistency (using Cronbach's alpha and McDonald's omega), and composite reliability were also evaluated.

RESULTS

The result of the CFA yielded three factors: Body Awareness, Subdiaphragmatic Reactivity, and Supradiaphragmatic Reactivity. Cronbach's alpha values for all BPQ_SF items were 0.94. Moreover, Concurrent validity between BPQ, SOM, and DASS was determined to be between 0.44 to 0.94. and had good internal consistency (McDonald's Omega range: .74-.93 Cronbach's alpha range: .76-.94).

CONCLUSIONS

The BPQ-SF demonstrated good psychometric properties among Iranians thus can be used to reliably assess body perception.

The relationship between sleep and interoception

The present study aimed to characterise the relationship between sleep and interoception in two independent studies. Theoretical grounds for such a relationship include a weak relationship between subjectively- and objectively-measured sleep, the covariance of sleep with pain, as well as the mass regulation of a number of visceral biological systems. In addition, such a relationship is often reflected in our language (i.e., 'feeling' tired). In both studies (Study 1: N = 118, 73% female, mean age 20.98 years; Study 2: N = 830, 49% female, mean age 38.04 years) sleep over the last month was self-reported. Confidence in interoceptive accuracy, which is the precision with which a person can monitor visceral signals, was measured using the Interoceptive Accuracy Scale, while interoceptive attention, which is the dispositional tendency to attend to bodily signals, was measured using the Body Perception Questionnaire. Study 1 revealed a relationship between long sleep latency and low confidence in interoceptive accuracy (β = -0.222, p = 0.021) and poor sleep quality and less interoceptive attention (β = -0.226, p = 0.016). Study 2 replicated these results as well as made clear a more general pattern whereby poor sleep-characterised by short duration, poor quality, less efficiency, long latency, and more frequent nighttime awakenings-related to an interoceptive phenotype of less confidence in interoceptive accuracy and more interoceptive attention (all β ≥ 0.047, p ≤ 0.17). In conclusion, results from these two independent studies provide robust cross-sectional evidence for associations between various dimensions of poor sleep and greater interoceptive attention, but less confidence in interoceptive accuracy.

Self-reported sensibility to bodily signals predicts individual differences in autobiographical memory: an exploratory study

Recent theoretical perspectives have advanced that autobiographical memory processes are supported by interoception, the perception of internal bodily sensations. Yet, this relationship remains largely underexplored. The present study addressed this critical gap in the literature by systematically investigating the association between self-reported Interoceptive Sensibility and various individual differences measures of autobiographical memory. In Study 1, using a correlational approach in a large sample of participants (N = 247), we identified significant correlations between standardised measures of interoception and the general experience of autobiographical memory and the frequency of involuntary mental time travel. These associations remained significant even after controlling for potential confounding factors in terms of age, gender, and trait affectivity, underscoring their robustness. Study 2 replicated and extended the associations identified in Study 1 in another large participant sample (N = 257), further validating them by accounting for the potential confounding effect of well-being. Our findings demonstrate that individuals' ability to perceive and understand bodily signals robustly relates to how they experience autobiographical memories. By adopting an exploratory approach based on individual differences, our results provide novel and concrete insights into the association between interoception and autobiographical memory, providing a strong foundation for future investigations into the causal mechanisms connecting these two constructs.

Interoception, somatic symptoms, and somatization tendency in Chinese individuals with subsyndromal depression: A follow-up study

Interoception refers to the sensation and perception of internal bodily sensations, and may be related to depressive symptoms. Schemata concerning the body vary across different cultures and may influence interoception and symptom presentations of depression. This study explored the relationship between interoception, depressive symptoms, and schema of somatic focus in Chinese people with subsyndromal depression. Thirty-nine individuals with subsyndromal depression (SD) and 40 healthy controls (HCs) were assessed at baseline and after 3 months. Participants completed the self-report questionnaires for assessing interoceptive sensibility, somatic and psychological symptoms of depression, and somatization tendency. They also completed the heartbeat perception behavioral task for estimating interoceptive accuracy. The results showed that both the SD and the HC groups showed similar interoceptive accuracy, although the SD group showed heightened interoceptive sensibility. The discrepancy between interoceptive sensibility and interoceptive accuracy is termed the interoceptive trait prediction error (ITPE). The ITPE was positive in SD participants but was negative in HCs. In the entire sample, interoceptive sensibility and the ITPE were correlated with somatic symptoms rather than with psychological symptoms of depression. Interoceptive sensibility partially mediated the relationship between somatization tendency and somatic symptoms, after controlling for psychological symptoms of depression. These results remained stable after 3 months. The shortcomings of the present study were a lack of clinical interview to ascertain diagnosis and a short follow-up duration. In conclusion, our study suggests that altered interoception occurs in subsyndromal depression. Interoception is related to somatic symptoms of depression. The schema of body was related to depressive symptoms, partially through interoception, in Chinese people with subsyndromal depression.

Awareness of embodiment enhances enjoyment and engages sensorimotor cortices

Whether in performing arts, sporting, or everyday contexts, when we watch others move, we tend to enjoy bodies moving in synchrony. Our enjoyment of body movements is further enhanced by our own prior experience with performing those movements, or our 'embodied experience'. The relationships between movement synchrony and enjoyment, as well as embodied experience and movement enjoyment, are well known. The interaction between enjoyment of movements, synchrony, and embodiment is less well understood, and may be central for developing new approaches for enriching social interaction. To examine the interplay between movement enjoyment, synchrony, and embodiment, we asked participants to copy another person's movements as accurately as possible, thereby gaining embodied experience of movement sequences. Participants then viewed other dyads performing the same or different sequences synchronously, and we assessed participants' recognition of having performed these sequences, as well as their enjoyment of each movement sequence. We used functional near-infrared spectroscopy to measure cortical activation over frontotemporal sensorimotor regions while participants performed and viewed movements. We found that enjoyment was greatest when participants had mirrored the sequence and recognised it, suggesting that awareness of embodiment may be central to enjoyment of synchronous movements. Exploratory analyses of relationships between cortical activation and enjoyment and recognition implicated the sensorimotor cortices, which subserve action observation and aesthetic processing. These findings hold implications for clinical research and therapies seeking to foster successful social interaction.

The Relationship Between Brain Activation for Taking Others' Perspective and Interoceptive Abilities in Autism Spectrum Disorder: An fMRI Study

Objectives

In this functional magnetic resonance imaging study, we aimed to investigate the differences in brain activation between individuals with autism spectrum disorder (ASD) and typically developing (TD) individuals during perspective taking. We also examined the association between brain activation and empathic and interoceptive abilities.

