1
|
Sugawara A, Katsunuma R, Terasawa Y, Sekiguchi A. Interoceptive training impacts the neural circuit of the anterior insula cortex. Transl Psychiatry 2024; 14:206. [PMID: 38782961 PMCID: PMC11116496 DOI: 10.1038/s41398-024-02933-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 05/12/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024] Open
Abstract
Interoception is the perception of afferent information that arises from anywhere and everywhere within the body. Recently, interoceptive accuracy could be enhanced by cognitive training. Given that the anterior insula cortex (AIC) is a key node of interoception, we hypothesized that resting functional connectivity (RSFC) from AIC was involved in an effect of interoceptive training. To address this issue, we conducted a longitudinal intervention study using interoceptive training and obtained RSFC using fMRI before and after the intervention. A heartbeat perception task evaluated interoceptive accuracy. Twenty-two healthy volunteers (15 females, age 19.9 ± 2.0 years) participated. After the intervention, interoceptive accuracy was enhanced, and anxiety levels and somatic symptoms were reduced. Also, RSFC from AIC to the dorsolateral prefrontal cortex (DLPFC), superior marginal gyrus (SMG), anterior cingulate cortex (ACC), and brain stem, including nucleus tractus solitarius (NTS) were enhanced, and those from AIC to the visual cortex (VC) were decreased according to enhanced interoceptive accuracy. The neural circuit of AIC, ACC, and NTS is involved in the bottom-up process of interoception. The neural circuit of AIC, DLPFC, and SMG is involved in the top-down process of interoception, which was thought to represent the cognitive control of emotion. The findings provided a better understanding of neural underpinnings of the effect of interoceptive training on somatic symptoms and anxiety levels by enhancing both bottom-up and top-down processes of interoception, which has a potential contribution to the structure of psychotherapies based on the neural mechanism of psychosomatics.
Collapse
Affiliation(s)
- Ayako Sugawara
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Ruri Katsunuma
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
- School of Psychology, The University of Queensland, St Lucia, QLD, 4072, Australia
| | - Yuri Terasawa
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Psychology, Keio University, Minato-ku, Tokyo, Japan
| | - Atsushi Sekiguchi
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan.
| |
Collapse
|
2
|
Toussaint B, Heinzle J, Stephan KE. A computationally informed distinction of interoception and exteroception. Neurosci Biobehav Rev 2024; 159:105608. [PMID: 38432449 DOI: 10.1016/j.neubiorev.2024.105608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Abstract
While interoception is of major neuroscientific interest, its precise definition and delineation from exteroception continue to be debated. Here, we propose a functional distinction between interoception and exteroception based on computational concepts of sensor-effector loops. Under this view, the classification of sensory inputs as serving interoception or exteroception depends on the sensor-effector loop they feed into, for the control of either bodily (physiological and biochemical) or environmental states. We explain the utility of this perspective by examining the perception of skin temperature, one of the most challenging cases for distinguishing between interoception and exteroception. Specifically, we propose conceptualising thermoception as inference about the thermal state of the body (including the skin), which is directly coupled to thermoregulatory processes. This functional view emphasises the coupling to regulation (control) as a defining property of perception (inference) and connects the definition of interoception to contemporary computational theories of brain-body interactions.
Collapse
Affiliation(s)
- Birte Toussaint
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich & ETH Zurich, Zurich, Switzerland.
| | - Jakob Heinzle
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich & ETH Zurich, Zurich, Switzerland
| | - Klaas Enno Stephan
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich & ETH Zurich, Zurich, Switzerland; Max Planck Institute for Metabolism Research, Cologne, Germany
| |
Collapse
|
3
|
Parrotta E, Bach P, Perrucci MG, Costantini M, Ferri F. Heart is deceitful above all things: Threat expectancy induces the illusory perception of increased heartrate. Cognition 2024; 245:105719. [PMID: 38278039 DOI: 10.1016/j.cognition.2024.105719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 11/24/2023] [Accepted: 01/08/2024] [Indexed: 01/28/2024]
Abstract
It has been suggested that our perception of the internal milieu, or the body's internal state, is shaped by our beliefs and previous knowledge about the body's expected state, rather than being solely based on actual interoceptive experiences. This study investigated whether heartbeat perception could be illusorily distorted towards prior subjective beliefs, such that threat expectations suffice to induce a misperception of heartbeat frequency. Participants were instructed to focus on their cardiac activity and report their heartbeat, either tapping along to it (Experiment 1) or silently counting (Experiment 2) while ECG was recorded. While completing this task, different cues provided valid predictive information about the intensity of an upcoming cutaneous stimulation (high- vs. low- pain). Results showed that participants expected a heart rate increase over the anticipation of high- vs. low-pain stimuli and that this belief was perceptually instantiated, as suggested by their interoceptive reports. Importantly, the perceived increase was not mirrored by the real heart rate. Perceptual modulations were absent when participants executed the same task but with an exteroceptive stimulus (Experiment 3). The findings reveal, for the first time, an interoceptive illusion of increased heartbeats elicited by threat expectancy and shed new light on interoceptive processes through the lenses of Bayesian predictive processes, providing tantalizing insights into how such illusory phenomena may intersect with the recognition and regulation of people's internal states.
Collapse
Affiliation(s)
- Eleonora Parrotta
- School of Psychology, University of Aberdeen, UK; School of Psychology, University of Plymouth, UK.
| | - Patric Bach
- School of Psychology, University of Aberdeen, UK; School of Psychology, University of Plymouth, UK
| | - Mauro Gianni Perrucci
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy; Institute for Advanced Biomedical Technologies - ITAB, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Marcello Costantini
- Department of Psychological, Health and Territorial Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy; Institute for Advanced Biomedical Technologies - ITAB, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Francesca Ferri
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy; Institute for Advanced Biomedical Technologies - ITAB, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| |
Collapse
|
4
|
Körmendi J, Ferentzi E. Heart activity perception: narrative review on the measures of the cardiac perceptual ability. Biol Futur 2024; 75:3-15. [PMID: 37747684 DOI: 10.1007/s42977-023-00181-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 09/10/2023] [Indexed: 09/26/2023]
Abstract
Measures of cardiac perceptual ability (also called cardiac accuracy) are methods of cardiac interoception, the perception of bodily sensation related to heart activity. This narrative review aims to provide an overview of these methods. We differentiate between three main measurement types: (1) change detection, i.e., when the task is to notice the change in the heart rate; also called: heart rate perception tasks, (2) discrimination tasks, i.e., when the task is to compare the internal sensations with external signal(s); also called: heartbeat detection tasks and (3) tracking tasks, i.e., when the task is to follow and report heartbeats via tapping or counting. We describe some of the new methods under "mixed methods," as they share features with more than one of the large measurement types described above. Specific measures differ in various aspects, such as their focus (heart rhythm vs. single beats), their sensitivity to non-conscious sensations and the calculated indices (e.g., whether significance level by hypothesis test is provided). When a measure of cardiac perceptual ability is chosen, it is advisable to take its characteristics into consideration in light of the planned research.
Collapse
Affiliation(s)
- János Körmendi
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Budapest, Hungary
- Ádám György Psychophysiology Research Group, Budapest, Hungary
| | - Eszter Ferentzi
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Budapest, Hungary.
- Ádám György Psychophysiology Research Group, Budapest, Hungary.
| |
Collapse
|
5
|
Köteles F. Vague sensations. About the background and consequences of discordance between actual and perceived physiological changes. Clin Psychol Rev 2024; 108:102382. [PMID: 38218123 DOI: 10.1016/j.cpr.2024.102382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 10/28/2023] [Accepted: 01/05/2024] [Indexed: 01/15/2024]
Abstract
Empirical evidence consistently shows that discordance, also called dissociation or discrepancy, between actual physiological (mainly visceral) events and their perceived counterparts is substantial. On the one hand, we typically do not perceive actual visceral events occurring in our bodies; on the other hand, sometimes we do perceive bodily changes that do not really take place. This narrative review presents the available empirical findings on the discordance, and summarizes possible explanations that approach the phenomenon from the viewpoint of evolution, cognitive development, and predictive processing. Also, the role of top-down factors, such as expectations and experiences is discussed. Finally, practically relevant consequences of the discordance are presented using the examples of mind-body practices, the placebo and nocebo phenomenon, and medically unexplained symptoms. It is concluded that the discordance between actual and perceived body changes can have a negative impact on health, mainly through issues with adherence and other behavioral factors. The existence of actual-perceived discordance should be taught and demonstrated in the elementary and high school, as well as in many areas of higher education.
Collapse
Affiliation(s)
- Ferenc Köteles
- Institute of Psychology, Károli Gáspár University of the Reformed Church in Hungary, Budapest, Hungary; Ádám György Psychophysiology Research Group, Budapest, Hungary.
| |
Collapse
|
6
|
Ventura‐Bort C, Weymar M. Transcutaneous auricular vagus nerve stimulation modulates the processing of interoceptive prediction error signals and their role in allostatic regulation. Hum Brain Mapp 2024; 45:e26613. [PMID: 38379451 PMCID: PMC10879907 DOI: 10.1002/hbm.26613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 01/03/2024] [Accepted: 01/18/2024] [Indexed: 02/22/2024] Open
Abstract
It has recently been suggested that predictive processing principles may apply to interoception, defined as the processing of hormonal, autonomic, visceral, and immunological signals. In the current study, we aimed at providing empirical evidence for the role of cardiac interoceptive prediction errors signals on allostatic adjustments, using transcutaneous auricular vagus nerve stimulation (taVNS) as a tool to modulate the processing of interoceptive afferents. In a within-subject design, participants performed a cardiac-related interoceptive task (heartbeat counting task) under taVNS and sham stimulation, spaced 1-week apart. We observed that taVNS, in contrast to sham stimulation, facilitated the maintenance of interoceptive accuracy levels over time (from the initial, stimulation-free, baseline block to subsequent stimulation blocks), suggesting that vagus nerve stimulation may have helped to maintain engagement to cardiac afferent signals. During the interoceptive task, taVNS compared to sham, produced higher heart-evoked potentials (HEP) amplitudes, a potential readout measure of cardiac-related prediction error processing. Further analyses revealed that the positive relation between interoceptive accuracy and allostatic adjustments-as measured by heart rate variability (HRV)-was mediated by HEP amplitudes. Providing initial support for predictive processing accounts of interoception, our results suggest that the stimulation of the vagus nerve may increase the precision with which interoceptive signals are processed, favoring their influence on allostatic adjustments.
Collapse
Affiliation(s)
- Carlos Ventura‐Bort
- Department of Biological Psychology and Affective Science, Faculty of Human SciencesUniversity of PotsdamPotsdamGermany
| | - Mathias Weymar
- Department of Biological Psychology and Affective Science, Faculty of Human SciencesUniversity of PotsdamPotsdamGermany
- Faculty of Health Sciences BrandenburgUniversity of PotsdamPotsdamGermany
| |
Collapse
|
7
|
Moffatt J, Finotti G, Tsakiris M. With hand on heart: A cardiac Rubber Hand Illusion. Biol Psychol 2024; 186:108756. [PMID: 38280444 DOI: 10.1016/j.biopsycho.2024.108756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/16/2024] [Accepted: 01/22/2024] [Indexed: 01/29/2024]
Abstract
Body illusions such as the Rubber Hand Illusion (RHI) have highlighted how multisensory integration underpins the sense of one's own body. Much of this research has focused on senses arising from outside the body (e.g. vision and touch), but sensations from within the body may also play a role. In a pre-registered study, participants completed a cardiac variation of the RHI, where taps to the finger occurred in or out of time with the heartbeat. We replicated the RHI effect, showing that synchronous but not asynchronous taps to the real and rubber hand increased sensations of embodiment over the rubber hand and caused a shift in the perceived hand location. However, there were no significant influences of cardiac timing on embodiment, nor did it interact with visuo-tactile synchrony. An exploratory analysis found a three-way interaction between synchrony, cardiac timing and interoceptive accuracy as measured by a heartbeat counting task, such that greater interoceptive accuracy was associated with lower embodiment ratings in the systole condition compared to diastole, but only during synchronous stimulation. Although our novel methodology successfully replicated the RHI, our findings suggest that the cooccurence of vision and touch with cardiac signals may make little contribution to the sense of one's body.
