The Filter Detection Task for measurement of breathing-related interoception and metacognition

Differential effects of negative valence and memory type on accuracy, confidence, and metacognitive efficiency

Emotion enhances the subjective experience of recollection. Previous research examined associations between memory accuracy and metamemory confidence judgments, but these studies have not quantified the relationship between accuracy and metacognitive confidence judgments. In this study we utilize signal detection theory frameworks to investigate how memory accuracy (measured by discrimination sensitivity) and the alignment between metamemory confidence judgments and memory accuracy (ie. metacognitive efficiency) varies for neutral and negative valence, as well as item and associative detail memory types. Our results indicate that valence and memory type have different effects on accuracy, confidence, and metacognitive efficiency. Negative valence was associated with enhanced accuracy for both items and associated details, but its relationship with response bias varied across memory types, with conservative recognition responses observed for items and liberal responses for associative details. We also observed a double dissociation between metamemory confidence judgements across valence and memory type with negative valence associated with increased confidence for item memory, but decreased confidence for associated details. Examining the association between memory accuracy and metamemory confidence revealed that metacognitive efficiency was greater for negatively valenced items compared to neutral, but this effect did not generalize to details associated with negatively valenced items. These findings advance our understanding of how arousing, negatively valenced information modulates memory and metacognition.

The duration discrimination respiratory task: A new test to measure respiratory interoceptive accuracy

Interoception, which refers to the perception of body's internal state, is implicated in emotional processes and psychopathological disorders. Over the last decades, different tools have been developed to measure interoceptive accuracy, or the ability to accurately perceive physiological signals. Most of these tools have focused on cardiac interoception, but respiratory interoception has been less investigated due to the more complex and less portable equipment required. In this study, we suggest a new duration discrimination respiratory (DDR) task that does not require complex equipment. Using an adaptive staircase procedure, this task aims to determine an individual's ability to detect exhalation longer than their resting reference duration. One hundred and twenty-three healthy subjects completed the DDR task, an interoceptive task of heart rate discrimination, and filled out questionnaires on interoceptive awareness (Multidimensional Assessment of Interoceptive Awareness), alexithymia (Toronto Alexithymia Scale [TAS]), affects (Positive and Negative Affect Scale [PANAS]), and anamnestic. Results demonstrated a good internal consistency (Cronbach's alpha = .93) of the DDR task. On average, subjects needed 99.22% (SD = 36.38) of their reference exhalation time in addition to reference exhalation to detect a prolonged exhalation. Higher self-reported fitness levels, not counting during the DDR task and lower difficulty in describing feelings (TAS subscale), predicted higher respiratory discrimination duration. In conclusion, this study demonstrates the utility of the DDR task as a valid measure of interoception.

Exploring sex differences in cardiac interoceptive accuracy using the phase adjustment task

Previous evidence suggests males and females differ with respect to interoception-the processing of internal bodily signals-with males typically outperforming females on tasks of interoceptive accuracy. However, interpretation of existing evidence in the cardiac domain is hindered by the limitations of existing tools. In this investigation, we pooled data from several samples to examine sex differences in cardiac interoceptive accuracy on the phase adjustment task, a new measure that overcomes several limitations of the existing tools. In a sample of 266 individuals, we observed that females outperformed males, indicative of better cardiac interoceptive accuracy, but had lower confidence than males. These results held after controlling for sex differences in demographic, physiological and engagement factors. Importantly, these results were specific to the measure of cardiac interoceptive accuracy. No sex differences were observed for individuals who completed the structurally identical screener task, although a similar pattern of results was observed in relation to confidence. These surprising data suggest the presence of a female advantage for cardiac interoceptive accuracy and potential differences in interoceptive awareness (metacognition). Possible reasons for mixed results in the literature, as well as implications for theory and future research, are discussed.

Heartbeat-evoked potentials following voluntary hyperventilation in epilepsy patients: respiratory influences on cardiac interoception

Introduction

Current evidence indicates a modulating role of respiratory processes in cardiac interoception, yet whether altered breathing patterns influence heartbeat-evoked potentials (HEP) remains inconclusive.

Methods

Here, we examined the effects of voluntary hyperventilation (VH) as part of a clinical routine examination on scalp-recorded HEPs in epilepsy patients (N = 80).