Methods

During scanning, participants from the ASD (n=17) and TD (n=22) groups were shown pain stimuli and asked to rate the level of the observed pain from both self- and other-perspectives. Empathic abilities, including perspective taking, were measured using an empathic questionnaire, and three dimensions of interoception were assessed: interoceptive accuracy, interoceptive sensibility, and interoceptive trait prediction errors.

Results

During self-perspective taking, the ASD group exhibited greater activation in the left precuneus than the TD group. During other-perspective taking, relative hyperactivation extended to areas including the right precuneus, right superior frontal gyrus, left caudate nucleus, and left amygdala. Brain activation levels in the right superior frontal gyrus while taking other-perspective were negatively correlated with interoceptive accuracy, and those in the left caudate were negatively correlated with perspective taking ability in the ASD group.

Conclusion

Individuals with ASD show atypical brain activation during perspective taking. Notably, their brain regions associated with stress reactions and escape responses are overactivated when taking other-perspective. This overactivity is related to poor interoceptive accuracy, suggesting that individuals with ASD may experience difficulties with the self-other distinction or atypical embodiment when considering another person's perspective.

The neurobiology of interoception and affect

Scholars have argued for centuries that affective states involve interoception, or representations of the state of the body. Yet, we lack a mechanistic understanding of how signals from the body are transduced, transmitted, compressed, and integrated by the brains of humans to produce affective states. We suggest that to understand how the body contributes to affect, we first need to understand information flow through the nervous system's interoceptive pathways. We outline such a model and discuss how unique anatomical and physiological aspects of interoceptive pathways may give rise to the qualities of affective experiences in general and valence and arousal in particular. We conclude by considering implications and future directions for research on interoception, affect, emotions, and human mental experiences.

Randomized trial on the effects of an EMDR intervention on traumatic and obsessive symptoms during the COVID-19 quarantine: a psychometric study

Introduction

It has been suggested that the COVID-19 pandemic was a potentially traumatic occurrence that may have induced generalized anxiety and discomfort, particularly in susceptible populations like individuals with mental illnesses. The therapeutic approach known as eye movement desensitization and reprocessing (EMDR) has been shown to be successful in helping patients process traumatic events and restore wellbeing. Nevertheless, little is known about the precise processes through which EMDR fosters symptom recovery.

Methods

In order to disentangle these issues, we conducted a randomized controlled trial (ClinicalTrials.gov Identifier NCT06110702) with 107 participants who were selected from university hospitals as a sample of investigation. Random assignments were applied to the participants in order to assign them to the experimental and control groups. The experimental group, but not the control group, underwent an 8-week EMDR intervention. Body perception, disgust, and emotions of guilt and shame, as well as mental contamination and posttraumatic and obsessive-compulsive symptoms, were investigated before and after the EMDR intervention.

Results

The EMDR intervention was able to improve all of the variables investigated. Path analysis showed that body perception was able to predict both disgust and emotions of guilt and shame. Disgust was able to predict both mental contamination and obsessive-compulsive symptoms, while guilt and shame were able to predict post-traumatic symptoms.

Conclusions

EMDR is an effective therapy for the treatment of post-traumatic and obsessive symptoms that acts through the promotion of improvement of the emotions of guilt/shame and disgust, respectively. Implications for clinical practice are examined.

Clinical trial registration

https://www.clinicaltrials.gov, identifier NCT06110702.

Dyadic body competence predicts movement synchrony during the mirror game

The process of synchronizing our body movements with others is known to enhance rapport, affect, and prosociality. Furthermore, emerging evidence suggests that synchronizing activities may enhance cognitive performance. Unknown, by contrast, is the extent to which people's individual traits and experiences influence their ability to achieve and maintain movement synchrony with another person, which is key for unlocking the social and affective benefits of movement synchrony. Here, we take a dyad-centered approach to gain a deeper understanding of the role of embodiment in achieving and maintaining movement synchrony. Using existing data, we explored the relationship between body competence and body perception scores at the level of the dyad, and the dyad's movement synchrony and complexity while playing a 2.5-min movement mirroring game. The data revealed that dyadic body competence scores positively correlate with movement synchrony, but not complexity, and that dyadic body perception scores are not associated with movement synchrony or complexity. Movement synchrony was greater when the more experienced member of the dyad was responsible for copying movements. Finally, movement synchrony and complexity were stable across the duration of the mirror game. These findings show that movement synchrony is sensitive to the composition of the dyad involved, specifically the dyad's embodiment, illuminating the value of dyadic approaches to understanding body movements in social contexts.

Cardiac interoception in the museum: A novel measure of experience

Interoception is the perception of the body's internal signals in response to various external and internal stimuli. The present study uses a novel method adapted from the CARdiac Elevation Detection Task to examine cardiac interoception objectively and subjectively in a unique context-in the presence of art. Self-report questionnaires were used to measure subjective interoceptive awareness, subjective interoceptive accuracy, and aesthetic appreciation. For objective interoceptive accuracy and sensibility, a wearable device (Shimmer) measured heart rate (HR) and connected to a mobile application to prompt two questions: "Is your heart beating faster than usual?" and "How confident are you in your previous response?" Participants explored an art gallery for 40 minutes while the Shimmer measured their HR and randomly prompted them to answer the questions. Using a Generalized Estimating Equation model, interoceptive sensibility was not found to predict the odds of submitting a correct response. It was also found that art does not improve participants' perceptions of their HR. Finally, there was no relation between aesthetic appreciation and subjective or objective cardiac interoception. Despite lack of statistical significance, the current study's method presents an improved method by examining interoceptive accuracy in the moment under ecological conditions. To date, findings and methods used in interoception are inconsistent or flawed; the value in the current study lies in the development and demonstration of a method to examine how the environment influences the body and self-awareness across a wide variety of contexts, thereby offering a possible standardized measure of interoception for investigators to adopt.

