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Jenkinson PM, Fotopoulou A, Ibañez A, Rossell S. Interoception in anxiety, depression, and psychosis: a review. EClinicalMedicine 2024; 73:102673. [PMID: 38873633 PMCID: PMC11169962 DOI: 10.1016/j.eclinm.2024.102673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 05/08/2024] [Accepted: 05/17/2024] [Indexed: 06/15/2024] Open
Abstract
Research has examined the relationship between interoception and anxiety, depression, and psychosis; however, it is unclear which aspects of interoception have been systematically examined, what the combined findings are, and which areas require further research. To answer these questions, we systematically searched and narratively synthesised relevant reviews, meta-analyses, and theory papers (total n = 34). Existing systematic reviews and meta-analyses (anxiety n = 2; depression n = 2; psychosis n = 0), focus on cardiac interoceptive accuracy (heartbeat perception), and indicate that heartbeat perception is not systematically impaired in anxiety or depression. Heartbeat perception might be poorer in people with psychosis, but further evidence is needed. Other aspects of interoception, such as different body systems and processing levels, have been studied but not systematically reviewed. We highlight studies examining these alternative bodily domains and levels, review the efficacy of interoception-based psychological interventions, and make suggestions for future research. Funding Wellcome Trust UK.
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Affiliation(s)
- Paul M. Jenkinson
- Faculty of Psychology, Counselling and Psychotherapy, The Cairnmillar Institute, Melbourne, Australia
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Aikaterini Fotopoulou
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Agustin Ibañez
- School of Psychology, Trinity College Dublin, Dublin, Ireland
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile
| | - Susan Rossell
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
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2
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Garland MM, Wilson R, Thompson WK, Stein MB, Paulus MP, Feinstein JS, Khalsa SS. A randomized controlled safety and feasibility trial of floatation-REST in anxious and depressed individuals. PLoS One 2024; 19:e0286899. [PMID: 38843272 PMCID: PMC11156321 DOI: 10.1371/journal.pone.0286899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 01/04/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Reduced Environmental Stimulation Therapy via floatation (floatation-REST) is a behavioral intervention designed to attenuate exteroceptive sensory input to the nervous system. Prior studies in anxious and depressed individuals demonstrated that single sessions of floatation-REST are safe, well-tolerated, and associated with an acute anxiolytic and antidepressant effect that persists for over 48 hours. However, the feasibility of using floatation-REST as a repeated intervention in anxious and depressed populations has not been well-investigated. METHODS In this single-blind safety and feasibility trial, 75 individuals with anxiety and depression were randomized to complete six sessions of floatation-REST in different formats: pool-REST (weekly 1-hour float sessions), pool-REST preferred (float sessions with flexibility of duration and frequency), or an active comparator (chair-REST; weekly 1-hour sessions in a Zero Gravity chair). Feasibility (primary outcome) was assessed via an 80% rate of adherence to the assigned intervention; tolerability via study dropout and duration/frequency of REST utilization; and safety via incidence of adverse events and ratings about the effects of REST. RESULTS Of 1,715 individuals initially screened, 75 participants were ultimately randomized. Six-session adherence was 85% for pool-REST (mean, M = 5.1 sessions; standard deviation, SD = 1.8), 89% for pool-REST preferred (M = 5.3 sessions; SD = 1.6), and 74% for chair-REST (M = 4.4 sessions; SD = 2.5). Dropout rates at the end of the intervention did not differ significantly between the treatment conditions. Mean session durations were 53.0 minutes (SD = 12.3) for pool-REST, 75.4 minutes (SD = 29.4) for pool-REST preferred, and 58.4 minutes (SD = 4.3) for chair-REST. There were no serious adverse events associated with any intervention. Positive experiences were endorsed more commonly than negative ones and were also rated at higher levels of intensity. CONCLUSIONS Six sessions of floatation-REST appear feasible, well-tolerated, and safe in anxious and depressed individuals. Floatation-REST induces positively-valenced experiences with few negative effects. Larger randomized controlled trials evaluating markers of clinical efficacy are warranted. CLINICAL TRIAL REGISTRATION IDENTIFIER NCT03899090.