Collapse
Affiliation(s)
- Jamie Moffatt
- Lab of Action & Body, Department of Psychology, Royal Holloway, University of London, UK.
| | - Gianluca Finotti
- Center for Studies and Research in Cognitive Neuroscience, Department of Psychology, University of Bologna, Italy
| | - Manos Tsakiris
- Lab of Action & Body, Department of Psychology, Royal Holloway, University of London, UK
| |
Collapse
|
8
|
Schwerdtfeger AR, Rominger C. Acute fasting modulates autonomic nervous system function and ambulatory cardiac interoception. Biol Psychol 2024; 186:108760. [PMID: 38331345 DOI: 10.1016/j.biopsycho.2024.108760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 02/10/2024]
Abstract
Intermittent fasting has been associated with diverse physical and psychological health benefits. According to previous research, fasting-induced alterations in psychophysiological functioning should facilitate the accurate detection of an internal bodily signal (like the heart), which is referred to as interoceptive accuracy. In two within-subjects studies we aimed to examine whether an intermittent fasting protocol (i) evokes distinct autonomic nervous system changes in the laboratory and (ii) improves (objectifiable) interoceptive accuracy and sensibility (i.e., the subjective belief in perceiving bodily signals) in everyday life. Study 1 (N = 36) found increasing heart rate variability (precisely, the root mean square of successive differences; RMSSD) accompanied by a more vascular than myocardial response following a 16 h fast. Study 2 (N = 40) applied an ecological momentary assessment design including intermittent fasting (8 h normal eating followed by 16 h fasting) and normal eating (24 h normal eating) for three consecutive days each. Findings suggested a tendency toward higher interoceptive accuracy and sensibility during the fasting regimen, which was particularly pronounced in individuals exhibiting lower RMSSD. Together, findings suggest that (short-term) fasting seems to facilitate momentary attention to organismic cues due to alterations in autonomic nervous system function.
Collapse
Affiliation(s)
| | - Christian Rominger
- Institute of Psychology, University of Graz, Universitaetsplatz 2/III, Graz, Austria
| |
Collapse
|
9
|
Crucianelli L, Radziun D, Ehrsson HH. Thermosensation and emotion: Thermosensory accuracy in a dynamic thermal matching task is linked to depression and anxiety symptomatology. Physiol Behav 2024; 273:114407. [PMID: 37967806 DOI: 10.1016/j.physbeh.2023.114407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/23/2023] [Accepted: 11/07/2023] [Indexed: 11/17/2023]
Abstract
Interoception is related to the generation of bodily feelings and the awareness of ourselves as 'sentient beings', informing the organism about its bodily needs to guarantee survival. Previous studies have reported links among interoception, emotion processing, and mental health. For example, the alignment of interoceptive dimensions (i.e., accuracy, sensibility, awareness) can predict emotional symptoms, such as anxiety. Here, we aimed to investigate the relationship between the perception of a certain type of skin-mediated interoceptive signal, i.e., thermosensation, and self-reported depression, anxiety, and stress. One hundred seventy participants completed the Depression Anxiety Stress Scale (DASS-21) and a dynamic thermal matching task, a static temperature detection task, and a heartbeat counting task. Our results revealed that self-reported anxiety and depression were related to the perception of temperature on hairy and non-hairy skin, respectively: higher anxiety was related to better performance on the thermal matching task on the forearm, while higher depression was related to poorer performance on dynamic and static temperature tasks on the palm. Discrepancies between thermosensory accuracy and sensibility measures ('trait prediction error') were related to heightened anxiety, in line with previous studies. No significant correlations were found between DASS-21 scores and heartbeat counting accuracy. In conclusion, this study suggests that individual differences in thermosensory perception in different areas of the body are associated with self-reported anxiety and depression.
Collapse
Affiliation(s)
- Laura Crucianelli
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Biological and Experimental Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, UK.
| | - Dominika Radziun
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - H Henrik Ehrsson
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
10
|
Rominger C, Schwerdtfeger AR. The misjudgment of interoceptive awareness: Systematic overrating of interoceptive awareness among individuals with lower interoceptive metacognitive skills. Conscious Cogn 2024; 117:103621. [PMID: 38113709 DOI: 10.1016/j.concog.2023.103621] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/22/2023] [Accepted: 12/07/2023] [Indexed: 12/21/2023]
Abstract
Knowing when perceiving inner bodily signals better and when perceiving them worse is a health relevant but understudied dimension of interoception. Therefore, the present study assessed interoceptive metacognition (IMC) as the skill to adequately monitor interoceptive accuracy in the cardiac domain. We used the Graz Ambulatory Interoception task (GRAIT), which applied two intervals of the heartbeat tracking task 12 times a day for 3 days in total to n = 66 participants. We assessed IMC as the relative correspondence between interoceptive accuracy and the subjective confidence ratings. We found that 6 % of the total IMC variance was due to person, which was assessed reliable (RKRn=0.81). Furthermore, the between-person variation of IMC was negatively associated with the MAIA (especially attention regulation and self-regulation). People who believe that they are aware of their interoceptive experiences (MAIA) showed lower IMC. This study advocates the assessment of interoception in everyday life.
Collapse
|
11
|
Desmedt O, Luminet O, Maurage P, Corneille O. The validity issues of the heartbeat counting task are not ruled out by Schulz et al. (2021): A commentary. Biol Psychol 2023; 184:108693. [PMID: 37775031 DOI: 10.1016/j.biopsycho.2023.108693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/21/2023] [Accepted: 09/24/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Olivier Desmedt
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland; The Swiss National Science Foundation (SNSF), Switzerland; Psychological Science Research Institute, UCLouvain, Louvain-la-Neuve, Belgium; Fund for Scientific Research - Belgium (FRS-FNRS), Belgium.
| | - Olivier Luminet
- Psychological Science Research Institute, UCLouvain, Louvain-la-Neuve, Belgium; Fund for Scientific Research - Belgium (FRS-FNRS), Belgium
| | - Pierre Maurage
- Psychological Science Research Institute, UCLouvain, Louvain-la-Neuve, Belgium; Fund for Scientific Research - Belgium (FRS-FNRS), Belgium
| | - Olivier Corneille
- Psychological Science Research Institute, UCLouvain, Louvain-la-Neuve, Belgium
| |
Collapse
|
12
|
Koreki A, Garfinkel S, Critchley H, Cope S, Agrawal N, Edwards M, Yogarajah M. Impaired cardiac modulation in patients with functional seizures: Results from a face intensity judgment task. Epilepsia 2023; 64:3073-3081. [PMID: 37611952 PMCID: PMC10952481 DOI: 10.1111/epi.17761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/19/2023] [Accepted: 08/21/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE Although interoceptive abnormality in patients with functional seizure (FSs) has been demonstrated using explicit tasks, implicit measurements of interoception such as the effect of interoception on perceptual brain processes have not been investigated. It has been shown that perception is normally modulated by interoceptive signals related to the different phases (systole vs diastole) of the cardiac cycle (cardiac modulation effect). Given our previous findings using explicit measures of interoception, we hypothesized that cardiac modulation would be impaired in FSs. METHODS Thirty-two patients with FSs and 30 age- and sex-matched non-clinical individuals conducted a face intensity judgment task, in which their intensity rating when fearful or neutral faces was presented was compared between systolic and diastolic phases. They also conducted the heartbeat discrimination task as a measure of their capacity to integrate both interoceptive and exteroceptive information. RESULTS Patients with FSs had impaired cardiac modulation of the perception of neutral faces (corrected p = .044). Individual differences in the heartbeat discrimination task predicted the degree to which cardiac modulation occurred across the whole group (p = .028). This cardiac modulation effect was significantly associated with seizure severity (p = .021). Regardless of cardiac phase, patients rated fearful facial expressions as less intense compared to control participants (p = .006). SIGNIFICANCE These findings highlight impaired implicit cardiac modulation effects in patients with FSs. This reflects interoceptive dysfunction in patients with FSs, and an inability of the brain to integrate interoceptive signaling with perceptual processing. This may have implications for our understanding of the pathophysiology in FSs and inform novel diagnostic approaches.
Collapse
Affiliation(s)
- Akihiro Koreki
- Neurosciences Research CentreSt George's University of LondonLondonUK
- Department of PsychiatryNational Hospital Organization Shimofusa Psychiatric Medical CenterChibaJapan
| | | | - Hugo Critchley
- Brighton and Sussex Medical SchoolSussex UniversitySussexUK
| | - Sarah Cope
- Atkinson Morley Regional Neuroscience CentreSt George's HospitalLondonUK
| | - Niruj Agrawal
- Atkinson Morley Regional Neuroscience CentreSt George's HospitalLondonUK
| | - Mark Edwards
- Neurosciences Research CentreSt George's University of LondonLondonUK
- Atkinson Morley Regional Neuroscience CentreSt George's HospitalLondonUK
| | - Mahinda Yogarajah
- Department of Clinical & Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- Chalfont Centre for EpilepsyLondonUK
- NIHR University College London Hospitals Biomedical Research CentreLondonUK
| |
Collapse
|
13
|
Parfenov EA, Duncan NW. Increasing familiarity with the heartbeat counting task does not affect performance. Biol Psychol 2023; 183:108662. [PMID: 37598881 DOI: 10.1016/j.biopsycho.2023.108662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 07/21/2023] [Accepted: 08/17/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Interoception is typically defined as the processing and perception of internal signals. A common evaluation of interoceptive abilities is the heartbeat counting task, during which participants count their heartbeats over a period of time. It has been argued recently, however, that performance in this task may reflect processes other than cardiac sensation. OBJECTIVE This study aimed to: 1) observe heartbeat counting task performance changes across multiple repetitions of the task; and 2) compare performance in the heartbeat counting task with that for a visual counting task to investigate generalised propensities for how uncertain stimuli are reported. METHODS Seventy-nine healthy participants performed seven blocks each of the heartbeat and visual counting tasks. Scores for each of the tasks were compared across blocks to identify any change in performance. Performance in the two tasks was then correlated. The study was preregistered at https://doi.org/10.17605/OSF.IO/GWAB7. RESULTS Heartbeat counting task performance did not change over blocks. In contrast, scores for the visual counting task reduced over time. A positive correlation was seen between performance in the two tasks (ρ(79) = .27). CONCLUSION Heartbeat counting task performance is stable across repetitions of the task, not changing with increasing familiarity. This suggests that non-interoceptive factors, such as beliefs, may be involved. The correlation between the heartbeat and visual counting tasks may point to a general propensity in counting uncertain stimuli across sensory domains. Together, these results raise questions about the interpretation of the heartbeat counting task as a measure of interoception.
Collapse
Affiliation(s)
- Evgeny A Parfenov
- Graduate Institute of Mind, Brain and Consciousness, Taipei Medical University, Taipei, Taiwan
| | - Niall W Duncan
- Graduate Institute of Mind, Brain and Consciousness, Taipei Medical University, Taipei, Taiwan.
| |
Collapse
|
14
|
Lernia DDI, Serino S, Tuena C, Cacciatore C, Polli N, Riva G. Mental health meets computational neuroscience: A predictive Bayesian account of the relationship between interoception and multisensory bodily illusions in anorexia nervosa. Int J Clin Health Psychol 2023; 23:100383. [PMID: 36937547 PMCID: PMC10017360 DOI: 10.1016/j.ijchp.2023.100383] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 02/21/2023] [Indexed: 03/09/2023] Open
Abstract
Mental health disorders pose a significant challenge to society. The Bayesian perspective on the mind offers unique insights and tools that may help address a variety of mental health conditions. Psychopathological dysfunctions are often connected to altered predictive and active inference processes, in which cognitive and physiological pathogenic beliefs shape the clinical condition and its symptoms. However, there is a lack of general empirical models that integrate cognitive beliefs, physiological experience, and symptoms in healthy and clinical populations. In this study, we examined the relationship between altered predictive mechanisms, interoception, and pathological bodily distortions in healty individuals and in individuals suffering from anorexia nervosa (AN). AN patients (N=15) completed a Virtual Reality Full-Body Illusion along with interoceptive tasks twice: at hospital admission during an acute symptomatological phase (Time 1) and after a 12-week outpatient clinical weight-restoring rehabilitative program (Time 2). Results were compared to a healthy control group. Our findings indicated that higher levels of interoceptive metacognitive awareness were associated with a greater embodiment. However, unlike in healthy participants, AN patients' interoceptive metacognition was linked to embodiment even in multisensory mismatching (asynchronous) conditions. In addition, unlike in healthy participants, higher interoceptive metacognition in AN patients was related to prior abnormal bodily distortions during the acute symptomatology phase. Prediction errors in bodily estimates predicted posterior bodily estimate distortions after the illusion, but while this relationship was only significant in the synchronous condition in healthy participants, there was no significant difference between synchronous and asynchronous conditions in AN patients. Despite the success of the rehabilitation program in restoring some dysfunctional patterns in the AN group, prediction errors and posterior estimate distortions were present at hospital discharge. Our findings suggest that individuals with AN prioritize interoceptive metacognitive processes (i.e., confidence in their own perceived sensations rather than their actual perceptions), disregarding bottom-up bodily inputs in favour of their prior altered top-down beliefs. Moreover, even if the rehabilitative program partially mitigated these alterations, the pathological condition impaired the patients' ability to coherently update their prior erroneous expectations with real-time multisensory bottom-up bodily information, possibly locking the patients in the experience of a distorted prior top-down belief. These results suggest new therapeutic perspectives and introduce the framework of regenerative virtual therapy (RVT), which aims at utilizing technology-based somatic modification techniques to restructure the maladaptive priors underlying a pathological condition.