Interoception as a function of hypnotizability during rest and a heartbeat counting task

The hypnotizability-related differences in morpho-functional characteristics of the insula could at least partially account for the differences in interoceptive accuracy (IA) observed between high and low hypnotizable individuals (highs, lows). Our aim was to investigate interoceptive processing in highs, lows, and medium hypnotizable individuals (mediums), who represent most of the population, during a 10-minute open eyes relaxation condition (Part 1) and three repetitions of consecutive 2-minute open eyes, closed eyes, and heartbeat counting conditions, followed by a 2-minute post-counting condition (Part 2). Electrocardiogram and electroencephalogram were recorded in 14 highs, 14 mediums, and 18 lows, classified according to the Stanford Hypnotic Susceptibility Scale: Form A. Heartbeat-evoked cortical potentials (HEP) were extracted throughout the entire session, and IA index was obtained for the heartbeat counting task (HCT). In Part 1, significant hypnotizability-related differences were observed in the right central region in both early and late HEP components, with lows showing positive amplitudes and highs/mediums showing negative amplitudes. In Part 2, the same group differences were limited to the early component. Moreover, in the left frontal regions, only mediums modified their HEP during the counting task with respect to the open/closed eyes conditions, whereas highs displayed HEP differences between counting and post-counting rest. HCT did not show significant group differences. In conclusion, highs and mediums seem to be more similar than mediums and lows regarding HEP, despite the absence of significant differences in HCT. Nonetheless, a negative correlation between hypnotizability scores and HEP amplitudes was observed in the regions showing group differences.

When the body fosters empathy: The interconnectivity between bodily reactivity, meditation, and embodied abstract concepts

Empathy is a fundamental social ability that allows humans to infer others' emotions and intentions. Empathy is thought to be rooted in bodily sensations coming from the autonomic nervous system. In parallel, the functionality and perceptions coming from the autonomic nervous system could be improved by practicing activities that involve mind-body interactions, such as meditation. Furthermore, perceptions from the autonomic nervous system are thought to be important in the embodiment of abstract concepts. Consequently, in the current study, we collected data online from 581 participants and explored the associations between levels of empathy and (1) the practice of meditation, music, and sports; (2) the impact of self-report measures on bodily awareness and reactivity; and (3) the embodiment of abstract concepts in interoception. In line with previous studies, Meditators were found to have higher empathy scores than Non-Meditators. In addition, lower levels of autonomic reactivity in organs above the diaphragm were associated with higher empathy. Finally, we also observed that empathy was positively associated with interoceptive components of abstract concepts in those participants with high autonomic reactivity. Taken together, the results suggest that meditation practice and having low autonomic reactivity are associated with empathy, arguably through the downregulation of autonomic responses. Implications for mind-body interaction in meditation and its role in promoting empathy are discussed.

Validation of the Italian version of the Neuroception of Psychological Safety Scale (NPSS)

Research on the neuroscience of fear in both humans and non-humans has suggested that a lack of acquisition of safety cues might be a biological hallmark of posttraumatic stress disorder (PTSD). Danger perception, and in particular, feeling as one's own life is in danger, is thought to represent a major predictor of PTSD. Persistent danger perception is concurrently associated with a persistence of lack of safety. However, despite several research efforts, no validated psychometric tools exist regarding psychological safety as a unique core construct in the domain of a soothing-contentment system. By including social, compassionate, and bodily components, the Neuroception of Psychological Safety Scale (NPSS), neurophysiologically rooted in the polyvagal theory, aims to specifically assess psychological safety. Originally developed in English, we employed a rather large non clinical sample to validate our Italian translation of the NPSS (n = 338) and the scale was found to retain a three-factor structure. In light of its positive moderate correlations with the Unconditional Self-Kindness Scale (ρ = 0.376) and the Self-Compassion Scale-Short-Form (ρ = 0.481), good convergent validity and robust psychometric properties were shown by the NPSS. The Subjective Traumatic Outlook Questionnaire (ρ = -0.283) and the three subscales of the Body Perception Questionnaire-22-Body Awareness (ρ = -0.103), Supradiaphragmatic Reactivity (ρ = -0.234), and Body Awareness/Subdiaphragmatic Reactivity (ρ = -0.146)-were found to have weak negative correlations with the NPSS, which further demonstrated its good discriminant validity. Eventually, the NPSS was found to show good test-retest reliability (intraclass correlation coefficient = 0.922; three-week time interval), and its usage is fostered in clinical and research contexts where the evaluation of psychological safety is of relevance.

Evaluations of dyadic synchrony: observers' traits influence estimation and enjoyment of synchrony in mirror-game movements

While evidence abounds that motor synchrony is a powerful form of 'social glue' for those involved, we have yet to understand how observers perceive motor synchrony: can observers estimate the degree of synchrony accurately? Is synchrony aesthetically pleasing? In two preregistered experiments (n = 161 each), we assess how accurately observers can estimate the degree of synchrony in dyads playing the mirror game, and how much observers enjoy watching these movements. We further assess whether accuracy and enjoyment are influenced by individual differences in self-reported embodied expertise (ability to reproduce movements, body awareness, body competence), psychosocial resources (extraversion, self-esteem), or social competencies (empathy, autistic traits), while objectively controlling for the degree of measured synchrony and complexity. The data revealed that observers' estimated synchrony with poor accuracy, showing a tendency to underestimate the level of synchrony. Accuracy for low synchrony improved with increasing body competence, while accuracy for high synchrony improved with increasing autistic traits. Observers' enjoyment of dyadic movements correlated positively with the degree of measured synchrony, the predictability of the movements, and the observer's empathy. Furthermore, very low enjoyment was associated with increased body perception. Our findings indicate that accuracy in perceiving synchrony is closely linked to embodiment, while aesthetic evaluations of action hinge on individual differences.

Acupuncture Treatment for Generalized Anxiety Disorder by Activating the Vagus Nerve and Improving Heart-Rate Variability and Heart-Rhythm Coherence, A Case-Series Study

Objective

The goal of this case series was to observe the effectiveness of acupuncture for reducing sympathetic stress and anxiety-related symptoms in generalized anxiety disorder. The effect of acupuncture on the balance of the autonomic nervous system was also examined.

Materials and Methods

This was a case-series study with 10 participants enrolled. Each participant received acupuncture treatment 2 times per week for 4 weeks. Participants were evaluated with the Generalized Anxiety Disorder-7 (GAD-7) scale and the Body Perception Questionnaire-Short Form (BPQ-SF) before and after the treatment program. Heart-rate variability heart-rhythm coherence (HRC) was also assessed during each acupuncture session.

Results

Five participants completed the program. Both GAD-7 and BPQ mean scores showed significant reductions. The mean HRC high-coherence ratio also increased significantly after acupuncture treatment. No adverse effects occurred.

Conclusions

Acupuncture may be an effective therapy for sympathetic stress and anxiety-related symptoms. The mechanism of action may be through activating the vagus nerve and improving the HRC high coherence ratio. It is feasible to conduct larger clinical trials with random controls, longer treatment durations, and long-term follow-ups to support the results of this study.