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Affiliation(s)
- McKenna M. Garland
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, Oklahoma, United States of America
- Kendall College of Arts and Sciences, University of Tulsa, Tulsa, Oklahoma, United States of America
| | - Raminta Wilson
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, Oklahoma, United States of America
| | - Wesley K. Thompson
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, Oklahoma, United States of America
| | - Murray B. Stein
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, United States of America
- Psychiatry Service, Veterans Affairs San Diego Healthcare System, San Diego, California, United States of America
| | - Martin P. Paulus
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, Oklahoma, United States of America
- Oxley College of Health Sciences, University of Tulsa, Tulsa, Oklahoma, United States of America
| | - Justin S. Feinstein
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, Oklahoma, United States of America
- Oxley College of Health Sciences, University of Tulsa, Tulsa, Oklahoma, United States of America
- Float Research Collective, Kihei, Hawaii, United States of America
| | - Sahib S. Khalsa
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, Oklahoma, United States of America
- Oxley College of Health Sciences, University of Tulsa, Tulsa, Oklahoma, United States of America
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3
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Cambi S, Solcà M, Micali N, Berchio C. Cardiac interoception in Anorexia Nervosa: A resting-state heartbeat-evoked potential study. EUROPEAN EATING DISORDERS REVIEW 2024; 32:417-430. [PMID: 38009624 DOI: 10.1002/erv.3049] [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: 08/01/2023] [Revised: 11/01/2023] [Accepted: 11/03/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE A deficit in interoception - the ability to perceive, interpret and integrate afferent signals about the physiological state of the body - has been shown in Anorexia Nervosa (AN), and linked to altered hunger sensations, body dysmorphia, and abnormal emotional awareness. The present high-density electroencephalography (hdEEG) study aims to assess cardiac interoception in AN and to investigate its neural correlates, using an objective neurophysiological measure. METHOD Heartbeat-evoked potentials (HEPs) were computed from 5 min of resting-state EEG and electrocardiogram (ECG) data and compared between individuals with AN (N = 22) and healthy controls (HC) (N = 19) with waveform, topographic, and source imaging analyses. RESULTS Differences in the cortical representation of heartbeats were present between AN and HC at a time window of 332-348 ms after the ECG R-peak. Source imaging analyses revealed a right-sided hypoactivation in AN of brain regions linked to interoceptive processing, such as the anterior cingulate and orbitofrontal areas. CONCLUSIONS To the best of our knowledge, this is the first study using hdEEG to localise the underlying sources of HEPs in AN. Results point to altered interoceptive processing during resting-state in AN. As our participants had a short duration of illness, this might not be the consequence of prolonged starvation. Interventions targeted at interoception could provide an additional tool to facilitate recovery.