Results

Using cluster-based permutation analyses, HEP amplitudes were compared across pre-VH and post-VH conditions within young and elderly subgroups, as well as for the total sample. No differences in the HEP were detected for younger participants or across the full sample, while an increased late HEP during pre-VH compared to post-VH was fond in the senior group, denoting decreased cardiac interoceptive processing after hyperventilation.

Discussion

The present study, thus, provides initial evidence of breathing-related HEP modulations in elderly epilepsy patients, emphasizing the potential of HEP as an interoceptive neural marker that could partially extend to the representation of pulmonary signaling. We speculate that aberrant CO2-chemosensing, coupled with disturbances in autonomic regulation, might constitute the underlying pathophysiological mechanism behind the obtained effect. Available databases involving patient records of routine VH assessment may constitute a valuable asset in disentangling the interplay of cardiac and ventilatory interoceptive information in various patient groups, providing thorough clinical data to parse, as well as increased statistical power and estimates of effects with higher precision through large-scale studies.

The Neurophysiology of Interoceptive Disruptions in Trauma-Exposed Populations

In the aftermath of psychological trauma, many individuals experience perturbations in interoception, a term that broadly references the ability to accurately detect body signals and integrate these signals with emotional states. These interoceptive disruptions can manifest in different ways, including blunting or amplification of sensitivity to internal physiological signals. In this chapter we review extant neurophysiological research on interoception in trauma-exposed populations, with a particular focus on the effects of chronic interpersonal trauma, such as childhood maltreatment and racial discrimination. We explore research that used different types of interoceptive assays, from self-report measures to electrophysiological and neuroimaging tools to characterize the disruptions in pain perception, interoceptive acuity, and physiological responses that may arise after a traumatic event. Finally, we discuss interventions that are designed to target interoceptive mechanisms, from exposure-based therapies to mindfulness-based practices, as well as future directions in trauma interoception research.

Hot metacognition: poorer metacognitive efficiency following acute but not traumatic stress

Aberrations to metacognition-the ability to reflect on and evaluate self-performance-are a feature of poor mental health. Theoretical models of post-traumatic stress disorder propose that following severe stress or trauma, maladaptive metacognitive evaluations and appraisals of the event drive the development of symptoms. Empirical research is required in order to reveal whether disruptions to metacognition cause or contribute to symptom development in line with theoretical accounts, or are simply a consequence of ongoing psychopathology. In two experiments, using hierarchical Bayesian modelling of metacognition measured in a memory recognition task, we assessed whether distortions to metacognition occur at a state-level after an acute stress induction, and/or at a trait-level in a sample of individuals experiencing intrusive memories following traumatic stress. Results from experiment 1, an in-person laboratory-based experiment, demonstrated that heightened psychological responses to the stress induction were associated with poorer metacognitive efficiency, despite there being no overall change in metacognitive efficiency from pre- to post-stress (N = 27). Conversely, in experiment 2, an online experiment using the same metamemory task, we did not find evidence of metacognitive alterations in a transdiagnostic sample of patients with intrusive memory symptomatology following traumatic stress (N = 36, compared to 44 matched controls). Our results indicate a relationship between state-level psychological responses to stress and metacognitive alterations. The lack of evidence for pre- to post-stress differences in metamemory illustrates the importance for future studies to reveal the direction of this relationship, and consequently the duration of stress-associated metacognitive impairments and their impact on mental health.

The future of metacognition research: Balancing construct breadth with measurement rigor

Foundational work in the psychology of metacognition identified a distinction between metacognitive knowledge (stable beliefs about one's capacities) and metacognitive experiences (local evaluations of performance). More recently, the field has focused on developing tasks and metrics that seek to identify metacognitive capacities from momentary estimates of confidence in performance, and providing precise computational accounts of metacognitive failure. However, this notable progress in formalising models of metacognitive judgments may come at a cost of ignoring broader elements of the psychology of metacognition - such as how stable meta-knowledge is formed, how social cognition and metacognition interact, and how we evaluate affective states that do not have an obvious ground truth. We propose that construct breadth in metacognition research can be restored while maintaining rigour in measurement, and highlight promising avenues for expanding the scope of metacognition research. Such a research programme is well placed to recapture qualitative features of metacognitive knowledge and experience while maintaining the psychophysical rigor that characterises modern research on confidence and performance monitoring.