Spatial factors influencing the pain-ameliorating effect of CT-optimal touch: a comparative study for modulating temporal summation of second pain

Recent studies show that CT-optimal touch, gentle slow stroking of the skin, can reduce pain. However, much is unknown regarding the factors influencing its pain-ameliorating effect, such as tactile attention and touch application site. The current study investigates in 36 healthy individuals, whether CT-optimal touch can reduce temporal summation of second pain (TSSP) compared to CT non-optimal touch and tapping the skin. TSSP refers to activation of the C-nociceptors; by stimulating these fibers a burning and/or tingling sensation can be elicited. All participants underwent three conditions on both the contralateral and ipsilateral side of pain induction. The results show that tapping the skin did not reduce TSSP, meaning that pain reduction through touch cannot be explained by tactile attention effects. CT non-optimal touch only reduced TSSP when applied on the ipsilateral side. Importantly, CT-optimal touch effectively reduced TSSP when applied on the contralateral or ipsilateral side. Furthermore, CT-optimal touch was more effective in reducing TSSP compared to CT non-optimal touch and Tapping. This study shows that that CT-optimal touch can reduce TSSP and this effect appears to be independent of touch application site, which is highly relevant for implementing CT-optimal touch as a treatment.

Subjective Sensitivity to Exteroceptive and Interoceptive processing in Highly Sensitive Person

A highly sensitive person is known to have greater levels of sensory processing sensitivity (SPS) referring to a personality trait to exhibit high stimulation and arousal while processing subtle sensory signals. However, how SPS levels reflect the profile of sensitivity in exteroceptive and interoceptive sensory processing remains inadequately understood. Thus, we collected data using the Highly Sensitive Person Scale (HSPS), the Glasgow Sensory Questionnaire (GSQ), and the Body Perception Questionnaire-Short Form (BPQ-SF) from 600 Japanese adults, and examined their relationships. The results revealed that SPS levels, assessed by the HSPS, were significantly, positively correlated with hypersensitivity scores of the GSQ in several exteroceptive sensory domains. Further, SPS levels were positively correlated with sensitivity in interoceptive awareness assessed by the BPQ-SF; however, it does so scarcely. Our findings suggest that SPS levels reflect a subjective sensitivity to exteroceptive sensory processing regardless of sensory domains and narrowly to the interoceptive sensory processing.

Calm Contact Technique Based on the Endocrinological Mechanism of Hypnosis-A Theoretical Proposal

This paper proposes the "calm contact" technique: an imaginative scenario where someone is in gentle contact with a loved one where the essence of the experience is to enjoy safety and calmness in peaceful social contact. The theoretical background is outlined by combining the brain mechanisms of stress reactions and hypnosis. In addition to the ancient stress responses (flight or fight or freeze), there are oxytocin-based options at the human level: tend and befriend behavior and the state of calm and connection, which is not a stress reaction but a resting reaction. These social-based reactions could prevent the organism from the primitive freezing response. Some studies proved that "hypnosis" as a setting reduces cortisol levels and could raise oxytocin levels. The beneficial mechanisms of the "calm contact" technique are analyzed in relation to "social support" and the psychoaffective effects of central oxytocin. The subjective effects of the proposed technique are outlined based on reports of healthy volunteers. The "calm contact" technique could be an alternative or adjunct to the "safe place" technique, applying the recent findings of endocrinological brain mechanisms of hypnosis. Clinical implications and limitations are briefly summarized.

Validation of the shortened 24-item multidimensional assessment of interoceptive awareness, version 2 (Brief MAIA-2)

The Multidimensional Assessment of Interoceptive Awareness (MAIA) was translated into many languages and frequently used in the last decade to assess self-reported interoceptive awareness. However, many studies demonstrated weaknesses regarding unstable factor structure and poor reliability of some scales. The 24-item Brief MAIA-2 questionnaire was developed, with only three items demonstrating the highest factor loadings in each of the eight scales of the MAIA-2. The cross-sectional online study used the 37-item MAIA-2 questionnaire in a non-clinical sample of 323 people aged between 16 and 75 (M = 26.17, SD = 9.12), including 177 women (54.80%). The sample comprised 156 athletes (48.30%) and 167 non-athletes (51.70%). The Confirmatory Factor Analysis showed adequate fit indices for a multidimensional model of the Brief MAIA-2, with the original eight scales: Noticing (awareness of subtle bodily sensations, such as the heartbeat, digestive sensations, or the breath), Not Distracting (ability to maintain attention to bodily sensations without being easily distracted by external stimuli), Not Worrying (tendency to not be overly concerned or anxious about bodily sensations or changes in the body), Attention Regulation (ability to regulate attention to bodily sensations and to shift attention between internal and external stimuli), Emotional Awareness (awareness and understanding of how emotions are associated with bodily sensations), Self Regulation (ability to regulate emotional responses and manage distress through an awareness of bodily sensations), Body Listening (tendency to listen to the body for insight and understanding), and Trusting (trust in bodily sensations as a source of information about one's feelings and needs). The hierarchical bi-factor (S·I - 1) model showed even better-fit indices. Therefore, the general factor of interoception was considered in further statistical tests. Confirmatory composite analysis showed high reliability and discriminant and convergent validity for most Brief MAIA-2 scales, except Noticing. Measurement invariance was confirmed across genders (Women, Men) and sports participation (Athletes, Non-athletes). However, group differences were also found for mean scores in particular scales of the Brief MAIA-2. Men scored significantly lower than women in Not Distracting but higher in Not Worrying, Attention Regulation, Self Regulation, Trusting, and the total score of interoceptive awareness. Gender discrepancies may be influenced by linguistic socialization, which tends to categorize shifts in internal states as either physiological or emotional. Athletes scored significantly lower than Non-athletes on the Not Distracting scale, but they showed higher scores in Noticing, Attention Regulation, Emotion Awareness, Self-Regulation, Body Listening, Trusting, and the global score, suggesting that physical training can improve most areas of interoception. Therefore, physical exercises and mindfulness training may be recommended to improve interoception, especially in women and people suffering from somatic and mental problems. The Brief MAIA-2 is a reliable and valid tool to measure multidimensional interoceptive sensibility in a non-clinical population. To improve well-being and athletic performance, Brief MAIA-2 can be used to assess the body's current perception of interoception and to detect its weak areas requiring improvement. However, the study has some limitations, such as a cross-sectional online self-report survey in a conventional non-clinical sample from Poland. Future cross-cultural studies should include representative samples for non-clinical and clinical populations from different countries and geographic regions to compare the Brief MAIA-2 with more objective psychophysiological methods of measuring interoception to reduce the limitations of these studies.