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Affiliation(s)
- Susanne Cambi
- Department of Psychiatry, Geneva University Hospital, Geneva, Switzerland
| | - Marco Solcà
- Department of Psychiatry, Geneva University Hospital, Geneva, Switzerland
| | - Nadia Micali
- Mental Health Services of the Capital Region of Denmark, Center for Eating and Feeding Disorders Research, Psychiatric Centre Ballerup, Ballerup, Denmark
- University College London, Great Ormond Street Institute of Child Health, London, UK
| | - Cristina Berchio
- Department of Translational Biomedicine and Neuroscience, University of Bari Aldo Moro, Bari, Italy
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4
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Mai-Lippold SA, Schultze J, Pollatos O. Interoceptive abilities impairment correlates with emotional eating and taste abnormalities in children with overweight and obesity. Appetite 2024; 194:107182. [PMID: 38154574 DOI: 10.1016/j.appet.2023.107182] [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: 07/20/2023] [Revised: 11/28/2023] [Accepted: 12/21/2023] [Indexed: 12/30/2023]
Abstract
Weight problems in children are associated with emotional eating, which has been linked to interoceptive abilities. Previous research also shows altered olfactory and gustatory perception in children with obesity and overweight. Therefore, we aimed to investigate the connection of alterations in olfactory and gustatory perception to interoceptive abilities and emotional eating among children with obesity and overweight. 23 children with overweight and obesity and age-matched controls with normal weight (12-16 years old) underwent olfactory and gustatory testing. Interoceptive abilities were assessed, focusing on interoceptive accuracy and interoceptive sensibility. Children with overweight and obesity showed significantly higher accuracy for detection of sweet taste, but descriptively lower accuracy for all other taste qualities compared to normal weight children. We found no changes in olfactory abilities in children with overweight and obesity. Emotional eating scores were elevated for children with overweight and obesity, and interoceptive accuracy scores were significantly lower. In both groups, interoceptive accuracy was inversely correlated with emotional eating. Our results support prior findings of altered gustatory abilities in children with overweight and obesity. The observed link between impaired interoceptive processes and heightened emotional eating in this group implies that interventions for overweight in children could benefit from targeting interoceptive abilities. This study provides meaningful grounds for further investigations into the roles of taste, emotional eating, and interoceptive abilities for overweight in children and adolescents.
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Affiliation(s)
- Sandra A Mai-Lippold
- Clinical and Health Psychology, Institute of Psychology, Ulm University, Germany
| | - Jasmin Schultze
- Clinical and Health Psychology, Institute of Psychology, Ulm University, Germany
| | - Olga Pollatos
- Clinical and Health Psychology, Institute of Psychology, Ulm University, Germany.
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5
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Yang W, Wang Y, Ko C, Niu X, Huang Y, Luo B, Wang G, He J, Li H. Effect of lite touch on the anxiety of low-risk pregnant women in the latent phase of childbirth: a randomized controlled trial. Front Psychol 2024; 15:1304274. [PMID: 38375113 PMCID: PMC10875089 DOI: 10.3389/fpsyg.2024.1304274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/22/2024] [Indexed: 02/21/2024] Open
Abstract
Introduction Women with perinatal anxiety have reduced coping capacity during labor, which affects labor progress and increases the likelihood of a cesarean section. Several non-pharmacological interventions for anxiety during childbirth are available. This study used the "lite touch" method, a non-pharmacological intervention based on physiological responses and obstetric clinical experience in women. We aimed to evaluate whether lite touch could relieve perinatal anxiety and investigate the effect of light skin stroking on the maternal hormones, catecholamine, and cortisol. Methods This randomized clinical trial involved women with low-risk singleton pregnancies at full term or near term. Eligible pregnant women who were latent and did not undergo epidural anesthesia were randomized into two groups. Participants in the intervention group underwent routine prenatal care, including lite touch, whereas the control group underwent routine prenatal care alone. Demographic data were collected through a questionnaire. Labor anxiety was assessed using the State Anxiety Inventory, and saliva was collected before and after the intervention. Changes in saliva cortisol and catecholamine levels were analyzed using a double-antibody sandwich enzyme-linked immunosorbent assay. Results In total, 83 participants were included, with 43 and 40 in the intervention and control groups, respectively. In the intervention group, pre-intervention anxiety scores were significantly lower (p < 0.01) than post-intervention anxiety scores, whereas the control group showed no difference in anxiety scores before and after intervention (p > 0.05). Cortisol and catecholamine levels in saliva were significantly lower in the intervention group than in the control group after the intervention (p < 0.01). Discussion Lite touch can reduce the latent anxiety state of low-risk pregnant women, thereby maintaining in vivo stability and facilitating labor. Clinical trial registration https://www.chictr.org.cn/aboutEN.html, ChiCTR2300070905, Retrospectively Registered Date: April 26, 2023.