The misjudgment of interoceptive awareness: Systematic overrating of interoceptive awareness among individuals with lower interoceptive metacognitive skills

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.

Respiratory Interoception and Pathological Illness Anxiety: Disentangling Bias

OBJECTIVE

Biased interoception decoupled from physiology might be relevant in the etiology of pathological illness anxiety (PIA). Empirical evidence for interoceptive deviations in illness anxiety is scarce but potentially informative to optimize treatments. We hypothesized that persons with PIA differ fundamentally in the classification of bodily sensations from those without PIA.

METHODS

In a respiratory categorization task, participants breathed into a pulmonary training device. Inspiration effort was varied by eight resistive loads. The lower/higher four loads were introduced as belonging to arbitrary categories "A"/"B," respectively. Participants memorized respiratory sensations in a first experimental block and were asked to label the resistances in a second block. We calculated the sensitivity of resistance classification according to category and response bias in terms of categorical misclassification. Data of 39 participants with PIA and 35 controls were compared with regard to sensitivity and response bias by group, resistive load, and their interaction in a multiple regression.

RESULTS

With similar sensitivity, patients more often labeled loads above the categorical border erroneously as belonging to category A, thus underestimating their resistance ( β = -0.06, p = .001; η2 = 0.02).

CONCLUSIONS

Individuals with PIA showed a systematic "wait and see" approach. Altered respiroception in PIA might stem from biased perception during training phase, the recognition phase, biased memory, or a combination of these. Its exact characteristics remain unknown, and future research must address the challenge of developing reliable and valid paradigms accounting for the variability of interoceptive biases.

REGISTRATION

This work was preregistered on OSF ( https://osf.io/9shcw ).

Puzzled by dysfunctional breathing disorder(s)? Consider the Bayesian brain hypothesis!

There is currently growing clinical concern regarding dysfunctional breathing disorder(s) (DBD), an umbrella term for a set of multidimensional clinical conditions that are characterized by altered breathing pattern associated with a variety of intermittent or chronic symptoms, notably dyspnea, in the absence or in excess of, organic disease. However, several aspects of DBD remain poorly understood and/or open to debate, especially the inconsistent relationship between the array of experienced symptoms and their supposedly underlying mechanisms. This may be partly due to a more general problem, i.e., the prevailing way we conceptualize symptoms. In the present article, after a brief review of the different aspects of DBD from the current perspective, I submit a call for considering DBD under the innovating perspective of the Bayesian brain hypothesis, i.e., a potent and novel model that fundamentally changes our views on symptom perception.

Increasing familiarity with the heartbeat counting task does not affect performance

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.

The new measures of interoceptive accuracy: A systematic review and assessment

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.

Interoceptive and metacognitive facets of fatigue in multiple sclerosis

Numerous disorders are characterised by fatigue as a highly disabling symptom. Fatigue plays a particularly important clinical role in multiple sclerosis (MS) where it exerts a profound impact on quality of life. Recent concepts of fatigue grounded in computational theories of brain-body interactions emphasise the role of interoception and metacognition in the pathogenesis of fatigue. So far, however, for MS, empirical data on interoception and metacognition are scarce. This study examined interoception and (exteroceptive) metacognition in a sample of 71 persons with a diagnosis of MS. Interoception was assessed by prespecified subscales of a standard questionnaire (Multidimensional Assessment of Interoceptive Awareness [MAIA]), while metacognition was investigated with computational models of choice and confidence data from a visual discrimination paradigm. Additionally, autonomic function was examined by several physiological measurements. Several hypotheses were tested based on a preregistered analysis plan. In brief, we found the predicted association of interoceptive awareness with fatigue (but not with exteroceptive metacognition) and an association of autonomic function with exteroceptive metacognition (but not with fatigue). Furthermore, machine learning (elastic net regression) showed that individual fatigue scores could be predicted out-of-sample from our measurements, with questionnaire-based measures of interoceptive awareness and sleep quality as key predictors. Our results support theoretical concepts of interoception as an important factor for fatigue and demonstrate the general feasibility of predicting individual levels of fatigue from simple questionnaire-based measures of interoception and sleep.