Collapse
Affiliation(s)
- Daniele DI Lernia
- Humane Technology Lab, Università Cattolica del Sacro Cuore di Milano, Italy
| | - Silvia Serino
- Humane Technology Lab, Università Cattolica del Sacro Cuore di Milano, Italy
| | - Cosimo Tuena
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Chiara Cacciatore
- UO di Endocrinologia e Malattie Metaboliche, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Nicoletta Polli
- UO di Endocrinologia e Malattie Metaboliche, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Giuseppe Riva
- Humane Technology Lab, Università Cattolica del Sacro Cuore di Milano, Italy
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
| |
Collapse
|
15
|
Rominger C, Schwerdtfeger AR. Dynamic heartbeat tracking beyond the laboratory: Introducing the novel Graz Ambulatory Interoception Task (GRAIT). Int J Psychophysiol 2023; 192:80-90. [PMID: 37574020 DOI: 10.1016/j.ijpsycho.2023.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 08/15/2023]
Abstract
We present a novel ambulatory method, the Graz Ambulatory Interoception Task (GRAIT), to assess the accuracy of interoceptive beliefs (AccIB). This method captures both between- and within-person variations of AccIB by having participants counting perceived heartbeats in daily life. Reliability analyses showed high between-person (RkR = 0.99) and moderate within-person reliability (RCn = 0.62). Validity was supported by associations with an established laboratory task (r = 0.87). Within-person associations revealed that interoceptive sensibility, heart rate variability, and states of low arousal coupled with positive affect were linked to AccIB. Study 2 replicated these findings and showed a relationship between AccIB and self-control in everyday life, highlighting the importance of cardiac interoception and its relevance for health.
Collapse
|
16
|
Desmedt O, Luminet O, Walentynowicz M, Corneille O. The new measures of interoceptive accuracy: A systematic review and assessment. Neurosci Biobehav Rev 2023; 153:105388. [PMID: 37708919 DOI: 10.1016/j.neubiorev.2023.105388] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 08/10/2023] [Accepted: 09/07/2023] [Indexed: 09/16/2023]
Abstract
Conscious interoception, the perception of internal bodily states, is thought to contribute to fundamental human abilities (e.g., decision-making and emotional regulation). One of its most studied dimensions is interoceptive accuracy: the objective capacity to detect internal bodily signals. In the past few years, several labs across the world have started developing new tasks aimed at overcoming limitations inherent in classical measures of interoceptive accuracy. In this systematic review, we identified these tasks (since 2015) for the cardiac, respiratory, and gastrointestinal domains. For each identified task, we discuss their strengths and weaknesses, and make constructive suggestions for further improvement. In the general discussion, we discuss the (potentially elusive) possibility of reaching high validity in the measurement of interoceptive accuracy. We also point out that interoceptive accuracy may not be the most critical dimension for informing current theories, and we encourage researchers to investigate other dimensions of conscious interoception.
Collapse
Affiliation(s)
- Olivier Desmedt
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland; Psychological Science Research Institute, UCLouvain, Louvain-la-Neuve, Belgium; Fund for Scientific Research (FRS-FNRS), Belgium.
| | - Olivier Luminet
- Psychological Science Research Institute, UCLouvain, Louvain-la-Neuve, Belgium; Fund for Scientific Research (FRS-FNRS), Belgium
| | - Marta Walentynowicz
- Centre for the Psychology of Learning and Experimental Psychopathology, KULeuven, Belgium
| | - Olivier Corneille
- Psychological Science Research Institute, UCLouvain, Louvain-la-Neuve, Belgium
| |
Collapse
|
17
|
von Mohr M, Finotti G, Esposito G, Bahrami B, Tsakiris M. Social interoception: Perceiving events during cardiac afferent activity makes people more suggestible to other people's influence. Cognition 2023; 238:105502. [PMID: 37336022 DOI: 10.1016/j.cognition.2023.105502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 05/04/2023] [Accepted: 05/24/2023] [Indexed: 06/21/2023]
Abstract
Our judgements are often influenced by other people's views and opinions. Interoception also influences decision making, but little is known about its role in social influence and particularly, the extent to which other people may influence our decisions. Across two experiments, using different forms of social influence, participants judged the trustworthiness of faces presented either during the systolic phase of the cardiac cycle, when baroreceptors convey information from the heart to the brain, or during diastolic phase, when baroreceptors are quiescent. We quantified the extent to which participants changed their minds (as an index of social influence) following the social feedback, in order to compare two competing hypotheses. According to the Arousal-Confidence Hypothesis, cardiac signals create a context of heightened bodily arousal that increases confidence in perceptual judgements. People should, therefore, be less subject to social influence during systole. By contrast, according to the Uncertainty-Conformity Hypothesis, cardiac signals increase neural noise and sensory attenuation, such that people should display greater effects of social influence during systole, as they then underweight private interoceptive signals in favour of the external social information. Across two studies that used different kind of social interactions, we found that participants changed their minds more when faces were presented at systole. Our results, therefore, support the Uncertainly-Conformity hypothesis and highlight how cardiac afferent signals contribute to shape our social decision-making in different types of social interactions.
Collapse
Affiliation(s)
- Mariana von Mohr
- Lab of Action and Body, Department of Psychology, Royal Holloway, University of London, UK; Centre for the Politics of Feelings, School of Advanced Study, University of London, UK.
| | - Gianluca Finotti
- Center for Studies and Research in Cognitive Neuroscience, Department of Psychology, University of Bologna, Italy
| | | | - Bahador Bahrami
- Department of Psychology, Ludwig Maximilian University, Munich, Germany; Department of Psychology, Royal Holloway, University of London, UK
| | - Manos Tsakiris
- Lab of Action and Body, Department of Psychology, Royal Holloway, University of London, UK; Centre for the Politics of Feelings, School of Advanced Study, University of London, UK
| |
Collapse
|
18
|
Desmedt O, Luminet O, Maurage P, Corneille O. Discrepancies in the Definition and Measurement of Human Interoception: A Comprehensive Discussion and Suggested Ways Forward. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2023:17456916231191537. [PMID: 37642084 DOI: 10.1177/17456916231191537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Interoception has been the subject of renewed interest over the past 2 decades. The involvement of interoception in a variety of fundamental human abilities (e.g., decision-making and emotional regulation) has led to the hypothesis that interoception is a central transdiagnostic process that causes and maintains mental disorders and physical diseases. However, interoception has been inconsistently defined and conceptualized. In the first part of this article, we argue that the widespread practice of defining interoception as the processing of signals originating from within the body and limiting it to specific physiological pathways (lamina I spinothalamic afferents) is problematic. This is because, in humans, the processing of internal states is underpinned by other physiological pathways generally assigned to the somatosensory system. In the second part, we explain that the consensual dimensions of interoception are empirically detached from existing measures, the latter of which capture loosely related phenomena. This is detrimental to the replicability of findings across measures and the validity of interpretations. In the general discussion, we discuss the main insights of the current analysis and suggest a more refined way to define interoception in humans and conceptualize its underlying dimensions.
Collapse
Affiliation(s)
- Olivier Desmedt
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
- The Swiss National Science Foundation, Berne, Switzerland
| | - Olivier Luminet
- Psychological Science Research Institute, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
- Fund for Scientific Research, Brussels, Belgium
| | - Pierre Maurage
- Psychological Science Research Institute, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
- Fund for Scientific Research, Brussels, Belgium
| | - Olivier Corneille
- Psychological Science Research Institute, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| |
Collapse
|
19
|
Ma K, Yang L, Hommel B. The impact of interoceptive accuracy and stimulation type on the out-of-body experience. Q J Exp Psychol (Hove) 2023; 76:1940-1952. [PMID: 36113171 DOI: 10.1177/17470218221128285] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
People tend to perceive a virtual body standing in front of them as their own if it is either stroked or moving synchronously with their own real body-the out-of-body experience (OBE). We combined synchrony manipulation with two other factors of theoretical interest: the kind of stimulation, visuotactile stimuli or visuomotor correlations, being synchronised and the interoceptive accuracy (IA) of participants, assessed by means of the heartbeat counting task. Results showed that explicit measures of embodiment were systematically affected by synchrony, and this synchrony effect was more pronounced for visuomotor than for visuotactile conditions. The walking drift was affected by IA: In visuotactile conditions, the synchrony effect was pronounced in individuals with low IA, presumably reflecting a stronger impact of the visual information. In visuomotor conditions, however, the synchrony effect was stronger in individuals with high IA, presumably reflecting a stronger impact of re-afferent information generated by the participants' own movements.
Collapse
Affiliation(s)
- Ke Ma
- Key Laboratory of Personality and Cognition, Faculty of Psychological Science, Southwest University, Chongqing, China
| | - Liping Yang
- Key Laboratory of Personality and Cognition, Faculty of Psychological Science, Southwest University, Chongqing, China
| | - Bernhard Hommel
- University Neuropsychology Center and Cognitive Neurophysiology, Faculty of Medicine, TU Dresden, Dresden, Germany
- Faculty of Psychology, TU Dresden, Dresden, Germany
- Department of Psychology, Shandong Normal University, Jinan, China
| |
Collapse
|
20
|
Wallman-Jones A, Nigg C, Benzing V, Schmidt M. Leave the screen: The influence of everyday behaviors on self-reported interoception. Biol Psychol 2023; 181:108600. [PMID: 37286096 DOI: 10.1016/j.biopsycho.2023.108600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 06/02/2023] [Accepted: 06/03/2023] [Indexed: 06/09/2023]
Abstract
The influence of physical activity on interoception is apparent, however little is known about within-person variability following physical activity and sedentary behavior in daily life. To test this, 70 healthy adults (Mage 21.67 ± 2.50) wore thigh-mounted accelerometers for 7-days, with self-reported interoception recorded on movement-triggered smartphones. Participants additionally reported the predominant activity type performed across the last 15 min. Investigating this timeframe, multi-level analyses revealed that each one-unit increase in physical activity was associated with an increase in self-reported interoception (B = 0.0025, p = .013), whereas contrastingly, each one-minute increase in sedentary behavior was associated with a decrease (B = -0.06. p = .009). Investigating the influence of different activity types in comparison to screen time behavior, both partaking in exercise (B = 4.48, p < .001) and daily-life physical activity (B = 1.21, p < .001) were associated with an increase in self-reported interoception. Regarding other behavior categories, non-screen time behavior both with (B = 1.13, p < .001) and without (B = 0.67, p = .004) social interaction were also associated with an increase in self-reported interoception compared to screen-time behavior. Extending from previous laboratory-based studies, these findings indicate that physical activity influences interoceptive processes in real-life, further supplemented by the novel and contrasting findings regarding sedentary behavior. Furthermore, associations with activity type reveal important mechanistic information, highlighting the importance of reducing screen-time behavior to preserve and support interoceptive perceptions. Findings can be used to inform health recommendations for reducing screen-time behavior and guiding evidence-based physical activity interventions to promote interoceptive processes.