Interoception and the musical brain: Evidence from cross-sectional and longitudinal behavioral and resting-state fMRI study

Musical training has been linked to enhanced interoceptive abilities and increased resting-state (RS) functional connectivity (FC) within the interoceptive brain network. We aimed to replicate and extend these findings with a unique cross-sectional and longitudinal study design. Professional musicians and matched individuals with no prior musical experience (training group) were recruited. Participants underwent RS fMRI scans and completed heartbeat counting and discrimination tasks outside of the scanner (time point 1). The training group additionally had RS scans and interoception tests repeated after a 6-month-long keyboard course training (time point 2). We found no evidence for increased interoceptive abilities in professional musicians relative to non-musicians, nor did we observe any improvements in interoception over the course of musical training. RS FC analysis revealed increased FC within the sensorimotor network in professional musicians compared to the training group at the first time point with no change in FC over time in the Training group. These findings challenge the view that musical training may improve interoceptive abilities. Yet, the results suggest that musical training is related to increased communication within the sensorimotor RS network, which consists of some hubs important for interoceptive processing (namely pre- and postcentral gyri and supplementary motor area).

Association of Self-Reported Autonomic Symptoms With Sensor-Based Physiological Measures

OBJECTIVE

Autonomic regulation of organ and tissues may give rise to disruptions of typical functions. The Body Perception Questionnaire Short Form (BPQ-SF) includes items that were developed to assess autonomic symptoms in daily life. This pair of studies aimed to establish previously unexplored psychometric properties of the BPQ-SF autonomic symptoms scale, develop normative values for clinical and research use, and assess the convergence of self-reports with sensor-based measures.

METHODS

Study 1 reports exploratory and confirmatory factor analysis on BPQ-SF autonomic symptom items from a large US population-based online study ( n = 2048). In study 2, BPQ-SF scores were examined for associations with heart period, respiratory sinus arrhythmia, and skin conductance during seated leg lifts in a community sample ( n = 62).

RESULTS

Study 1 results supported a two-factor supradiaphragmatic and subdiaphragmatic autonomic symptom solution (confirmatory factor analysis: root mean squared error of approximation = 0.040, Comparative Fit Index = 0.99, Tucker-Lewis Index = 0.99), although a one-factor solution also fit the data well (root mean squared error of approximation = 0.080, Comparative Fit Index = 0.99, Tucker-Lewis Index = 0.99). In study 2, heart period responses to leg lifts and rests were demonstrated at all autonomic symptom levels. However, low autonomic symptoms were associated with optimal autonomic nervous system patterns of activation and recovery to baseline levels. Moderate symptoms were associated with prolonged sympathetic activation. The highest symptom levels were associated with impaired autonomic nervous system coordination across activation and recovery.

CONCLUSIONS

Results support the utility of self-reports of autonomic symptoms in research and clinical applications, with higher symptoms likely indicating autonomic impairment.

Predicting postpartum depressive symptoms by evaluating self-report autonomic nervous system reactivity during pregnancy

OBJECTIVE

Altered self-reported autonomic reactivity is associated with worse mental health in the general population. Although dysfunctional changes in ANS during pregnancy have been investigated in relation to depressive symptoms, no studies addressed the relationship between self-report autonomic reactivity during pregnancy and depressive symptoms after the delivery. The present study aimed to assess the impact of prepartum self-reported autonomic reactivity on the development of postpartum depressive symptoms.

METHODS

In this longitudinal study, 170 women were assessed during pregnancy (i.e., second or third trimester) and after childbirth (i.e., one month after the delivery). Self-reported autonomic reactivity was assessed through the Body Perception Questionnaire - Short Form that evaluates the autonomic functions related to organs above (i.e., supradiaphragmatic reactivity) and below (i.e., subdiaphragmatic reactivity) the diaphragm. In addition, prepartum and postpartum depressive symptoms were evaluated using the Patient Health Questionnaire - 9.

RESULTS

Findings showed that higher prepartum supradiaphragmatic reactivity predicted higher depressive symptoms in the postpartum period (β = 0.112, p = 0.009) after controlling for prepartum depressive symptomatology and other potential covariates.

CONCLUSIONS

Evaluation of self-reported autonomic activity may be a useful tool to identify antenatally women at risk of postpartum depressive symptoms. Future studies are needed to evaluate the effectiveness of interventions aimed at reducing the threat-responsive autonomic reactivity at rest and improving adaptive autonomic regulation to prevent postpartum depression.

The vagal paradox: A polyvagal solution

Although there is a consistent literature documenting that vagal cardioinhibitory pathways support homeostatic functions, another less frequently cited literature implicates vagal cardioinhibitory pathways in compromises to survival in humans and other mammals. The latter is usually associated with threat reactions, chronic stress, and potentially lethal clinical conditions such as hypoxia. Solving this 'vagal paradox' in studies conducted in the neonatal intensive care unit served as the motivator for the Polyvagal Theory (PVT). The paradox is resolved when the different functions of vagal cardioinhibitory fibers originating in two anatomically distinguishable brainstem areas are recognized. One pathway originates in a dorsal area known as the dorsal motor nucleus of the vagus and the other in a ventral area of the brainstem known as nucleus ambiguus. Unlike mammals, in all ancestral vertebrates from which mammals evolved, cardioinhibitory vagal fibers primarily originate in the dorsal motor nucleus of the vagus. Thus, in mammals the vagus nerve is 'poly' vagal because it contains two distinct efferent pathways. Developmental and evolutionary biology identify a ventral migration of vagal cardioinhibitory fibers that culminate in an integrated circuit that has been labeled the ventral vagal complex. This complex consists of the interneuronal communication of the ventral vagus with the source nuclei involved in regulating the striated muscles of the head and face via special visceral efferent pathways. This integrated system enables the coordination of vagal regulation of the heart with sucking, swallowing, breathing, and vocalizing and forms the basis of a social engagement system that allows sociality to be a potent neuromodulator resulting in calm states that promote homeostatic function. These biobehavioral features, dependent on the maturation of the ventral vagal complex, can be compromised in preterm infants. Developmental biology informs us that in the immature mammal (e.g., fetus, preterm infant) the ventral vagus is not fully functional and myelinization is not complete; this neuroanatomical profile may potentiate the impact of vagal cardioinhibitory pathways originating in the dorsal motor nucleus of the vagus. This vulnerability is confirmed clinically in the life-threatening reactions of apnea and bradycardia in human preterm newborns, which are hypothetically mediated through chronotropic dorsal vagal pathways. Neuroanatomical research documents that the distribution of cardioinhibitory neurons representing these two distinct vagal source nuclei varies among mammals and changes during early development. By explaining the solution of the 'vagal paradox' in the preterm human, the paper highlights the functional cardioinhibitory functions of the two vagal source nuclei and provides the scientific foundation for the testing of hypotheses generated by PVT.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Development of a Scale to Examine Responses to Bodily Sensations

OBJECTIVE

Individual differences in the perception of bodily sensations is known to be associated with affective symptomatology. However, the way people psychologically respond to everyday bodily sensations has not been examined in a systematic and balanced way. Thus, we developed the Bodily Sensations Response Scale (BSRS) to evaluate participants' self-reported cognitive, emotional, and behavioral responses to their bodily sensations. We investigated the scale's factor structure and its psychometric properties in two studies.