Functional connectivity between interoceptive brain regions is associated with distinct health-related domains: A population-based neuroimaging study

Interoception is the sensation, perception, and integration of signals from within the body. It has been associated with a broad range of physiological and psychological processes. Further, interoceptive variables are related to specific regions and networks in the human brain. However, it is not clear whether or how these networks relate empirically to different domains of physiological and psychological health at the population level. We analysed a data set of 19,020 individuals (10,055 females, 8965 males; mean age: 63 years, age range: 45-81 years), who have participated in the UK Biobank Study, a very large-scale prospective epidemiological health study. Using canonical correlation analysis (CCA), allowing for the examination of associations between two sets of variables, we related the functional connectome of brain regions implicated in interoception to a selection of nonimaging health and lifestyle related phenotypes, exploring their relationship within modes of population co-variation. In one integrated and data driven analysis, we obtained four statistically significant modes. Modes could be categorised into domains of arousal and affect and cardiovascular health, respiratory health, body mass, and subjective health (all p < .0001) and were meaningfully associated with distinct neural circuits. Circuits represent specific neural "fingerprints" of functional domains and set the scope for future studies on the neurobiology of interoceptive involvement in different lifestyle and health-related phenotypes. Therefore, our research contributes to the conceptualisation of interoception and may lead to a better understanding of co-morbid conditions in the light of shared interoceptive structures.

Age-related decreases in global metacognition are independent of local metacognition and task performance

Metacognition refers to a capacity to reflect on and control other cognitive processes, commonly quantified as the extent to which confidence tracks objective performance. There is conflicting evidence about how "local" metacognition (monitoring of individual judgments) and "global" metacognition (estimates of self-performance) change across the lifespan. Additionally, the degree to which metacognition generalises across cognitive domains may itself change with age due to increased experience with one's own abilities. Using a gamified suite of performance-controlled memory and visual perception tasks, we measured local and global metacognition in an age-stratified sample of 304 healthy volunteers (18-83 years; N = 50 in each of 6 age groups). We calculated both local and global metrics of metacognition and quantified how and whether domain-generality changes with age. First-order task performance was stable across the age range. People's global self-performance estimates and local metacognitive bias decreased with age, indicating overall lower confidence in performance. In contrast, local metacognitive efficiency was spared in older age and remained correlated across the two cognitive domains. A stability of local metacognition indicates distinct mechanisms contributing to local and global metacognition. Our study reveals how local and global metacognition change across the lifespan and provide a benchmark against which disease-related changes in metacognition can be compared.

Psychiatrically relevant signatures of domain-general decision-making and metacognition in the general population

Human behaviours are guided by how confident we feel in our abilities. When confidence does not reflect objective performance, this can impact critical adaptive functions and impair life quality. Distorted decision-making and confidence have been associated with mental health problems. Here, utilising advances in computational and transdiagnostic psychiatry, we sought to map relationships between psychopathology and both decision-making and confidence in the general population across two online studies (N's = 344 and 473, respectively). The results revealed dissociable decision-making and confidence signatures related to distinct symptom dimensions. A dimension characterised by compulsivity and intrusive thoughts was found to be associated with reduced objective accuracy but, paradoxically, increased absolute confidence, whereas a dimension characterized by anxiety and depression was associated with systematically low confidence in the absence of impairments in objective accuracy. These relationships replicated across both studies and distinct cognitive domains (perception and general knowledge), suggesting that they are reliable and domain general. Additionally, whereas Big-5 personality traits also predicted objective task performance, only symptom dimensions related to subjective confidence. Domain-general signatures of decision-making and metacognition characterise distinct psychological dispositions and psychopathology in the general population and implicate confidence as a central component of mental health.

The Effects of a 3-Week Heartbeat Perception Training on Interoceptive Abilities

Recent studies showed promising short-term effects of heartbeat perception training on interoceptive abilities. Research on the effects of heartbeat perception training on interoceptive abilities over time is sparse. Therefore, the aim of this study was to examine the short-term effects and the effects of a 3-week heartbeat perception training over time on interoceptive abilities, namely, cardiac interoceptive accuracy (IAc) and interoceptive sensibility (IS). A total of 40 healthy participants were randomized to the intervention group (n = 20) or the control group (n = 20). The intervention group conducted three cardiac biofeedback sessions (one per week) at the laboratory, whereas the control group watched a documentary instead. Interoceptive abilities were assessed via the heartbeat perception task (IAc) and confidence ratings (IS) at baseline, after each laboratory session, and 1 week after the last session (post-measurement). IAc was significantly increased in the intervention group compared to the control group after the first training session (short-term effect). There were no significant improvements in IS due to the first session, and neither on IAc nor IS over time. Descriptive trends of improved interoceptive abilities over time were found in both groups. Single session of heartbeat perception training seems to be a promising approach to improve IAc. Future research should further investigate the long-term effects of diverse heartbeat perception training varying in frequency and intensity of the training sessions in diverse samples aiming to improve interoceptive abilities.