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Affiliation(s)
- Wenqian Yang
- Department of Obstetrics Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Yonghong Wang
- Department of Obstetrics Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Chingyuan Ko
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
- Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoyu Niu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
- Department of Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yan Huang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
- Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Biru Luo
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
- Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Guoyu Wang
- Department of Obstetrics Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Jingjing He
- Department of Obstetrics Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Huafeng Li
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
- Department of Anesthesiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
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Gallagher S. Minimal self-consciousness and the flying man argument. Front Psychol 2023; 14:1296656. [PMID: 38169988 PMCID: PMC10760637 DOI: 10.3389/fpsyg.2023.1296656] [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: 09/18/2023] [Accepted: 11/14/2023] [Indexed: 01/05/2024] Open
Abstract
The concept of minimal self-consciousness or "minimal self" is equivalent to a very basic form of first-person, pre-reflective self-awareness, which includes bodily self-awareness, and is related to phenomenal experience (qualia) and sentience. This phenomenological concept plays a role in characterizations of the senses of ownership and agency; in recent debates about Buddhist conceptions of the no-self; in explanations of illusions such as the Rubber Hand Illusion; as well as in characterizations of schizophrenia as a self-disorder. Despite its relevance to these complex investigations, a number of theorists have recently pointed out that the concept is not well defined. In order to provide some clarification about the notion of minimal self and how it relates to bodily and sensory processes this paper reaches back to the ideas expressed in a famous medieval thought experiment proposed in the 11th century: Avicenna's Flying Man argument. The paper then provides a review of some of the contemporary debates about the minimal self, pointing especially to questions about the role of bodily and social processes.
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Affiliation(s)
- Shaun Gallagher
- Department of Philosophy, The University of Memphis, Memphis, TN, United States
- School of Liberal Arts, University of Wollongong, Wollongong, NSW, Australia
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Bijsterbosch JM, Hasenack B, van Rooijen B, Sternheim LC, Boelen PA, Dijkerman HC, Keizer A. Intolerable feelings of uncertainty within the body: Associations between interoceptive awareness, intolerance of uncertainty, and body dissatisfaction. J Adolesc 2023; 95:1678-1688. [PMID: 37655512 DOI: 10.1002/jad.12237] [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: 01/19/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Adolescence is a period marked by important physical and social changes, which often leads to an increase of body dissatisfaction. Recent studies have shown an association between interoception and body dissatisfaction in female adolescents. One variable that may contribute to the association between interoceptive awareness and body dissatisfaction is intolerance of uncertainty (IU). This study aims to investigate multiple facets of interoceptive awareness, IU, and their relations with body dissatisfaction in adolescent girls. METHODS In a cross-sectional study, a convenience sample of 307 adolescent girls (mean age = 17.73; SD = 1.02) was recruited in the Netherlands in 2022. Three questionnaires were completed measuring interoceptive awareness, IU, and body dissatisfaction. A moderation analyses using a multiple hierarchical regression was used to investigate associations between variables. RESULTS Correlation analyses indicated that several facets of lower interoceptive awareness (Not distracting, Not worrying and Trusting) were related to higher levels of body dissatisfaction. IU only marginally moderated the relationship between several domains of interoceptive awareness (Notice, Attention regulation and Emotional awareness) and body dissatisfaction. DISCUSSION Findings suggest that experiencing bodily signals as ambiguous and uncertain may result in more complex body image issues. Within certain domains of interoceptive awareness, IU may affect the process of appraising bodily signals. Furthermore, adolescent girls who do not feel safe in their body and who find it difficult to distract their thoughts when experiencing pain or discomfort in their body may be particularly at risk for developing more complex body image disturbances and may benefit from interventions improving both interoceptive awareness and IU. Moreover, future research should focus on interoceptive awareness and IU as potential underlying mechanisms for body image issues.