Collapse
Affiliation(s)
| | - Carina Nigg
- Institute of Sport Science, University of Bern, Bern, Switzerland
| | - Valentin Benzing
- Institute of Sport Science, University of Bern, Bern, Switzerland
| | - Mirko Schmidt
- Institute of Sport Science, University of Bern, Bern, Switzerland
| |
Collapse
|
21
|
Campos C, Rocha NB, Barbosa F. Dissociating cognitive and affective empathy across psychopathy dimensions: The role of interoception and alexithymia. Front Psychol 2023; 14:1082965. [PMID: 37457066 PMCID: PMC10345207 DOI: 10.3389/fpsyg.2023.1082965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/15/2023] [Indexed: 07/18/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Carlos Campos
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Neurocognition Group|LabRP, School of Health, Center for Rehabilitation Research, Polytechnic University of Porto, Porto, Portugal
| | - Nuno Barbosa Rocha
- School of Health, Center for Translational Health and Medical Biotechnology Research, Polytechnic University of Porto, Porto, Portugal
| | - Fernando Barbosa
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| |
Collapse
|
22
|
Characterizing Interoceptive Differences in Autism: A Systematic Review and Meta-analysis of Case-control Studies. J Autism Dev Disord 2023; 53:947-962. [PMID: 35819587 PMCID: PMC9832174 DOI: 10.1007/s10803-022-05656-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 01/13/2023]
Abstract
Interoception, the body's perception of its own internal states, is thought to be altered in autism, though results of empirical studies have been inconsistent. The current study systematically reviewed and meta-analyzed the extant literature comparing interoceptive outcomes between autistic (AUT) and neurotypical (NT) individuals, determining which domains of interoception demonstrate robust between-group differences. A three-level Bayesian meta-analysis compared heartbeat counting performance, heartbeat discrimination performance, heartbeat counting confidence ratings, and self-reported interoceptive attention between AUT and NT groups (15 studies; nAUT = 467, nNT = 478). Autistic participants showed significantly reduced heartbeat counting performance [g = - 0.333, CrI95% (- 0.535, - 0.138)] and higher confidence in their heartbeat counting abilities [g = 0.430, CrI95% (0.123, 0.750)], but groups were equivalent on other meta-analyzed outcomes. Implications for future interoception research in autism are discussed.
Collapse
|
23
|
Critchley HD, Sherrill SP, Ewing DL, van Praag CG, Habash-Bailey H, Quadt L, Eccles JA, Meeten F, Jones AM, Garfinkel SN. Cardiac interoception in patients accessing secondary mental health services: A transdiagnostic study. Auton Neurosci 2023; 245:103072. [PMID: 36709619 DOI: 10.1016/j.autneu.2023.103072] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/19/2022] [Accepted: 01/08/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Abnormalities in the regulation of physiological arousal and interoceptive processing are implicated in the expression and maintenance of specific psychiatric conditions and symptoms. We undertook a cross-sectional characterisation of patients accessing secondary mental health services, recording measures relating to cardiac physiology and interoception, to understand how physiological state and interoceptive ability relate transdiagnostically to affective symptoms. METHODS Participants were patients (n = 258) and a non-clinical comparison group (n = 67). Clinical diagnoses spanned affective disorders, complex personality presentations and psychoses. We first tested for differences between patient and non-clinical participants in terms of cardiac physiology and interoceptive ability, considering interoceptive tasks and a self-report measure. We then tested for correlations between cardiac and interoceptive measures and affective symptoms. Lastly, we explored group differences across recorded clinical diagnoses. RESULTS Patients exhibited lower performance accuracy and confidence in heartbeat discrimination and lower heartbeat tracking confidence relative to comparisons. In patients, greater anxiety and depression predicted greater self-reported interoceptive sensibility and a greater mismatch between performance accuracy and sensibility. This effect was not observed in comparison participants. Significant differences between patient groups were observed for heart rate variability (HRV) although post hoc differences were not significant after correction for multiple comparisons. Finally, accuracy in heartbeat tracking was significantly lower in schizophrenia compared to other diagnostic groups. CONCLUSIONS The multilevel characterisation presented here identified certain physiological and interoceptive differences associated with psychiatric symptoms and diagnoses. The clinical stratification and therapeutic targeting of interoceptive mechanisms is therefore of potential value in treating certain psychiatric conditions.
Collapse
Affiliation(s)
- Hugo D Critchley
- Department of Neuroscience, Brighton and Sussex Medical School, United Kingdom of Great Britain and Northern Ireland; Sussex Partnership NHS Foundation Trust, United Kingdom of Great Britain and Northern Ireland; Sussex Neuroscience, University of Sussex, United Kingdom of Great Britain and Northern Ireland.
| | - Samantha P Sherrill
- Department of Neuroscience, Brighton and Sussex Medical School, United Kingdom of Great Britain and Northern Ireland; Sussex Neuroscience, University of Sussex, United Kingdom of Great Britain and Northern Ireland
| | - Donna L Ewing
- Department of Neuroscience, Brighton and Sussex Medical School, United Kingdom of Great Britain and Northern Ireland; School of Humanities and Social Science, University of Brighton, United Kingdom of Great Britain and Northern Ireland
| | - Cassandra Gould van Praag
- Department of Neuroscience, Brighton and Sussex Medical School, United Kingdom of Great Britain and Northern Ireland; Department of Psychiatry, University of Oxford, United Kingdom of Great Britain and Northern Ireland
| | - Haniah Habash-Bailey
- Department of Neuroscience, Brighton and Sussex Medical School, United Kingdom of Great Britain and Northern Ireland; School of Psychology, University of Sussex, United Kingdom of Great Britain and Northern Ireland
| | - Lisa Quadt
- Department of Neuroscience, Brighton and Sussex Medical School, United Kingdom of Great Britain and Northern Ireland; Sussex Neuroscience, University of Sussex, United Kingdom of Great Britain and Northern Ireland
| | - Jessica A Eccles
- Department of Neuroscience, Brighton and Sussex Medical School, United Kingdom of Great Britain and Northern Ireland; Sussex Partnership NHS Foundation Trust, United Kingdom of Great Britain and Northern Ireland; Sussex Neuroscience, University of Sussex, United Kingdom of Great Britain and Northern Ireland
| | - Fran Meeten
- Department of Neuroscience, Brighton and Sussex Medical School, United Kingdom of Great Britain and Northern Ireland; School of Psychology, University of Sussex, United Kingdom of Great Britain and Northern Ireland
| | - Anna-Marie Jones
- Sussex Partnership NHS Foundation Trust, United Kingdom of Great Britain and Northern Ireland
| | - Sarah N Garfinkel
- Institute of Cognitive Neuroscience, University College London, United Kingdom of Great Britain and Northern Ireland
| |
Collapse
|
24
|
Schmitz M, Back SN, Seitz KI, Harbrecht NK, Streckert L, Schulz A, Herpertz SC, Bertsch K. The impact of traumatic childhood experiences on interoception: disregarding one's own body. Borderline Personal Disord Emot Dysregul 2023; 10:5. [PMID: 36788573 PMCID: PMC9930318 DOI: 10.1186/s40479-023-00212-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 02/01/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Deficient interoception, the processing and perception of internal bodily signals, has been discussed as a mechanism underlying various mental disorders. First results indicate a mediating role of interoception in the interplay of traumatic childhood experiences and adult mental disorders. Traumatic childhood experiences may hinder the adequate processing, integration, and trust in bodily signals that are important in order to understand and regulate own needs and emotions, thereby increasing the vulnerability for mental disorders. However, an overarching study investigating alterations in different interoceptive measures and trauma-related disorders as well as their mediating role between early trauma and emotion dysregulation is still missing. METHODS One hundred thirty-six individuals with varying levels of traumatic childhood experiences who either had a current diagnosis of major depression, posttraumatic stress disorder, or somatic symptom disorder, or no mental disorder, took part in a multidimensional assessment of interoceptive processes, including interoceptive accuracy, sensibility, and awareness. Kruskal-Wallis tests were used to compare groups regarding interoceptive processes and associations with traumatic childhood experiences and emotion dysregulation were analyzed with Spearman correlations. Furthermore, mediation analyses were computed to examine and compare interoceptive processes as potential mediators between traumatic childhood experiences and emotion dysregulation. RESULTS Only body dissociation, a measure for interoceptive sensibility, was significantly reduced in individuals with a current mental disorder. Body dissociation was also the only interoceptive measure significantly associated with traumatic childhood experiences and emotion dysregulation and the only significant mediator in the relationship between traumatic childhood experiences and emotion dysregulation across groups. CONCLUSION Results suggest body dissociation, but not other interoceptive measures, as an important feature linking traumatic childhood experiences to current emotion dysregulation, an important transdiagnostic feature. As body dissociation refers to a habitual non-attendance or disregard of interoceptive signals, integrative therapeutic interventions could help affected individuals to overcome difficulties in emotion perception and regulation. TRIAL REGISTRATION The general study design was preregistered; see the German Clinical Trials Register (DRKS-ID: DRKS00015182). This study's analysis plan was not preregistered.
Collapse
Affiliation(s)
- Marius Schmitz
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany. .,Department of Psychology, Ludwig-Maximilians-University Munich, Munich, Germany. .,Institute of Psychology, University of Heidelberg, Heidelberg, Germany.
| | - Sarah N Back
- Department of Psychology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Katja I Seitz
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.,Institute of Psychology, University of Heidelberg, Heidelberg, Germany
| | - Nele K Harbrecht
- Department of Psychology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Lena Streckert
- Department of Psychology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - André Schulz
- Department of Behavioural and Cognitive Sciences, Clinical Psychophysiology Laboratory, University of Luxembourg, Esch-Sur-Alzette, Luxembourg
| | - Sabine C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Katja Bertsch
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.,Department of Psychology, Ludwig-Maximilians-University Munich, Munich, Germany
| |
Collapse
|
25
|
Ironside M, DeVille DC, Kuplicki RT, Burrows KP, Smith R, Teed AR, Paulus MP, Khalsa SS. The unique face of comorbid anxiety and depression: increased interoceptive fearfulness and reactivity. Front Behav Neurosci 2023; 16:1083357. [PMID: 36755667 PMCID: PMC9899910 DOI: 10.3389/fnbeh.2022.1083357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/21/2022] [Indexed: 01/25/2023] Open
Abstract
Anxiety and depression commonly co-occur, yet the underlying brain and behavioral processes are poorly understood. Here we examined the hypothesis that individuals with comorbid anxiety and depression would show increased fearful reactivity to an aversive interoceptive perturbation relative to depressed-only individuals. One-hundred and eighty anxious and/or depressed participants from the Tulsa 1000 study completed multi-level behavioral or functional magnetic resonance imaging assessments of interoception and nociception including breath-hold and cold-pressor challenges, and heartbeat perception and interoceptive attention tasks. One-hundred and four individuals with comorbid depression and anxiety disorders (Dep+Anx) were propensity matched with 52 individuals with depression-only (Dep). Data were analyzed using mixed-effects linear regression. The Dep+Anx group showed significantly greater self-reported fear of suffocation during breath holding (Wilcoxon r = 0.23) and reduced cold pain tolerance (R 2 = 0.027) signified by hand removal during immersion. However, these groups did not differ with respect to neutrally-valenced behavioral indices of heartbeat perception or neural indices of interoceptive attention. Individuals with comorbid depression and anxiety, vs. those with only depression, show increased respiratory fearfulness and nociceptive reactivity during perturbations of these signals, whilst showing similar interoceptive awareness in the absence of perturbation. Our findings suggest that individuals with comorbid anxiety and depression process aversive interoceptive and nociceptive signals differently than those with depression alone, providing support for a process model of increased threat sensitivity and hyperarousal in anxious depression.