The role of interoception in the overlap between eating disorders and autism: Methodological considerations

Significant comorbidity has been demonstrated between feeding and eating disorders and autism. Atypical interoception (perception of bodily signals) may, at least in part, be responsible for this association, as it has been implicated in the aetiology of both conditions. However, significant methodological limitations are impeding progress in this area. This paper provides a brief overview of how interoception has been linked to autism and feeding and eating disorders in both adolescent and adult populations before identifying several issues with current measures of interoception. We suggest that methodological issues may be contributing to the inconsistency in the empirical literature, and provide suggestions for future research.

Atypical interoception is linked to both feeding and eating disorders, and autism and may contribute to the comorbidity between the two.

Existing measures of interoception across cardiac, gastric and respiratory domains are severely limited.

Novel and better‐validated measures of interoception will allow us to better understand the clinical potential of interoceptive training.

Baseline Psychological Traits Contribute to Lake Louise Acute Mountain Sickness Score at High Altitude

Talks, Benjamin James, Catherine Campbell, Stephanie J. Larcombe, Lucy Marlow, Sarah L. Finnegan, Christopher T. Lewis, Samuel J.E. Lucas, Olivia K. Harrison, and Kyle T.S. Pattinson. Baseline psychological traits contribute to Lake Louise Acute Mountain Sickness score at high altitude. High Alt Med Biol. 23:69-77, 2022. Background: Interoception refers to an individual's ability to sense their internal bodily sensations. Acute mountain sickness (AMS) is a common feature of ascent to high altitude that is only partially explained by measures of peripheral physiology. We hypothesized that interoceptive ability may explain the disconnect between measures of physiology and symptom experience in AMS. Methods: Two groups of 18 participants were recruited to complete a respiratory interoceptive task three times at 2-week intervals. The control group remained in Birmingham (140 m altitude) for all three tests. The altitude group completed test 1 in Birmingham, test 2 the day after arrival at 2,624 m, and test 3 at 2,728 m after an 11-day trek at high altitude (up to 4,800 m). Results: By measuring changes to metacognitive performance, we showed that acute ascent to altitude neither presented an interoceptive challenge, nor acted as interoceptive training. However, AMS symptom burden throughout the trek was found to relate to sea level measures of anxiety, agoraphobia, and neuroticism. Conclusions: This suggests that the Lake Louise AMS score is not solely a reflection of physiological changes on ascent to high altitude, despite often being used as such by researchers and commercial trekking companies alike.

Metacognition in functional cognitive disorder

Functional cognitive disorder is common but underlying mechanisms remain poorly understood. Metacognition, an individual's ability to reflect on and monitor cognitive processes, is likely to be relevant. Local metacognition refers to an ability to estimate confidence in cognitive performance on a moment-to-moment basis, whereas global metacognition refers to long-run self-evaluations of overall performance. Using a novel protocol comprising task-based measures and hierarchical Bayesian modelling, we compared local and global metacognitive performance in individuals with functional cognitive disorder. Eighteen participants with functional cognitive disorder (mean age = 49.2 years, 10 males) were recruited to this cross-sectional study. Participants completed computerized tasks that enabled local metacognitive efficiency for perception and memory to be measured using the hierarchical meta-d' model within a signal detection theory framework. Participants also completed the Multifactorial Memory Questionnaire measuring global metacognition, and questionnaires measuring anxiety and depression. Estimates of local metacognitive efficiency were compared with those estimated from two control groups who had undergone comparable metacognitive tasks. Global metacognition scores were compared with the existing normative data. A hierarchical regression model was used to evaluate associations between global metacognition, depression and anxiety and local metacognitive efficiency, whilst simple linear regressions were used to evaluate whether affective symptomatology and local metacognitive confidence were associated with global metacognition. Participants with functional cognitive disorder had intact local metacognition for perception and memory when compared with controls, with the 95% highest density intervals for metacognitive efficiency overlapping with the two control groups in both cognitive domains. Functional cognitive disorder participants had significantly lower global metacognition scores compared with normative data; Multifactorial Memory Questionnaire-Ability subscale (t = 6.54, P < 0.0001) and Multifactorial Memory Questionnaire-Satisfaction subscale (t = 5.04, P < 0.0001). Mood scores, global metacognitive measures and metacognitive bias were not significantly associated with local metacognitive efficiency. Local metacognitive bias [β = -0.20 (SE = 0.09), q = 0.01] and higher depression scores as measured by the Patient Health Questionnaire-9 [β = -1.40 (SE = 2.56), q = 0.01] were associated with the lower global metacognition scores. We show that local metacognition is intact, whilst global metacognition is impaired, in functional cognitive disorder, suggesting a decoupling between the two metacognitive processes. In a Bayesian model, an aberrant prior (impaired global metacognition), may override bottom-up sensory input (intact local metacognition), giving rise to the subjective experience of abnormal cognitive processing. Future work should further investigate the interplay between local and global metacognition in functional cognitive disorder.