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Affiliation(s)
| | - Birgit Hasenack
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Bregje van Rooijen
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Lot C Sternheim
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Paul A Boelen
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
- ARQ National Psychotrauma Centre, Diemen, The Netherlands
- ARQ Centrum'45, Diemen, The Netherlands
| | - H Chris Dijkerman
- Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands
| | - Anouk Keizer
- Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands
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Choquette EM, Flux MC, Moseman SE, Chappelle S, Naegele J, Upshaw V, Morton A, Paulus MP, Feinstein JS, Khalsa SS. The impact of floatation therapy on body image and anxiety in anorexia nervosa: a randomised clinical efficacy trial. EClinicalMedicine 2023; 64:102173. [PMID: 37936658 PMCID: PMC10626164 DOI: 10.1016/j.eclinm.2023.102173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/05/2023] [Accepted: 08/08/2023] [Indexed: 11/09/2023] Open
Abstract
Background Body image disturbance and anxiety are core features of anorexia nervosa (AN), a psychiatric disorder with one of the highest mortality rates. This study examined the efficacy of a novel non-pharmacological treatment, floatation-REST (Reduced Environmental Stimulation Therapy) on body image disturbance and anxiety in inpatients with AN. Methods This parallel group randomised controlled trial compared floatation-REST vs. care as usual in women and girls hospitalised for treatment of AN in Tulsa, Oklahoma, USA. Participants were randomised on a 2:1 ratio to receive eight, twice-weekly, 60-min floatation-REST sessions for 4 weeks, in addition to care as usual, or to receive care as usual. The primary outcome was the average change in body dissatisfaction from pre- to post-float as measured by the Photographic Figure Rating Scale. The secondary outcome was the average change in anxiety from pre- to post-float as measured by the state version of the State Trait Anxiety Inventory. Longitudinal effects of floatation-REST on body dissatisfaction were also examined. All analyses were conducted using the intention-to-treat principle. Planned linear mixed models tested the effect of floatation-REST vs. care as usual. The trial was preregistered (clinicaltrials.govNCT03610451). Findings Between March 16, 2018 and February 25, 2021, 133 participants were screened for eligibility, and 86 were consented. Eighteen were excluded after consent, for a final randomisation sample of 68 participants (45 floatation-REST; 23 care as usual). There were two session by condition interactions on body dissatisfaction (p = 0.00026) and state anxiety (p < 0.0001), such that the floatation-REST group exhibited acute (i.e., pre- to post-session) reductions in body dissatisfaction (floatation-REST group mean change (Δm) = -0.43; 95% CI -0.56 to -0.30, p < 0.0001, Cohen's d = 0.23), and acute reductions in anxiety (floatation-REST group Δm = -15.75; 95% CI -17.95 to -13.56, p < 0.0001, Cohen's d = 1.52); however, the care as usual group exhibited no significant changes. With regard to longitudinal results, there was a significant time by treatment interaction between baseline and immediately post intervention (p = 0.012) and baseline and six-month follow up (p = 0.0019). At immediately post intervention, there was a trending reduction in body dissatisfaction for the floatation-REST group (Δm = -0.41, 95% CI -0.86 to 0.03, p = 0.068) and care as usual group (Δm = 0.61; 95% CI -0.04 to 1.27, p = 0.070). At six-months post-intervention, the floatation-REST group exhibited lower body dissatisfaction (Δm = -0.91; 95% CI -1.37 to -0.45, p = 0.0020, Cohen's d = 0.53) whereas the care as usual group reported no change in body dissatisfaction (Δm = 0.35; 95% CI -0.28 to 0.98, p = 0.96) relative to baseline. There were no adverse events related to the trial during the study. Interpretation Our findings suggest that Floatation-REST decreased body dissatisfaction compared to care as usual acutely after each float session and at six-month follow-up. Floatation-REST has potential utility for the treatment of body image disturbance and anxiety in AN. These results may be limited by some generalisability concerns given the recruitment of a modest sample receiving inpatient treatment at a single site. Funding The William K. Warren Foundation.