Collapse
Affiliation(s)
- Maria Ironside
- Laureate Institute for Brain Research, Tulsa, OK, United States,Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, United States,*Correspondence: Maria Ironside
| | - Danielle C. DeVille
- Laureate Institute for Brain Research, Tulsa, OK, United States,Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | | | | | - Ryan Smith
- Laureate Institute for Brain Research, Tulsa, OK, United States,Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, United States
| | - Adam R. Teed
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | - Martin P. Paulus
- Laureate Institute for Brain Research, Tulsa, OK, United States,Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, United States
| | - Sahib S. Khalsa
- Laureate Institute for Brain Research, Tulsa, OK, United States,Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, United States
| |
Collapse
|
26
|
Crucianelli L, Ehrsson HH. The Role of the Skin in Interoception: A Neglected Organ? PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2023; 18:224-238. [PMID: 35969893 PMCID: PMC9902974 DOI: 10.1177/17456916221094509] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
In the past 2 decades, interoception has received increasing attention in the fields of psychology and cognitive science, as well as neuroscience and physiology. A plethora of studies adopted the perception of cardiac signals as a proxy for interoception. However, recent findings have cast doubt on the methodological and intrinsic validity of the tasks used thus far. Therefore, there is an ongoing effort to improve the existing cardiac interoceptive tasks and to identify novel channels to target the perception of the physiological state of the body. Amid such scientific abundancy, one could question whether the field has been partially neglecting one of our widest organs in terms of dimensions and functions: the skin. According to some views grounded on anatomical and physiological evidence, skin-mediated signals such as affective touch, pain, and temperature have been redefined as interoceptive. However, there is no agreement in this regard. Here, we discuss some of the anatomical, physiological, and experimental arguments supporting the scientific study of interoception by means of skin-mediated signals. We argue that more attention should be paid to the skin as a sensory organ that monitors the bodily physiological state and further propose thermosensation as a particularly attractive model of skin-mediated interoception.
Collapse
Affiliation(s)
- Laura Crucianelli
- Laura Crucianelli, Department of Neuroscience, Karolinska Institutet
| | | |
Collapse
|
27
|
Embodied feelings-A meta-analysis on the relation of emotion intensity perception and interoceptive accuracy. Physiol Behav 2022; 254:113904. [PMID: 35820627 DOI: 10.1016/j.physbeh.2022.113904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 05/06/2022] [Accepted: 06/10/2022] [Indexed: 11/23/2022]
Abstract
Emotion theories emphasize the relevance of (predicted) bodily changes for the construction of one's own emotions and an extensive overlap of brain regions involved during emotion intensity perception and somatosensory processing. The ability to accurately perceive bodily changes and its impact on the perception of emotion intensity has been studied for at least 40 years. The results of previous studies were summarized in a meta-analysis to examine how closely interoceptive accuracy and emotion intensity are related. After a systematic literature search, 4036 studies were screened for eligibility. Only studies assessing adults from general population samples were considered. Samples recruited to examine mental disorders or neurological conditions were excluded. Thirty studies with a quantifiable measure for the relation of interoceptive accuracy and emotion intensity perception were included in the meta-analysis. Interoceptive accuracy was significantly related with emotion intensity perception, when emotions were experimentally induced (k= 22, r= 0.15). However, the relationship was only found when IAPS images (k= 9, r= 0.33) or facial expressions (k= 3, r= 0.24) were used for emotion induction. No significant relation was found in studies without emotion induction (k= 19, r = -0.007). There was considerable bias, varying dependent on bias assessment method, study protocol and examined risk of bias dimension. We discuss the impact of differences in study protocols, review the operationalization of interoceptive accuracy critically and derive directions for future research.
Collapse
|
28
|
Wallman-Jones A, Palser ER, Benzing V, Schmidt M. Acute physical-activity related increases in interoceptive ability are not enhanced with simultaneous interoceptive attention. Sci Rep 2022; 12:15054. [PMID: 36064565 PMCID: PMC9445090 DOI: 10.1038/s41598-022-19235-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/25/2022] [Indexed: 01/23/2023] Open
Abstract
Interoception, the sense of the internal body, is proposed to support self-regulation, and consequently influence mental health. Researchers have therefore shown interest in improving the ability to accurately monitor internal signals (i.e., interoceptive accuracy, IAcc). Research suggests that cardiac IAcc is modifiable by both manipulations of interoceptive attention (guided attention towards the internal body), and interoceptive exposure (strategically inducing somatic signals e.g., via physical activity). Whilst successful in isolation, it is unclear whether a combined approach (i.e., directing attention towards the internal body when signals are more salient) could elicit greater benefits. In a 2 × 2 within-subject design, 48 healthy adults (Mage = 25.98 ± 4.73 years, 50% female) completed four 20-min conditions varying in both attentional focus (interoceptive vs exteroceptive) and physical activity (active vs rest), with cardiac IAcc measured immediately after. Results revealed a main effect for physical activity (p < 0.001), however, there was no effect for attentional focus (p = 0.397), and no interaction effect (p = 0.797). Differential analyses showed that a higher sporting background increased sensitivity to physical activity-related increases in cardiac IAcc (p = 0.031). Findings indicate that (irrespective of attentional focus) moderate-vigorous physical activity-based interventions have the potential to increase cardiac IAcc, with certain individuals potentially benefiting more.
Collapse
Affiliation(s)
- A Wallman-Jones
- Institute of Sport Science, University of Bern, 145 Bremgartenstrasse, 3012, Bern, Switzerland.
| | - E R Palser
- Department of Neurology, University of California, San Francisco, CA, 94158, USA
| | - V Benzing
- Institute of Sport Science, University of Bern, 145 Bremgartenstrasse, 3012, Bern, Switzerland
| | - M Schmidt
- Institute of Sport Science, University of Bern, 145 Bremgartenstrasse, 3012, Bern, Switzerland
| |
Collapse
|
29
|
Interoceptive accuracy and bias in somatic symptom disorder, illness anxiety disorder, and functional syndromes: A systematic review and meta-analysis. PLoS One 2022; 17:e0271717. [PMID: 35980959 PMCID: PMC9387777 DOI: 10.1371/journal.pone.0271717] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 07/06/2022] [Indexed: 12/03/2022] Open
Abstract
Somatic symptom disorder, illness anxiety disorder, and functional syndromes are characterized by burdensome preoccupation with somatic symptoms. Etiological models propose either increased interoceptive accuracy through hypervigilance to the body, or decreased and biased interoception through top-down predictions about sensory events. This systematic review and meta-analysis summarizes findings of 68 studies examining interoceptive accuracy and 8 studies examining response biases in clinical or non-clinical groups. Analyses yielded a medium population effect size for decreased interoceptive accuracy in functional syndromes, but no observable effect in somatic symptom disorder and illness anxiety disorder. The overall effect size was highly heterogeneous. Regarding response bias, there was a small significant effect in somatic symptom disorder and illness anxiety disorder. Our findings strengthen the notion of top-down factors that result in biased rather than accurate perception of body signals in somatic symptom disorder and illness anxiety disorder.
Collapse
|
30
|
What counts when heartbeats are counted. Trends Cogn Sci 2022; 26:832-835. [PMID: 35965165 DOI: 10.1016/j.tics.2022.07.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 11/21/2022]
Abstract
Schandry's mental heartbeat tracking task is a widely used measure of interoception, assessing heartbeat perception. We classify the factors that contribute to performance on the task as (i) trait-like characteristics, (ii) expectation-related factors, and (iii) factors showing participants' task set. We recommend conducting further research to better understand what exactly the task measures.
Collapse
|
31
|
Hübner AM, Trempler I, Schubotz RI. Interindividual differences in interoception modulate behavior and brain responses in emotional inference. Neuroimage 2022; 261:119524. [PMID: 35907498 DOI: 10.1016/j.neuroimage.2022.119524] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/26/2022] [Accepted: 07/26/2022] [Indexed: 11/28/2022] Open
Abstract
Emotional experiences are proposed to arise from contextualized perception of bodily responses, also referred to as interoceptive inferences. The recognition of emotions benefits from adequate access to one's own interoceptive information. However, direct empirical evidence of interoceptive inferences and their neural basis is still lacking. In the present fMRI study healthy volunteers performed a probabilistic emotion classification task with videotaped dynamically unfolding facial expressions. In a first step, we aimed to determine functional areas involved in the processing of dynamically unfolding emotional expressions. We then tested whether individuals with higher interoceptive accuracy (IAcc), as assessed by the Heartbeat detection task (HDT), or higher interoceptive sensitivity (IS), as assessed by the Multidimensional Assessment of Interoceptive Awareness, Version 2 (MAIA-2), benefit more from the contextually given likelihood of emotional valence and whether brain regions reflecting individual IAcc and/or IS play a role in this. Individuals with higher IS benefitted more from the biased probability of emotional valence. Brain responses to more predictable emotions elicited a bilateral activity pattern comprising the inferior frontal gyrus and the posterior insula. Importantly, individual IAcc scores positively covaried with brain responses to more surprising and less predictable emotional expressions in the insula and caudate nucleus. We show for the first time that IAcc score is associated with enhanced processing of interoceptive prediction errors, particularly in the anterior insula. A higher IS score seems more likely to be associated with a stronger weighting of attention to interoceptive changes processed by the posterior insula and ventral prefrontal cortex.
Collapse
Affiliation(s)
| | - Ima Trempler
- Department of Psychology, University of Muenster, Germany; Otto-Creutzfeldt-Center for Cognitive and Behavioral Neuroscience, University of Muenster, Germany
| | - Ricarda I Schubotz
- Department of Psychology, University of Muenster, Germany; Otto-Creutzfeldt-Center for Cognitive and Behavioral Neuroscience, University of Muenster, Germany
| |
Collapse
|
32
|
Honda T, Nakao T. Impact of Cardiac Interoception on the Self-Prioritization Effect. Front Psychol 2022; 13:825370. [PMID: 35903730 PMCID: PMC9315346 DOI: 10.3389/fpsyg.2022.825370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 06/22/2022] [Indexed: 11/19/2022] Open
Abstract
Self-relevant information is processed faster and more accurately than non-self-relevant information. Such a bias is developed even for newly associated information with the self, which is also known as the self-prioritization effect (SPE). Interoception, which refers to the overall processing of information from within the body, is crucial for self-relevant processing; however, its role in SPE remains unexplored. In this study, we investigated the relationship between the magnitude of SPE and interoceptive accuracy (IAc), defined as one’s ability to accurately perceive one’s own interoceptive state. Additionally, to explore the causal relationship, we measured SPE by presenting self- or other-relevant stimuli based on the participant’s cardiac cycle in the shape-label matching task. We demonstrated that IAc was negatively correlated with the magnitude of SPE in terms of discrimination of the relevance of the stimuli. In addition, a correlation was observed only when the stimuli were presented during cardiac systole. Furthermore, IAc was negatively correlated with the processing of self-relevant stimuli but not with other-relevant stimuli. Collectively, our results show that individuals with higher IAc have relatively lower discriminative sensitivity to newly and temporary associated self-relevant stimuli presented during the accentuation of cardiac interoceptive information. Although SPE is a phenomenon in which newly self-associated stimuli are preferentially processed, our results suggest that individuals with higher IAc prioritized processing interoceptive information over temporarily associated self-relevant external information. Conversely, previous studies using paradigms other than the shape-label matching paradigm with familiar self-relevant stimuli, such as self-face, reported that interoceptive information enhances the processing of self-relevant stimuli. Whether interoceptive information enhances the processing of external self-relevant information may depend on the familiarity with the self-relevant stimuli and the experimental paradigm.
Collapse
Affiliation(s)
- Tatsuru Honda
- Graduate School of Education, Hiroshima University, Hiroshima, Japan
- *Correspondence: Tatsuru Honda,
| | - Takashi Nakao
- Graduate School of Humanities and Social Sciences, Hiroshima University, Hiroshima, Japan
| |
Collapse
|
33
|
Crucianelli L, Enmalm A, Ehrsson HH. Interoception as independent cardiac, thermosensory, nociceptive, and affective touch perceptual submodalities. Biol Psychol 2022; 172:108355. [PMID: 35597523 DOI: 10.1016/j.biopsycho.2022.108355] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 05/04/2022] [Accepted: 05/09/2022] [Indexed: 11/19/2022]
Abstract
Interoception includes signals from inner organs and thin afferents in the skin, providing information about the body's physiological state. However, the functional relationships between interoceptive submodalities are unclear, and thermosensation as skin-based interoception has rarely been considered. We used five tasks to examine the relationships among cardiac awareness, thermosensation, affective touch, and nociception. Thermosensation was probed with a classic temperature detection task and the new dynamic thermal matching task, where participants matched perceived moving thermal stimuli in a range of colder/warmer stimuli around thermoneutrality. We also examined differences between hairy and non-hairy skin and found superior perception of dynamic temperature and static cooling on hairy skin. Notably, no significant correlations were observed across interoceptive submodality accuracies (except for cold and pain perception in the palm), which indicates that interoception at perceptual levels should be conceptualised as a set of relatively independent processes and abilities rather than a single construct. DATA AVAILABILITY STATEMENT: Data of this study are available as a supplementary file.