METHOD

In Study 1, 297 participants completed the 50-item BSRS and exploratory factor analysis (EFA) was performed on the responses. In Study 2 (N = 284), confirmatory factor analysis (CFA) was used to confirm the factor structure of the 32-item BSRS identified in Study 1.

RESULTS

In Study 1, the EFA identified a 32-item three-factor solution as the best fit for the data. Factor 1 described a defeat response to bodily sensations, Factor 2 described an acceptance response, and Factor 3 described a sensitization response. In Study 2, the three-factor solution was shown not to be parsimonious. Rather, CFA identified that the 27-item BSRS had two interpretable factors (Defeat and Acceptance) that explained participants' psychological responses to bodily sensations. The Defeat subscale was moderately to strongly correlated with awareness of bodily sensations (i.e., Body Perception Questionnaire-Short Form scores) and depression, anxiety, and stress symptom severity (i.e., Depression Anxiety Stress Scales-21 scores), whereas the Acceptance subscale was unrelated or only slightly negatively correlated to awareness of bodily sensations and depression, anxiety, and stress symptoms.

CONCLUSION

The 27-item BSRS provides a psychometrically robust assessment of the way in which people psychologically respond to everyday bodily sensations. The measure can assist researchers to better understand how people psychologically process their salient bodily sensations and how this is linked to psychopathology.

The thermoception task: a thermal imaging-based procedure for measuring awareness of changes in peripheral body temperature

Although thermal body signals provide crucial information about the state of an organism and changes in body temperature may be a sign of affective states (e.g., stress, pain, sexual arousal), research on thermal awareness is limited. Here we developed a task measuring awareness of changes in peripheral body temperature (thermal interoception) and compared it to the classical heartbeat counting task (cardiac interoception). With an infrared light bulb we delivered stimuli of different temperature intensities to the right hand of 31 healthy participants. Thermal interoceptive accuracy, i.e., the difference between participants' real and perceived change in hand temperature, showed good interindividual variability. We found that thermal interoception did not correlate with (and was generally higher than) cardiac interoception, suggesting that different interceptive channels provide separate contributions to awareness of bodily states. Moreover, the results hint at the great salience of thermal signals and the need for thermoregulation in day-to-day life. Finally, thermal interoceptive accuracy was associated with self-reported awareness of body temperature changes and with the ability to regulate distress by focusing on body sensations. Our task has the potential to significantly increase current knowledge about the role of interoception in cognition and behavior, particularly in social and emotional contexts.NEW & NOTEWORTHY We developed a novel task measuring awareness of changes in peripheral body temperature (i.e., thermal interoception). To avoid tactile confounds present in existing thermoceptive tasks, we used an infrared light bulb to deliver stimuli of different temperature intensities to the hand of participants and asked them to judge the perceived change in their hand temperature. Performance in the task showed good interindividual variability, did not correlate with cardiac interoceptive tasks, and was associated with self-reported thermosensitivity.

A multi-site German validation of the Interoceptive Accuracy Scale and its relation to psychopathological symptom burden

Altered interoception is thought to be implicated in the development of psychopathology. Recent proposals highlight the need to differentiate between dimensions of interoception to better understand its relation to mental health. Here, we validated a German version of the Interoceptive Accuracy Scale (IAS) and investigated the relationship between IAS scores and clinical outcomes, across seven samples from four research centers (N = 3462). The German IAS version was best explained by a one-factor structure that showed acceptable psychometric properties. We replicated previous findings showing a negative association between IAS scores and measures of alexithymia. IAS scores were negatively related to measures of clinical symptomatology (e.g., anxiety, depressive, and somatoform symptoms) and neurotic traits. These findings suggest that the German IAS is a reliable and valid instrument for subjective interoceptive accuracy. Results emphasize the importance of distinguishing between dimensions of interoception to understand its potential modulatory and protective role in psychopathology.

The integrative process promoted by EMDR in dissociative disorders: neurobiological mechanisms, psychometric tools, and intervention efficacy on the psychological impact of the COVID-19 pandemic

Dissociative disorders (DDs) are characterized by a discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, bodily representation, motor control, and action. The life-threatening coronavirus disease 2019 (COVID-19) pandemic has been identified as a potentially traumatic event and may produce a wide range of mental health problems, such as depression, anxiety disorders, sleep disorders, and DD, stemming from pandemic-related events, such as sickness, isolation, losing loved ones, and fear for one's life. In our conceptual analysis, we introduce the contribution of the structural dissociation of personality (SDP) theory and polyvagal theory to the conceptualization of the COVID-19 pandemic-triggered DD and the importance of assessing perceived safety in DD through neurophysiologically informed psychometric tools. In addition, we analyzed the contribution of eye movement desensitization and reprocessing (EMDR) to the treatment of the COVID-19 pandemic-triggered DD and suggest possible neurobiological mechanisms of action of the EMDR. In particular, we propose that, through slow eye movements, the EMDR may promote an initial non-rapid-eye-movement sleep stage 1-like activity, a subsequent access to a slow-wave sleep activity, and an oxytocinergic neurotransmission that, in turn, may foster the functional coupling between paraventricular nucleus and both sympathetic and parasympathetic cardioinhibitory nuclei. Neurophysiologically informed psychometric tools for safety evaluation in DDs are discussed. Furthermore, clinical and public health implications are considered, combining the EMDR, SDP theory, and polyvagal conceptualizations in light of the potential dissociative symptomatology triggered by the COVID-19 pandemic.