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Affiliation(s)
| | | | - Scott E. Moseman
- Laureate Eating Disorders Program, Saint Francis Health System, Tulsa, Oklahoma, USA
| | | | | | - Valerie Upshaw
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
| | - Alexa Morton
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
| | - Martin P. Paulus
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
- Oxley College of Health Sciences, University of Tulsa, Tulsa, Oklahoma, USA
| | - Justin S. Feinstein
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
- Float Research Collective, Kihei, Hawaii, USA
| | - Sahib S. Khalsa
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
- Oxley College of Health Sciences, University of Tulsa, Tulsa, Oklahoma, USA
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Heim N, Bobou M, Tanzer M, Jenkinson PM, Steinert C, Fotopoulou A. Psychological interventions for interoception in mental health disorders: A systematic review of randomized-controlled trials. Psychiatry Clin Neurosci 2023; 77:530-540. [PMID: 37421414 PMCID: PMC7615164 DOI: 10.1111/pcn.13576] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 06/14/2023] [Accepted: 07/03/2023] [Indexed: 07/10/2023]
Abstract
Disturbed interoception (i.e., the sensing, awareness, and regulation of internal body signals) has been found across several mental disorders, leading to the development of interoception-based interventions (IBIs). Searching PubMed and PsycINFO, we conducted the first systematic review of randomized-controlled trials (RCTs) investigating the efficacy of behavioral IBIs at improving interoception and target symptoms of mental disorders in comparison to a non-interoception-based control condition [CRD42021297993]. Thirty-one RCTs fulfilled inclusion criteria. Across all studies, a pattern emerged with 20 (64.5%) RCTs demonstrating IBIs to be more efficacious at improving interoception compared to control conditions. The most promising results were found for post-traumatic stress disorder, irritable bowel syndrome, fibromyalgia and substance use disorders. Regarding symptom improvement, the evidence was inconclusive. The IBIs were heterogenous in their approach to improving interoception. The quality of RCTs was moderate to good. In conclusion, IBIs are potentially efficacious at improving interoception for some mental disorders. In terms of symptom reduction, the evidence is less promising. Future research on the efficacy of IBIs is needed.
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Affiliation(s)
- Nikolas Heim
- International Psychoanalytic University Berlin, Berlin, Germany
- Wellcome Centre for Human Neuroimaging, University College London, London, UK
| | - Marina Bobou
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Michal Tanzer
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Paul M Jenkinson
- Institute for Social Neuroscience, Melbourne, Victoria, Australia
| | - Christiane Steinert
- International Psychoanalytic University Berlin, Berlin, Germany
- Department of Psychosomatics and Psychotherapy, Justus-Liebig-University Giessen, Giessen, Germany
| | - Aikaterini Fotopoulou
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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10
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Joshi SA, Aupperle RL, Khalsa SS. Interoception in Fear Learning and Posttraumatic Stress Disorder. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:266-277. [PMID: 37404967 PMCID: PMC10316209 DOI: 10.1176/appi.focus.20230007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
Posttraumatic stress disorder (PTSD) is a psychiatric condition characterized by sustained symptoms, including reexperiencing, hyperarousal, avoidance, and mood alterations, following exposure to a traumatic event. Although symptom presentations in PTSD are heterogeneous and incompletely understood, they likely involve interactions between neural circuits involved in memory and fear learning and multiple body systems involved in threat processing. PTSD differs from other psychiatric conditions in that it is a temporally specific disorder, triggered by a traumatic event that elicits heightened physiological arousal, and fear. Fear conditioning and fear extinction learning have been studied extensively in relation to PTSD, because of their central role in the development and maintenance of threat-related associations. Interoception, the process by which organisms sense, interpret, and integrate their internal body signals, may contribute to disrupted fear learning and to the varied symptom presentations of PTSD in humans. In this review, the authors discuss how interoceptive signals may serve as unconditioned responses to trauma that subsequently serve as conditioned stimuli, trigger avoidance and higher-order conditioning of other stimuli associated with these interoceptive signals, and constitute an important aspect of the fear learning context, thus influencing the specificity versus generalization of fear acquisition, consolidation, and extinction. The authors conclude by identifying avenues for future research to enhance understanding of PTSD and the role of interoceptive signals in fear learning and in the development, maintenance, and treatment of PTSD.