Collapse
Affiliation(s)
- Laura Crucianelli
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Adam Enmalm
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - H Henrik Ehrsson
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
34
|
Kritzman L, Eidelman-Rothman M, Keil A, Freche D, Sheppes G, Levit-Binnun N. Steady-state visual evoked potentials differentiate between internally and externally directed attention. Neuroimage 2022; 254:119133. [PMID: 35339684 DOI: 10.1016/j.neuroimage.2022.119133] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 03/21/2022] [Accepted: 03/21/2022] [Indexed: 12/26/2022] Open
Abstract
While attention to external visual stimuli has been extensively studied, attention directed internally towards mental contents (e.g., thoughts, memories) or bodily signals (e.g., breathing, heartbeat) has only recently become a subject of increased interest, due to its relation to interoception, contemplative practices and mental health. The present study aimed at expanding the methodological toolbox for studying internal attention, by examining for the first time whether the steady-state visual evoked potential (ssVEP), a well-established measure of attention, can differentiate between internally and externally directed attention. To this end, we designed a task in which flickering dots were used to generate ssVEPs, and instructed participants to count visual targets (external attention condition) or their heartbeats (internal attention condition). We compared the ssVEP responses between conditions, along with alpha-band activity and the heartbeat evoked potential (HEP) - two electrophysiological measures associated with internally directed attention. Consistent with our hypotheses, we found that both the magnitude and the phase synchronization of the ssVEP decreased when attention was directed internally, suggesting that ssVEP measures are able to differentiate between internal and external attention. Additionally, and in line with previous findings, we found larger suppression of parieto-occipital alpha-band activity and an increase of the HEP amplitude in the internal attention condition. Furthermore, we found a trade-off between changes in ssVEP response and changes in HEP and alpha-band activity: when shifting from internal to external attention, increase in ssVEP response was related to a decrease in parieto-occipital alpha-band activity and HEP amplitudes. These findings suggest that shifting between external and internal directed attention prompts a re-allocation of limited processing resources that are shared between external sensory and interoceptive processing.
Collapse
Affiliation(s)
- Lior Kritzman
- School of Psychological Sciences, Tel Aviv University, Israel; Sagol Center for Brain and Mind, Reichman University, Israel.
| | | | - Andreas Keil
- Center for the Study of Emotion & Attention, University of Florida, USA
| | - Dominik Freche
- Sagol Center for Brain and Mind, Reichman University, Israel; Physics of Complex Systems, Weizmann Institute of Science, Israel
| | - Gal Sheppes
- School of Psychological Sciences, Tel Aviv University, Israel
| | | |
Collapse
|
35
|
Burrows K, DeVille DC, Cosgrove KT, Kuplicki RT, Paulus MP, Aupperle R, Khalsa SS, Stewart JL. Impact of serotonergic medication on interoception in major depressive disorder. Biol Psychol 2022; 169:108286. [PMID: 35149138 PMCID: PMC8958795 DOI: 10.1016/j.biopsycho.2022.108286] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 12/28/2022]
Abstract
Unmedicated individuals with major depressive disorder (MDD) show abnormal interoception, but it is unclear whether antidepressant treatment via serotonergic medication alters this relationship. The current cross-sectional study examined associations between neural and behavioral indices of interoceptive processing and chronic serotonergic medication administration in MDD. 47 selective serotonin reuptake inhibitor (SSRI)-medicated MDD (MDD-SSRI) individuals were propensity-matched with 48 unmedicated current MDD (MDD-UnMed) and 41 healthy comparison (HC) participants on demographics including age, sex, body mass index, education, as well as on dimensional scales of symptom severity including depression and anxiety. All participants completed an interoceptive attention task during functional magnetic resonance imaging, and a behavioral heartbeat tapping task under three conditions: Guessing, No Guessing, and Breath Hold. Relative to HC, both MDD groups: (1) exhibited lower mid-insula, amygdala, putamen, and caudate activation during interoceptive versus exteroceptive attention; and (2) showed poorer heartbeat tapping performance during the Breath Hold condition. However, the MDD-SSRI group reported higher intensity ratings of heartbeat and stomach sensations than MDD-UnMed and HC during the interoceptive attention task. These findings suggest that the attenuated patterns of neural activation observed in depressed individuals during interoceptive attention are not ameliorated by the chronic administration of serotonergic medications. However, amplified interoceptive sensation ratings suggest a potential impact of chronic serotonergic medication on conscious experiences of internal body states. Future investigations will need to determine the extent to which serotonergic medications acutely influence interoceptive processing, and whether such changes play a role in therapeutic responses during treatment initiation.
Collapse
Affiliation(s)
- Kaiping Burrows
- Laureate Institute for Brain Research, Tulsa, OK, United States.
| | | | | | | | | | - Martin P. Paulus
- Laureate Institute for Brain Research, Tulsa, OK,Department of Community Medicine, University of Tulsa, Tulsa, OK
| | - Robin Aupperle
- Laureate Institute for Brain Research, Tulsa, OK,Department of Community Medicine, University of Tulsa, Tulsa, OK
| | - Sahib S. Khalsa
- Laureate Institute for Brain Research, Tulsa, OK,Department of Community Medicine, University of Tulsa, Tulsa, OK
| | - Jennifer L. Stewart
- Laureate Institute for Brain Research, Tulsa, OK,Department of Community Medicine, University of Tulsa, Tulsa, OK
| |
Collapse
|
36
|
Pohl A, Dummel S, Bothur M, Gerlach AL. Interoceptive accuracy does not predict emotion perception in daily life. OPEN PSYCHOLOGY 2022. [DOI: 10.1515/psych-2022-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Peripheral emotion theories suggest a crucial role of interoception for emotion perception, which in turn facilitates emotion regulation. Laboratory studies found positive relations between interoceptive accuracy and perceived emotion intensity and arousal. Studies in natural settings are largely missing, but seem important by virtue of emotional experience and regulation diversity.
On hundred seven participants underwent a cardiovascular interoceptive accuracy task. Afterwards, participants provided detailed information on perceived emotions and emotion regulation strategies in an ecological momentary assessment (EMA). Multilevel models were calculated. In consideration of valence, emotion intensity, arousal, intensity of body sensations and, emotion regulation success were modeled as a function of centered interoceptive accuracy.
Interoceptive accuracy did not predict any emotion perception criterion. Lower accuracy was related to a slightly stronger decrease of perceived arousal after regulation.
Differences in emotion categories, intensity, and sample collection might explain divergences to laboratory studies.
Collapse
Affiliation(s)
- Anna Pohl
- Universitat zu Koln , Köln , Germany
| | - Sebastian Dummel
- Department of Psychology , University of Cologne , Cologne , Germany
| | - Mascha Bothur
- Institute of Clinical Psychology and Psychotherapy , University of Cologne , Cologne , Germany
| | - Alexander L. Gerlach
- Institute of Clinical Psychology and Psychotherapy , University of Cologne , Cologne , Germany
| |
Collapse
|
37
|
Radziun D, Crucianelli L, Ehrsson HH. Limits of Cross-modal Plasticity? Short-term Visual Deprivation Does Not Enhance Cardiac Interoception, Thermosensation, or Tactile Spatial Acuity. Biol Psychol 2021; 168:108248. [PMID: 34971758 DOI: 10.1016/j.biopsycho.2021.108248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 11/01/2021] [Accepted: 12/23/2021] [Indexed: 01/30/2023]
Abstract
In the present study, we investigated the effect of short-term visual deprivation on discriminative touch, cardiac interoception, and thermosensation by asking 64 healthy volunteers to perform four behavioral tasks. The experimental group contained 32 subjects who were blindfolded and kept in complete darkness for 110minutes, while the control group consisted of 32 volunteers who were not blindfolded but were otherwise kept under identical experimental conditions. Both groups performed the required tasks three times: before and directly after deprivation (or control) and after an additional washout period of 40minutes, in which all participants were exposed to normal light conditions. Our results showed that short-term visual deprivation had no effect on any of the senses tested. This finding suggests that short-term visual deprivation does not modulate basic bodily senses and extends this principle beyond tactile processing to the interoceptive modalities of cardiac and thermal sensations.
Collapse
Affiliation(s)
- Dominika Radziun
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Laura Crucianelli
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - H Henrik Ehrsson
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| |
Collapse
|
38
|
Legrand N, Nikolova N, Correa C, Brændholt M, Stuckert A, Kildahl N, Vejlø M, Fardo F, Allen M. The heart rate discrimination task: a psychophysical method to estimate the accuracy and precision of interoceptive beliefs. Biol Psychol 2021; 168:108239. [PMID: 34902450 DOI: 10.1016/j.biopsycho.2021.108239] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 11/19/2021] [Accepted: 12/02/2021] [Indexed: 11/02/2022]
Abstract
Interoception - the physiological sense of our inner bodies - has risen to the forefront of psychological and psychiatric research. Much of this research utilizes tasks that attempt to measure the ability to accurately detect cardiac signals. Unfortunately, these approaches are confounded by well-known issues limiting their validity and interpretation. At the core of this controversy is the role of subjective beliefs about the heart rate in confounding measures of interoceptive accuracy. Here, we recast these beliefs as an important part of the causal machinery of interoception, and offer a novel psychophysical "heart rate discrimination" method to estimate their accuracy and precision. By applying this task in 223 healthy participants, we demonstrate that cardiac interoceptive beliefs are more biased, less precise, and are associated with poorer metacognitive insight relative to an exteroceptive control condition. Our task, provided as an open-source python package, offers a robust approach to quantifying cardiac beliefs.
Collapse
Affiliation(s)
- Nicolas Legrand
- Center of Functionally Integrative Neuroscience, Aarhus University Hospital, Denmark
| | - Niia Nikolova
- Center of Functionally Integrative Neuroscience, Aarhus University Hospital, Denmark
| | - Camile Correa
- Center of Functionally Integrative Neuroscience, Aarhus University Hospital, Denmark
| | - Malthe Brændholt
- Center of Functionally Integrative Neuroscience, Aarhus University Hospital, Denmark
| | - Anna Stuckert
- Center of Functionally Integrative Neuroscience, Aarhus University Hospital, Denmark
| | - Nanna Kildahl
- Center of Functionally Integrative Neuroscience, Aarhus University Hospital, Denmark
| | - Melina Vejlø
- Center of Functionally Integrative Neuroscience, Aarhus University Hospital, Denmark
| | - Francesca Fardo
- Center of Functionally Integrative Neuroscience, Aarhus University Hospital, Denmark; Danish Pain Research Center
| | - Micah Allen
- Center of Functionally Integrative Neuroscience, Aarhus University Hospital, Denmark; Aarhus Institute of Advanced Studies, Aarhus University, Denmark; Cambridge Psychiatry, University of Cambridge, United Kingdom
| |
Collapse
|
39
|
Rominger C, Weber B, Aldrian A, Berger L, Schwerdtfeger AR. Short-term fasting induced changes in HRV are associated with interoceptive accuracy: Evidence from two independent within-subjects studies. Physiol Behav 2021; 241:113558. [PMID: 34411572 DOI: 10.1016/j.physbeh.2021.113558] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
Previous research suggested increased cardiac interoceptive accuracy after 24-h food-deprivation by means of the heartbeat tracking task. The present study investigated if 16-h of voluntary fasting shows similar effects and whether changes in interoceptive accuracy are accompanied by changes in autonomic function. In two independent within-subjects studies two measures of interoceptive accuracy, the heartbeat tracking task and the heartbeat discrimination task were applied. In study 1 (n = 24) and study 2 (n = 72) vagally-mediated HRV increases and heart rate decreases were observed. Stronger effects of fasting on vagally-mediated HRV went along with a higher interoceptive accuracy increase in the heartbeat tracking task. Furthermore, the fasting associated changes in interoceptive accuracy in both tasks were significantly associated, suggesting that these tasks are suitable to track changes in cardiac interoception. Taken together, fasting of 16-h might be suitable to increase participants' parasympathetic efference, thereby facilitating interoception.