Interoception of breathing and its relationship with anxiety

Interoception, the perception of internal bodily states, is thought to be inextricably linked to affective qualities such as anxiety. Although interoception spans sensory to metacognitive processing, it is not clear whether anxiety is differentially related to these processing levels. Here we investigated this question in the domain of breathing, using computational modeling and high-field (7 T) fMRI to assess brain activity relating to dynamic changes in inspiratory resistance of varying predictability. Notably, the anterior insula was associated with both breathing-related prediction certainty and prediction errors, suggesting an important role in representing and updating models of the body. Individuals with low versus moderate anxiety traits showed differential anterior insula activity for prediction certainty. Multi-modal analyses of data from fMRI, computational assessments of breathing-related metacognition, and questionnaires demonstrated that anxiety-interoception links span all levels from perceptual sensitivity to metacognition, with strong effects seen at higher levels of interoceptive processes.

Measuring metacognitive performance: type 1 performance dependence and test-retest reliability

Research on metacognition-thinking about thinking-has grown rapidly and fostered our understanding of human cognition in healthy individuals and clinical populations. Of central importance is the concept of metacognitive performance, which characterizes the capacity of an individual to estimate and report the accuracy of primary (type 1) cognitive processes or actions ensuing from these processes. Arguably one of the biggest challenges for measures of metacognitive performance is their dependency on objective type 1 performance, although more recent methods aim to address this issue. The present work scrutinizes the most popular metacognitive performance measures in terms of two critical characteristics: independence of type 1 performance and test-retest reliability. Analyses of data from the Confidence Database (total N = 6912) indicate that no current metacognitive performance measure is independent of type 1 performance. The shape of this dependency is largely reproduced by extending current models of metacognition with a source of metacognitive noise. Moreover, the reliability of metacognitive performance measures is highly sensitive to the combination of type 1 performance and trial number. Importantly, trial numbers frequently employed in metacognition research are too low to achieve an acceptable level of test-retest reliability. Among common task characteristics, simultaneous choice and confidence reports most strongly improved reliability. Finally, general recommendations about design choices and analytical remedies for studies investigating metacognitive performance are provided.

Dissociating breathlessness symptoms from mood in asthma

It is poorly understood why asthma symptoms are often discordant with objective medical tests. Differences in interoception (perception of internal bodily processes) may help explain symptom discordance, which may be further influenced by mood and attention. We explored inter-relationships between interoception, mood and attention in 63 individuals with asthma and 30 controls. Questionnaires, a breathing-related interoception task, two attention tasks, and standard clinical assessments were performed. Questionnaires were analysed using exploratory factor analysis, and linear regression examined relationships between measures. K-means clustering also defined asthma subgroups. Two concordant asthma subgroups (symptoms related appropriately to pathophysiology, normal mood) and one discordant subgroup (moderate symptoms, minor pathophysiology, low mood) were found. In all participants, negative mood correlated with decreased interoceptive ability and faster reaction times in an attention task. Our findings suggest that interpreting bodily sensations relates to mood, and this effect may be heightened in subgroups of individuals with asthma.