Interoceptive accuracy mediates the longitudinal relationship between attention deficit hyperactivity disorder (ADHD) inattentive symptoms and disordered eating in a community sample

Attention deficit hyperactivity disorder (ADHD) symptoms are associated with disordered eating and interoceptive deficits (as assessed by reliance on hunger/satiety cues) have been suggested as a potential mediating influence. The aim of this longitudinal study was to examine whether the association between ADHD symptoms and disordered eating is explained by deficits in specific facets of interoception. We also aimed to provide further evidence on the previously reported association between ADHD symptoms, negative mood and disordered eating. A community-based sample of 345 adult men and women (M age = 33.9, 72.5% women) completed questionnaires assessing disordered eating (restrictive and binge-type), ADHD symptoms, reliance on hunger/ satiety cues, specific facets of interoception (interoceptive accuracy and interoceptive sensibility) and negative mood at two timepoints over a 6-month period. We tested the mediating influence of reliance on hunger/satiety cues, facets of interoception and negative mood on the relationship between ADHD symptoms and disordered eating. Reliance on hunger/satiety cues mediated the relationship between inattentive symptoms of ADHD and both restrictive and binge-type eating. Interoceptive accuracy, but not sensibility mediated the relationship between inattentive ADHD symptoms and binge-type eating. Negative mood mediated the relationship between both ADHD symptom types and restrictive and binge-type eating. The results from this longitudinal study confirm that deficits in interoception and negative mood contribute to the relationship between ADHD symptoms and disordered eating and extend knowledge by highlighting interoceptive accuracy specifically as the most important facet of interoception in the relationship between inattentive symptoms and binge-type eating.

Development and validation of the Exteroceptive Body Awareness (EBA-q) questionnaire

The conscious processing of body signals influences higher-order psychological and cognitive functions, including self-awareness. Dysfunctions in the processing of these signals has been connected to neurological and psychiatric disorders characterized by altered states of self-consciousness. Studies indicate that perceiving the body through interoceptive signals (e.g., from internal organs such as heartbeat and breathing) is distinct from perceiving the body through exteroceptive signals (e.g., by relying on visual, tactile and olfactory cues). While questionnaires are available for assessing interoception, there are no validated self-report instruments for measuring bodily exterception. To fill this gap, we performed three studies to develop and validate a novel scale designed to assess bodily self-consciousness based on the processing of exteroceptive bodily signals. Exploratory factor analysis (Study 1, N = 302) led to an 18-item questionnaire comprised of four factors. We called this instrument Exteroceptive Body Awareness questionnaire (EBA-q). Confirmatory factor analysis (Study 2, N = 184) run on a second sample showed an acceptable fit for a bifactor model, suggesting researchers may use the questionnaire as a unidimensional scale reflecting exteroceptive bodily self-consciousness, or use each of its four sub-scales, reflecting "visuo-tactile body awareness", "spatial coordination", "awareness of body changes" and "awareness of clothing fit". Overall EBA-q showed good internal consistency. Convergent and divergent validity were assessed via cross-validation with existing body awareness questionnaires (Study 3, N = 366) and behavioral measures (Study 3, N = 64) of exteroceptive and interoceptive bodily self-consciousness. Research applications are discussed within a multi-faceted model of exteroception and interoception as distinct, but at the same time interconnected, dimensions of bodily self-consciousness.

Using remotely delivered Spring Forest Qigong™ to reduce neuropathic pain in adults with spinal cord injury: protocol of a quasi-experimental feasibility clinical trial

BACKGROUND

About 69% of Americans living with spinal cord injury (SCI) suffer from long-term debilitating neuropathic pain, interfering with the quality of daily life. Neuropathic pain is refractory to many available treatments-some carrying a risk for opioid addiction-highlighting an urgent need for new treatments. In this study, we will test our hypothesis that Spring Forest Qigong™ will reduce SCI-related neuropathic pain by improving body awareness. We will determine whether remotely delivered Qigong is feasible and we will collect data on neuropathic pain, and other reported associations with pain such as spasms frequency and/or severity, functional performance, mood, and body awareness.

METHODS

In this quasi-experimental pilot clinical trial study, adults with SCI will practice Qigong at home with a 45-min video, at least 3 × /week for 12 weeks. The Qigong practice includes movements with guided breathing and is individualized based on functional abilities, i.e., the participants follow along with the Qigong movements to the level of their ability, with guided breathing, and perform kinesthetic imagery by focusing on the feeling in the whole body as if doing the whole-body Qigong movement while standing. The highest, average, and lowest neuropathic pain ratings perceived in the prior week will be recorded weekly until the 6-week follow-up. The other outcomes will be collected at 5 time points: at baseline, midway during the Qigong intervention (6 weeks), after the Qigong intervention (12 weeks), after a 6-week and 1-year follow-up. Rate parameters for the feasibility markers will be estimated based on the participants who achieved each benchmark.

DISCUSSION

The University of Minnesota (UMN)'s Institutional Review Board (IRB) approved the study (IRB #STUDY00011997). All participants will sign electronic informed consent on the secure UMN REDCap platform. The results will be presented at academic conferences and published in peer-reviewed publications.

TRIAL REGISTRATION

ClinicalTrial.gov registration number: NCT04917107 , (this protocol paper refers to the substudy), first registered 6/8/2021.

Do we need to accurately perceive our heartbeats? Cardioceptive accuracy and sensibility are independent from indicators of negative affectivity, body awareness, body image dissatisfaction, and alexithymia

Assessment of the acuity of heartbeat perception, dubbed cardioceptive accuracy, as well as its association with various psychological characteristics are hot topics of interoception research. In this study, we aimed (1) to replicate previously reported findings on the association between the mental tracking task and a novel motor tracking task that eliminates disturbing tactile sensations; and (2) to explore associations between performance in the latter task and indicators of negative affectivity (anxiety, depression, anxiety sensitivity, somatic symptom distress), alexithymia, body focus, and dissatisfaction with body image. 102 young people (age = 20.8±5.08 yrs) participated in the study. Mental tracking score was significantly higher than motor tracking scores, although they were strongly associated. Frequentist correlation analysis showed no significant associations between indicators of cardioceptive accuracy and questionnaire scores; Bayesian analysis indicated the lack of association for the majority of the cases. Similarly, detectors and non-detectors showed no differences in any of the assessed characteristics and Bayesian results typically supported the lack of associations. In conclusion, cardioceptive accuracy, as assessed with different tracking methods, is not associated with the aforementioned self-reported characteristics in young individuals.