Collapse
|
40
|
Opdensteinen KD, Schaan L, Pohl A, Schulz A, Domes G, Hechler T. Interoception in preschoolers: New insights into its assessment and relations to emotion regulation and stress. Biol Psychol 2021; 165:108166. [PMID: 34389438 DOI: 10.1016/j.biopsycho.2021.108166] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 08/06/2021] [Accepted: 08/08/2021] [Indexed: 10/20/2022]
Abstract
Interoception may play an important role for emotion regulation and stress, thereby affecting mental health in children and adults. Yet, little is known on interoception in preschool children. Therefore, we investigated interoceptive accuracy using the adapted Jumping Jack Paradigm (JJP) and its relationship with emotion regulation and stress. In Study I, 40 preschoolers completed the JJP and an emotion regulation task, demonstrating a positive relationship between interoceptive accuracy and emotion regulation at trend level (R² = 0.231, p = .023; β = .278, p = .073). In Study II, 31 preschoolers completed the adapted JJP before and after an acute laboratory stress test. Higher total cortisol output following acute stress induction was associated with reduced interoceptive accuracy (r = -0.670, p = .017). Extending earlier findings in adults and school-children, the relationship of interoceptive accuracy with emotion regulation and stress highlights the importance to investigate interoception in early childhood.
Collapse
Affiliation(s)
- Kim D Opdensteinen
- Department of Clinical Psychology and Psychotherapy for Children and Adolescents, University of Trier, Trier, Germany
| | - Luca Schaan
- Department of Clinical Psychology and Psychotherapy for Children and Adolescents, University of Trier, Trier, Germany
| | - Anna Pohl
- Institute of Clinical Psychology and Psychotherapy, University of Cologne, Cologne, Germany
| | - André Schulz
- Clinical Psychophysiology Laboratory, Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Gregor Domes
- Department of Biological and Clinical Psychology, University of Trier, Trier, Germany
| | - Tanja Hechler
- Department of Clinical Psychology and Psychotherapy for Children and Adolescents, University of Trier, Trier, Germany.
| |
Collapse
|
41
|
Mental heartbeat tracking and rating of emotional pictures are not related. PSYCHOLOGICAL RESEARCH 2021; 86:1487-1494. [PMID: 34557988 PMCID: PMC9177488 DOI: 10.1007/s00426-021-01593-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 09/02/2021] [Indexed: 12/03/2022]
Abstract
Our aim was to conceptually replicate the findings of previous empirical studies showing that people with higher cardiac interoceptive accuracy experience more intense emotions. Apart of the mental heartbeat tracking task of Schandry, Hungarian (n = 46, 76.0% female, mean age 22.28 ± 2.228) and Norwegian (n = 50, 60.0% female, mean age 24.66 ± 3.048) participants rated the arousal and valence evoked by positive, neutral and negative pictures. Multivariate repeated analysis of variance (applying both frequentist and Bayesian approaches) did not reveal any connection between heartbeat perception scores and the subjective ratings (i.e., arousal and valence) of the pictures in any of the two groups. The lack of the expected association between cardioceptive accuracy and arousal might partly be explained by the methodological differences between previous studies and this one; for example, we did not split or preselected the sample based on the performance on the Schandry task and applied a relatively strict instruction (i.e., by encouraging to count felt heartbeats only, and to report zero if no sensations were detected).
Collapse
|
42
|
Vig L, Ferentzi E, Köteles F. Sustained attention is related to heartbeat counting task performance but not to self-reported aspects of interoception and mindfulness. Conscious Cogn 2021; 95:103209. [PMID: 34534738 DOI: 10.1016/j.concog.2021.103209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 09/05/2021] [Accepted: 09/06/2021] [Indexed: 10/20/2022]
Abstract
Although association between sustained attention and various aspects of interoception (i.e. the perception of the body state) seems plausible, research on this subject is scarce. In the present study, 74 undergraduate students (41 females; age: 22.3 ± 4.04 yrs) filled out the Body Awareness Questionnaire, the Mindful Attention Awareness Scale, and the Somatosensory Amplification Scale and completed the Heartbeat Counting Task (HCT), a sensory-perceptual measure of cardiac interoception and the PEBL Continuous Performance Test (CPT) assessing sustained attention. The HCT score showed a weak to moderate negative correlation with the number of commission errors shown in CPT, indicating a lack of response inhibition (frequentist analysis: rs = -0.313, p = 0.008; Bayesian analysis: τb = -0.216, BF10 = 5.865). Questionnaire measures did not show any connection with CPT-performance. These findings suggest that the subjective representation of attentiveness to bodily processes is unrelated to the objectively measured sustained attention. Response inhibition, however, is moderately related to HCT performance.
Collapse
Affiliation(s)
- Luca Vig
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Kazinczy utca 23-27., 1075 Budapest, Hungary; Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Bogdánfy Ödön utca 10/B, 1117 Budapest, Hungary
| | - Eszter Ferentzi
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Bogdánfy Ödön utca 10/B, 1117 Budapest, Hungary.
| | - Ferenc Köteles
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Bogdánfy Ödön utca 10/B, 1117 Budapest, Hungary
| |
Collapse
|
43
|
Harrison OK, Garfinkel SN, Marlow L, Finnegan SL, Marino S, Köchli L, Allen M, Finnemann J, Keur-Huizinga L, Harrison SJ, Stephan KE, Pattinson KTS, Fleming SM. The Filter Detection Task for measurement of breathing-related interoception and metacognition. Biol Psychol 2021; 165:108185. [PMID: 34487805 DOI: 10.1016/j.biopsycho.2021.108185] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 08/11/2021] [Accepted: 08/31/2021] [Indexed: 01/07/2023]
Abstract
The study of the brain's processing of sensory inputs from within the body ('interoception') has been gaining rapid popularity in neuroscience, where interoceptive disturbances are thought to exist across a wide range of chronic physiological and psychological conditions. Here we present a task and analysis procedure to quantify specific dimensions of breathing-related interoception, including interoceptive sensitivity, decision bias, metacognitive bias, and metacognitive performance. Two major developments address some of the challenges presented by low trial numbers in interoceptive experiments: (i) a novel adaptive algorithm to maintain task performance at 70-75% accuracy; (ii) an extended hierarchical metacognitive model to estimate regression parameters linking metacognitive performance to relevant (e.g. clinical) variables. We demonstrate the utility of the task and analysis developments, using both simulated data and three empirical datasets. This methodology represents an important step towards accurately quantifying interoceptive dimensions from a simple experimental procedure that is compatible with clinical settings.
Collapse
Affiliation(s)
- Olivia K Harrison
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Switzerland; Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Department of Psychology, University of Otago, New Zealand.
| | - Sarah N Garfinkel
- Institute of Cognitive Neuroscience, University College London, United Kingdom
| | - Lucy Marlow
- Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom
| | - Sarah L Finnegan
- Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom
| | - Stephanie Marino
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Switzerland
| | - Laura Köchli
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Switzerland
| | - Micah Allen
- Aarhus Institute of Advanced Studies, Aarhus University, Denmark; Center of Functionally Integrative Neuroscience, Aarhus University Hospital, Denmark; Cambridge Psychiatry, University of Cambridge, United Kingdom
| | | | | | - Samuel J Harrison
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Switzerland
| | - Klaas E Stephan
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Switzerland
| | - Kyle T S Pattinson
- Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom
| | - Stephen M Fleming
- Wellcome Centre for Human Neuroimaging, University College London, United Kingdom; Max Planck Centre for Computational Psychiatry and Ageing Research, University College London, United Kingdom; Department of Experimental Psychology, University College London, United Kingdom
| |
Collapse
|
44
|
Quadt L, Garfinkel SN, Mulcahy JS, Larsson DEO, Silva M, Jones AM, Strauss C, Critchley HD. Interoceptive training to target anxiety in autistic adults (ADIE): A single-center, superiority randomized controlled trial. EClinicalMedicine 2021; 39:101042. [PMID: 34401684 PMCID: PMC8350004 DOI: 10.1016/j.eclinm.2021.101042] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/01/2021] [Accepted: 07/09/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND This trial tested if a novel therapy, Aligning Dimensions of Interoceptive Experience (ADIE), reduces anxiety in autistic adults. ADIE targets the association of anxiety with mismatch between subjective and behavioral measures of an individual's interoceptive sensitivity to bodily signals, including heartbeats. METHODS In this superiority randomized controlled trial, autistic adults (18-65 years) from clinical and community settings in Southern England were randomly assigned (1:1) to receive six sessions of ADIE or an active 'exteroceptive' control therapy (emotional prosody identification). Researchers conducting outcome assessments were blind to allocation. ADIE combines two modified heartbeat detection tasks with performance feedback and physical activity manipulation that transiently increases cardiac arousal. Participants were followed-up one-week (T1) and 3-months post-intervention (T2). The primary outcome was Spielberger Trait Anxiety Score (STAI-T) at T2. Outcomes were assessed on an intention-to-treat basis using multiple imputation for dealing with missing values. This trial was registered at International Standard Randomized Controlled Trial Registry, ISRCTN14848787. FINDINGS Between July 01, 2017, and December 31, 2019, 121 participants were randomly allocated to ADIE (n = 61) or prosody (n = 60) intervention groups. Data at T1 was provided by 85 (70%) participants (46 [75%] ADIE; 39 [65%] prosody). Data at T2 was provided by 61 (50%) participants (36 [59%] ADIE; 25 [42%] prosody). One adverse event (cardiac anxiety following ADIE) was recorded. A statistically significant group effect of ADIE on trait anxiety continued at T2 (estimated mean difference 3•23 [95% CI 1•13 to 5•29]; d = 0•30 [95% CI 0•09 to 0•51]; p = 0•005) with 31% of ADIE group participants meeting trial criteria for recovery (compared to 16% in the control group). INTERPRETATION ADIE can reduce anxiety in autistic adults, putatively improving regulatory control over internal stimuli. With little reliance on language and emotional insight, ADIE may constitute an inclusive intervention. FUNDING MQ Transforming Mental Health PsyImpact Grant.
Collapse
Affiliation(s)
- Lisa Quadt
- Department of Neuroscience, Brighton and Sussex Medical School,Trafford Centre, University of Sussex Brighton, United Kingdom
- Sussex Partnership NHS Foundation Trust Brighton, United Kingdom
| | - Sarah N Garfinkel
- Department of Neuroscience, Brighton and Sussex Medical School,Trafford Centre, University of Sussex Brighton, United Kingdom
- Institute for Cognitive Neuroscience, University College London, London, United Kingdom
| | - James S Mulcahy
- Department of Neuroscience, Brighton and Sussex Medical School,Trafford Centre, University of Sussex Brighton, United Kingdom
| | - Dennis EO Larsson
- Department of Neuroscience, Brighton and Sussex Medical School,Trafford Centre, University of Sussex Brighton, United Kingdom
- School of Psychology, University of Sussex, Brighton, United Kingdom
- Leverhulme Trust, London, United Kingdom
| | - Marta Silva
- Cognition and Brain Plasticity Unit, Institute for Neurosciences, University of Barcelona, Barcelona, Spain
| | - Anna-Marie Jones
- Sussex Partnership NHS Foundation Trust Brighton, United Kingdom
| | - Clara Strauss
- Sussex Partnership NHS Foundation Trust Brighton, United Kingdom
- School of Psychology, University of Sussex, Brighton, United Kingdom
| | - Hugo D Critchley
- Department of Neuroscience, Brighton and Sussex Medical School,Trafford Centre, University of Sussex Brighton, United Kingdom
- Sussex Partnership NHS Foundation Trust Brighton, United Kingdom
| |
Collapse
|
45
|
Smith R, Mayeli A, Taylor S, Al Zoubi O, Naegele J, Khalsa SS. Gut inference: A computational modelling approach. Biol Psychol 2021; 164:108152. [PMID: 34311031 PMCID: PMC8429276 DOI: 10.1016/j.biopsycho.2021.108152] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 12/22/2022]
Abstract
Neurocomputational theories have hypothesized that Bayesian inference underlies interoception, which has become a topic of recent experimental work in heartbeat perception. To extend this approach beyond cardiac interoception, we describe the application of a Bayesian computational model to a recently developed gastrointestinal interoception task completed by 40 healthy individuals undergoing simultaneous electroencephalogram (EEG) and peripheral physiological recording. We first present results that support the validity of this modelling approach. Second, we provide a test of, and confirmatory evidence supporting, the neural process theory associated with a particular Bayesian framework (active inference) that predicts specific relationships between computational parameters and event-related potentials in EEG. We also offer some exploratory evidence suggesting that computational parameters may influence the regulation of peripheral physiological states. We conclude that this computational approach offers promise as a tool for studying individual differences in gastrointestinal interoception.