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Affiliation(s)
- Sonalee A Joshi
- Laureate Institute for Brain Research, Tulsa, Oklahoma (all authors); Department of Psychology, University of Michigan, Ann Arbor (Joshi); Oxley College of Health Sciences, School of Community Medicine, University of Tulsa, Tulsa (Aupperle, Khalsa)
| | - Robin L Aupperle
- Laureate Institute for Brain Research, Tulsa, Oklahoma (all authors); Department of Psychology, University of Michigan, Ann Arbor (Joshi); Oxley College of Health Sciences, School of Community Medicine, University of Tulsa, Tulsa (Aupperle, Khalsa)
| | - Sahib S Khalsa
- Laureate Institute for Brain Research, Tulsa, Oklahoma (all authors); Department of Psychology, University of Michigan, Ann Arbor (Joshi); Oxley College of Health Sciences, School of Community Medicine, University of Tulsa, Tulsa (Aupperle, Khalsa)
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11
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Flux MC, Fine TH, Poplin T, Al Zoubi O, Schoenhals WA, Schettler J, Refai HH, Naegele J, Wohlrab C, Yeh HW, Lowry CA, Levine JC, Smith R, Khalsa SS, Feinstein JS. Exploring the acute cardiovascular effects of Floatation-REST. Front Neurosci 2022; 16:995594. [PMID: 36570829 PMCID: PMC9780456 DOI: 10.3389/fnins.2022.995594] [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: 07/16/2022] [Accepted: 11/16/2022] [Indexed: 12/13/2022] Open
Abstract
The central nervous system (CNS) exerts a strong regulatory influence over the cardiovascular system in response to environmental demands. Floatation-REST (Reduced Environmental Stimulation Therapy) is an intervention that minimizes stimulation from the environment, yet little is known about the autonomic consequences of reducing external sensory input to the CNS. We recently found that Floatation-REST induces a strong anxiolytic effect in anxious patients while paradoxically enhancing their interoceptive awareness for cardiorespiratory sensations. To further investigate the physiologic nature of this anxiolytic effect, the present study measured acute cardiovascular changes during Floatation-REST using wireless and waterproof equipment that allowed for concurrent measurement of heart rate, heart rate variability (HRV), breathing rate, and blood pressure. Using a within-subjects crossover design, 37 clinically anxious participants with high levels of anxiety sensitivity and 20 non-anxious comparison participants were randomly assigned to undergo a 90-min session of either Floatation-REST or an exteroceptive comparison condition that entailed watching a relaxing nature film. Measures of state anxiety and serenity were collected before and after each session, while indices of autonomic activity were measured throughout each session. HRV was calculated using both time-series and frequency domain analyses. Linear mixed-effects modeling revealed a significant main effect of condition such that relative to the film condition, Floatation-REST elicited significant decreases (p < 0.001) in diastolic blood pressure, systolic blood pressure, breathing rate, and certain metrics of HRV including the standard deviation of the interbeat interval (SDNN), low-frequency HRV, and very low-frequency HRV. Heart rate showed a non-significant trend (p = 0.073) toward being lower in the float condition, especially toward the beginning of the session. The only metric that showed a significant increase during Floatation-REST was normalized high-frequency HRV (p < 0.001). The observed physiological changes were consistent across both anxious and non-anxious participants, and there were no significant group by condition interactions. Blood pressure was the only cardiac metric significantly associated with float-related reductions in state anxiety and increases in serenity. These findings suggest that Floatation-REST lowers sympathetic arousal and alters the balance of the autonomic nervous system toward a more parasympathetic state. Clinical trial registration [https://clinicaltrials.gov/show/NCT03051074], identifier [NCT03051074].