Dissociating cognitive and affective empathy across psychopathy dimensions: The role of interoception and alexithymia

This study examined the associations between psychopathy dimensions (triarchic phenotypes and classical factors), empathy domains (cognitive and affective), and interoception (interoceptive attention and accuracy) while accounting for the putative role of alexithymia. A community sample (n = 515) completed an online survey encompassing: Triarchic Psychopathy Measure (boldness, meanness, disinhibition); Levenson Self-Report Psychopathy Scale (primary and secondary psychopathy); Body Perception Questionnaire (interoceptive attention); Interoceptive Accuracy Scale; Toronto Alexithymia Scale. Hierarchical linear regression models were implemented for hypothesis-driven analyses examining the associations between psychopathy, empathy, and interoception while controlling for sex, age, and alexithymia. Exploratory path models were employed to investigate alexithymia and/or cognitive empathy as mediators between interoception and psychopathy. Our results largely confirmed the postulated empathy profiles across psychopathy dimensions, as meanness and primary psychopathy displayed a broad empathy impairment, while disinhibition and secondary psychopathy were only associated with diminished cognitive empathy. Importantly, boldness displayed a unique pattern (enhanced cognitive empathy and reduced affective empathy), further reinforcing its importance within the constellation of psychopathy traits. Contrary to our hypotheses, self-perceived interoceptive attention and accuracy were not associated with either psychopathy dimension after controlling for alexithymia. However, interoceptive accuracy and alexithymia were associated with cognitive empathy, while alexithymia was also positively related to all psychopathy dimensions (as expected), despite the unexpected strong and negative association with boldness. Exploratory analyses suggested significant indirect effects (mediation) between interoceptive accuracy and psychopathy via alexithymia and/or cognitive empathy. These mediating effects must be interpreted with caution and future studies should be designed to formally test this model.

Association of Hypnotizability, Interoception, and Emotion

The present scoping review reports the reciprocal relations between hypnotizability, interoception, and emotion. Brain morpho-functional differences may account for the lower interoceptive accuracy, higher interoceptive sensitivity, and different emotional strategies observed in highly hypnotizable participants with respect to medium-to-low hypnotizables. Since interoception is relevant to both physical and mental health and hypnotizability can predict both interoceptive abilities and the efficacy of interoception-based mental training, this allows for the development of new forms of treatment and rehabilitation.

Breath-centered virtual mind-body medicine reduces COVID-related stress in women healthcare workers of the Regional Integrated Support for Education in Northern Ireland: a single group study

Background

During the COVID-19 pandemic, healthcare workers endured prolonged stress affecting their psychological well-being. Objectives: (1) Evaluate the effects of the Breath-Body-Mind Introductory Course (BBMIC) on COVID-related stress among employees of the Regional Integrated Support for Education, Northern Ireland, (2) Reduce the risk of adverse effects from COVID-related stress, and (3) Evaluate the effects of BBMIC on indicators of psychophysiological states and the consistency with hypothesized mechanisms of action.

Methods

In this single group study, a convenience sample of 39 female healthcare workers completed informed consent and baseline measures: Perceived Stress Scale (PSS), Stress Overload Scale-Short (SOS-S), and Exercise-Induced Feelings Inventory (EFI). Following the online BBMIC 4 h/day for 3 days and the 6 week solo (20 min/day) and group practice (45 min weekly), repeat testing plus the Indicators of Psychophysiological State (IPSS) and Program Evaluation were obtained.

Results

Baseline (T1) mean PSS score was significantly elevated compared to a normative sample: PSS = 18.2 vs. 13.7 (p < 0.001) and improved significantly 11 weeks post-BBMIC (T4). SOS-S mean score declined from 10.7(T1) to 9.7 at 6 week post-test (T3). The SOS-S proportion of High Risk scores found in 22/29 participants (T1), dropped to 7/29 (T3). EFI mean subscale scores improved significantly from T1 to T2 and T3 for Revitalization (p < 0.001); Exhaustion (p < 0.002); and Tranquility (p < 0.001); but not Engagement (p < 0.289).

Conclusion

Among RISE NI healthcare workers affected by COVID-related stress, participation in the BBMIC significantly reduced scores for Perceived Stress, Stress Overload, and Exhaustion. EFI Revitalization and Tranquility scores significantly improved. More than 60% of participants reported moderate to very strong improvements in 22 indicators of psychophysiological state, e.g., tension, mood, sleep, mental focus, anger, connectedness, awareness, hopefulness, and empathy. These results are consistent with the hypothesized mechanisms of action whereby voluntarily regulated breathing exercises change interoceptive messaging to brain regulatory networks that shift psychophysiological states of distress and defense to states of calmness and connection. These positive findings warrant validation in larger, controlled studies to extend the understanding of how breath-centered Mind-body Medicine practices could mitigate adverse effects of stress.

Validation of the neuroconnective endophenotype questionnaire (NEQ): a new clinical tool for medicine and psychiatry resulting from the contribution of Ehlers-Danlos syndrome

Introduction

The link between anxiety disorders and joint hypermobility syndrome (now under hypermobility spectrum disorders, which include hypermobile Ehlers-Danlos syndrome) has been widely replicated over the past 30 years and has grown beyond the initial nosological limits. To integrate clinical and research progress in this field, a new neuroconnective endophenotype (NE) and its corresponding instrument, the Neuroconnective Endophenotype Questionnaire (NEQ), have been developed. This new clinical construct, created with the active participation of patients, includes both somatic and psychological dimensions and symptoms and resilience items.

Methods

The NE includes five dimensions: (1) sensorial sensitivity, (2) body signs and symptoms, (3) somatic conditions, (4) polar behavioral strategies, and (5) psychological and psychopathological dimensions. The NEQ information is collected through four self-administered questionnaires (sensorial sensitivity, body signs and symptoms, polar behavioral strategies, and psychological characteristics) and a structured diagnostic part that should be completed by a trained observer. This hetero-administered part incorporates (a) psychiatric diagnoses (using structured criteria, e.g., MINI), (b) somatic disorders diagnosis, using structured criteria, and (c) assessment of joint hypermobility criteria.

Results

In a sample of 36 anxiety cases with 36 matched controls, the NEQ obtained high scores for test-retest, inter-rater reliability, and internal consistency. As for predictive validity, cases and controls significantly differed in all five dimensions and hypermobility measurements.

Discussion

We can conclude that the NEQ has achieved acceptable reliability and validity values and, therefore, is ready to be used and tested in different samples. This original and consistent construct including somatic and mental items may improve clinical specificity, the search for more comprehensive therapies, and their genetic and neuroimaging bases.