Collapse
Affiliation(s)
- Ryan Smith
- Laureate Institute for Brain Research, Tulsa, OK, United States.
| | - Ahmad Mayeli
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | - Samuel Taylor
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | - Obada Al Zoubi
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | - Jessyca Naegele
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | - Sahib S Khalsa
- Laureate Institute for Brain Research, Tulsa, OK, United States; Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, United States.
| |
Collapse
|
46
|
Schulz A, Back SN, Schaan VK, Bertsch K, Vögele C. On the construct validity of interoceptive accuracy based on heartbeat counting: Cardiovascular determinants of absolute and tilt-induced change scores. Biol Psychol 2021; 164:108168. [PMID: 34411619 DOI: 10.1016/j.biopsycho.2021.108168] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 08/11/2021] [Accepted: 08/11/2021] [Indexed: 12/18/2022]
Abstract
Interoceptive accuracy (IAcc) as assessed with the heartbeat counting task (IAccHBCT) may be affected by a range of factors including (1.) the ability to adequately detect cardiac signals, indicated by IAcc in a heartbeat discrimination task (IAccHBDT), (2.) cardiac signal properties, affected by sympathetic and parasympathetic tone, and (3.) non-interoceptive processes, including time estimation accuracy (TEAcc). In the current study we investigated the contribution of these factors to absolute and Δ IAccHBCT scores, induced by passive head-up and head-down tilt in 49 healthy individuals. A set of hierarchical regression models showed IAccHBDT scores as the strongest and, across different orthostatic (tilt) conditions, most stable (positive) predictor of absolute and Δ IAccHBCT scores. Neither indicators of cardiac signal properties (except for HR in head-down-tilt), nor TEAcc predicted absolute or Δ IAccHBCT scores. These findings support the convergent and discriminant validity of absolute and Δ IAccHBCT scores.
Collapse
Affiliation(s)
- André Schulz
- Clinical Psychophysiology Laboratory, Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg.
| | - Sarah N Back
- Clinical Psychophysiology Laboratory, Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg; Division of Clinical Psychology and Psychotherapy, Department of Psychology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Violetta K Schaan
- Clinical Psychophysiology Laboratory, Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Katja Bertsch
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Claus Vögele
- Clinical Psychophysiology Laboratory, Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| |
Collapse
|
47
|
Xu M, Tachibana T, Suzuki N, Hoshino E, Terasawa Y, Miki N, Minagawa Y. The effect of haptic stimulation simulating heartbeats on the regulation of physiological responses and prosocial behavior under stress: The influence of interoceptive accuracy. Biol Psychol 2021; 164:108172. [PMID: 34407425 DOI: 10.1016/j.biopsycho.2021.108172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 12/19/2022]
Abstract
Research has discovered the modulatory effect of peripheral stimulation simulating altered bodily signals on emotion. Whether such an effect varies depending on one's interoceptive accuracy (IAc) remains unclear. Therefore, we provided haptic stimulation simulating participants' slowed-down heartbeats or no stimulation while they engaged in socially stressful tasks to examine whether participants reacted differently depending on their IAc. Results showed that haptic stimulation exhibited the opposite effect on participants with different levels of IAc for both heart rate and heart rate variability (HRV). When receiving the stimulation, participants with higher IAc showed less increased heart rate and more elevated HF than participants with lower IAc. In contrast, in the absence of stimulation, an opposite pattern of response depending on participants' IAc was observed. The modulatory effect of stimuli and IAc on prosocial behavior was not significant. Individual differences in IAc were shown to affect how one perceives/responds to altered bodily signals.
Collapse
Affiliation(s)
- Mingdi Xu
- Global Research Institute, Keio University, Tokyo, Japan; Department of Psychology, Faculty of Letters, Keio University, Tokyo, Japan
| | - Takeshi Tachibana
- Department of Mechanical Engineering, Faculty of Science and Technology, Keio University, Kanagawa, Japan
| | - Nana Suzuki
- Department of Psychology, Faculty of Letters, Keio University, Tokyo, Japan
| | - Eiichi Hoshino
- Global Research Institute, Keio University, Tokyo, Japan; Department of Psychology, Faculty of Letters, Keio University, Tokyo, Japan
| | - Yuri Terasawa
- Department of Psychology, Faculty of Letters, Keio University, Tokyo, Japan
| | - Norihisa Miki
- Department of Mechanical Engineering, Faculty of Science and Technology, Keio University, Kanagawa, Japan
| | - Yasuyo Minagawa
- Department of Psychology, Faculty of Letters, Keio University, Tokyo, Japan.
| |
Collapse
|
48
|
Körmendi J, Ferentzi E, Köteles F. Expectation predicts performance in the mental heartbeat tracking task. Biol Psychol 2021; 164:108170. [PMID: 34400273 DOI: 10.1016/j.biopsycho.2021.108170] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/25/2021] [Accepted: 08/11/2021] [Indexed: 01/10/2023]
Abstract
The mental heartbeat tracking task by Schandry is sensitive to non-interoceptive (top-down) influences, e.g., estimation of heart rate and expectation. The two studies reported here investigated the impact of these factors on the outcome of the task. In Study 1, performance-related expectation was assessed between the training interval and the real trials. Performance was strongly related (β = .595, p < .001) to expectation even after controlling for sex, body fat, resting heart rate and estimation of heart rate. In Study 2, expectation was assessed before and after the training interval for Group 1 and 2, respectively. The strong association (r = 0.78, p < .001) between performance and expectation was replicated for Group 2; however, a moderate association (r = 0.39, p < .01) was also found in Group 1. People with high expectation may be prone to categorize and count vague sensations, such as attention evoked sensations, as heartbeats; this can lead to an inflated Schandry-score.
Collapse
Affiliation(s)
- János Körmendi
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Eszter Ferentzi
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Ferenc Köteles
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Budapest, Hungary.
| |
Collapse
|
49
|
Critchley HD, Botan V, Ward J. Absence of reliable physiological signature of illusory body ownership revealed by fine-grained autonomic measurement during the rubber hand illusion. PLoS One 2021; 16:e0237282. [PMID: 33793569 PMCID: PMC8016256 DOI: 10.1371/journal.pone.0237282] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 03/10/2021] [Indexed: 01/15/2023] Open
Abstract
The neural representation of a 'biological self' is linked theoretically to the control of bodily physiology. In an influential model, selfhood relates to internal agency and higher-order interoceptive representation, inferred from the predicted impact of efferent autonomic nervous activity on afferent viscerosensory feedback. Here we tested if an altered representation of physical self (illusory embodiment of an artificial hand) is accompanied by sustained shifts in autonomic activity. Participants (N = 37) underwent procedures for induction of the rubber hand illusion (synchronous stroking of own unseen hand and observed stroking of artificial hand) and a control condition (asychronous stroking). We recorded electrocardiography, electrodermal activity, and a non-invasive measure of multiunit skin sympathetic nerve activity (SKNA) from the chest. We compared these autonomic indices between task conditions, and between individuals who did and did not experience the illusion. Bayes factors quantified the strength of evidence for and against null hypotheses. Observed proprioceptive drift and subjective reports confirmed the efficacy of the synchronous (vs asynchronous) condition in inducing illusory hand ownership. Stringent discriminant analysis classified 24/37 individuals as experiencing the rubber hand illusion. Surprisingly, heart rate, heart rate variability, electrodermal activity, and SKNA measures revealed no autonomic differences between synchronous vs asynchronous conditions, nor between individuals who did or did not experience the rubber hand illusion. Bayes factors indicated substantial evidence for no physiological differences. In contrast to earlier reports, our autonomic data show the absence of a reliable change in physiological state during the rubber hand illusion. More encompassing perturbations of self-experience, for example in full body illusions, may nevertheless be coupled to, or facilitated by, changes in efferent autonomic activity and afferent viscerosensory feedback. Our findings suggest that such changes in bodily physiology are not sustained as an obligatory component of the rubber hand illusion.
Collapse
Affiliation(s)
- Hugo D. Critchley
- School of Psychology, University of Sussex, Brighton, United Kingdom
- Sackler Centre for Consciousness Science, University of Sussex, Brighton, United Kingdom
- Brighton and Sussex Medical School, University of Sussex and University of Brighton, Brighton, United Kingdom
| | - Vanessa Botan
- School of Psychology, University of Sussex, Brighton, United Kingdom
- Sackler Centre for Consciousness Science, University of Sussex, Brighton, United Kingdom
| | - Jamie Ward
- School of Psychology, University of Sussex, Brighton, United Kingdom
- Sackler Centre for Consciousness Science, University of Sussex, Brighton, United Kingdom
| |
Collapse
|
50
|
Ricciardi L, Nisticò V, Andrenelli E, Cunha JM, Demartini B, Kirsch LP, Crucianelli L, Yogarajah M, Morgante F, Fotopoulou A, Edwards MJ. Exploring three levels of interoception in people with functional motor disorders. Parkinsonism Relat Disord 2021; 86:15-18. [PMID: 33819899 DOI: 10.1016/j.parkreldis.2021.03.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 03/12/2021] [Accepted: 03/24/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION A three-level model of interoception has recently been defined. We aim to study the interoceptive processing in individuals with functional motor disorder (FMD). METHODS Twenty-two patients with FMD were compared to 23 healthy controls. They underwent a protocol measuring different levels of interoception including: accuracy (a heart-beat tracking task), awareness (participant's confidence level) and sensibility (the Body Awareness Questionnaire-BAQ). Depression, anxiety and alexithymia were assessed by means of validated clinical scales. RESULTS The FMD group showed a lower cardiac interoceptive accuracy and sensibility than healthy controls but they did not differ in terms of awareness (p = 0.03 and 0.005 respectively). They were aware of their poor performance in the accuracy task. Cardiac interoceptive accuracy positively correlated with the BAQ sub-scales "Predict Body Reaction" (r = 0.49, p = 0.001) and "Sleep-Wake Cycle" (r = 0.52, p < 0.001). A mediation analysis showed a significant indirect effect of group on cardiac interoceptive accuracy through BAQ "Predict Body Reaction" (b = -2.95, 95% BCa CI[-7.2;-0.2]). The direct effect of group on "Predict Body Reaction" was still significant (b = - 6.95, p = 0.02, 95% CI[-13.18;-0.73]). CONCLUSIONS People with FMD have impaired cardiac interoceptive accuracy and sensibility but no difference in metacognitive interoception compared to healthy controls.
Collapse
Affiliation(s)
- Lucia Ricciardi
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK; MRC Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, Oxford, UK.
| | - Veronica Nisticò
- Dipartimento di Scienze Della Salute, Università Degli Studi di Milano, Milano, Italy; "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, Università Degli Studi di Milano, Milano, Italy
| | - Elisa Andrenelli
- Department of Experimental and Clinical Medicine, Neurorehabilitation Clinic, "Politecnica Delle Marche" University of Ancona, Ancona, Italy
| | - Joana Macedo Cunha
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Benedetta Demartini
- Dipartimento di Scienze Della Salute, Università Degli Studi di Milano, Milano, Italy; "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, Università Degli Studi di Milano, Milano, Italy; Unità di Psichiatria II, A.O. San Paolo, ASST Santi Paolo e Carlo, Milano, Italy
| | - Louise P Kirsch
- Institut des Systèmes Intelligents et de Robotique (ISIR), Sorbonne Université, Paris, France
| | - Laura Crucianelli
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden; Research Department of Clinical, Educational and Health Psychology, University College London, United Kingdom
| | - Mahinda Yogarajah
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Francesca Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Aikaterini Fotopoulou
- Research Department of Clinical, Educational and Health Psychology, University College London, United Kingdom
| | - Mark J Edwards
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| |
Collapse
|