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Affiliation(s)
- M. C. Flux
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, United States
| | - Thomas H. Fine
- Department of Psychiatry, University of Toledo College of Medicine, Toledo, OH, United States
| | - Tate Poplin
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | - Obada Al Zoubi
- Laureate Institute for Brain Research, Tulsa, OK, United States,Department of Electrical and Computer Engineering, The University of Oklahoma, Tulsa, OK, United States
| | - William A. Schoenhals
- Laureate Institute for Brain Research, Tulsa, OK, United States,The University of Tulsa, Tulsa, OK, United States
| | - Jesse Schettler
- Laureate Institute for Brain Research, Tulsa, OK, United States,Department of Electrical and Computer Engineering, The University of Oklahoma, Tulsa, OK, United States
| | - Hazem H. Refai
- Department of Electrical and Computer Engineering, The University of Oklahoma, Tulsa, OK, United States
| | - Jessyca Naegele
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | - Colleen Wohlrab
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | - Hung-Wen Yeh
- Laureate Institute for Brain Research, Tulsa, OK, United States,Children’s Mercy Research Institute, Kansas City, MO, United States,University of Missouri-Kansas City, Kansas City, MO, United States
| | - Christopher A. Lowry
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, United States
| | - Jason C. Levine
- Department of Psychiatry, University of Toledo College of Medicine, Toledo, OH, United States
| | - Ryan Smith
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | - Sahib S. Khalsa
- Laureate Institute for Brain Research, Tulsa, OK, United States,The University of Tulsa, Tulsa, OK, United States
| | - Justin S. Feinstein
- Laureate Institute for Brain Research, Tulsa, OK, United States,The University of Tulsa, Tulsa, OK, United States,Float Research Collective, Kihei, HI, United States,*Correspondence: Justin S. Feinstein,
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12
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van Doorn M, Nijhuis LA, Monsanto A, van Amelsvoort T, Popma A, Jaspers MWM, Noordzij ML, Öry FG, Alvarez-Jimenez M, Nieman DH. Usability, Feasibility, and Effect of a Biocueing Intervention in Addition to a Moderated Digital Social Therapy-Platform in Young People With Emerging Mental Health Problems: A Mixed-Method Approach. Front Psychiatry 2022; 13:871813. [PMID: 35693972 PMCID: PMC9174529 DOI: 10.3389/fpsyt.2022.871813] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/22/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction To optimize treatment, it is of utmost importance to take into account the myriad of biological, social, and psychological changes that young people go through during adolescence which make them more vulnerable for developing mental health problems. Biocueing, a non-invasive method to transform physiological parameters into an observable signal, could strengthen stress- and emotion regulation by cueing physiologically unusual values in daily life. The aim of this study is to investigate the usability, feasibility, and exploratory effect of biocueing in addition to ENgage YOung people earlY (ENYOY), a moderated digital social therapy-platform, in young people with emerging mental health complaints. Methods A user-centered mixed-method design was used. A focus group was conducted to optimize the ENYOY-platform and biocueing intervention. Biocueing was operationalized by a smartwatch and the Sense-IT app. A within-subjects design was used; 10 days for all participants 'biofeedback off' (control), followed by 10 days 'biofeedback on' (experimental). Emotional awareness and perceived stress were measured using ecological momentary assessment. Eight individuals participated. User-friendliness, usability, and acceptance were assessed using a qualitative design. Results Findings from the focus group resulted in several adaptations of the biocueing intervention to the ENYOY-platform and vice versa. The average measurement compliance rate was 78.8%. Level-one findings showed different individual effects on perceived stress and emotional awareness. Level-two analyses showed no overall effects on perceived stress (B = -0.020, p = 0.562) and overall positive effects on emotional awareness (B = 0.030, p = 0.048) with small effect sizes (Improvement Rate Difference = 0.05-0.35). The intervention was found to be acceptable and showed moderate usability. Participants indicated they experienced improvements in reflection on feelings and changes in behavior, such as pausing and evaluating the situation. Conclusion These preliminary results show that biocueing could be a promising addition to digital treatment platforms and help young people become more emotionally aware. Improvements should be made regarding the usability and acceptability of the smartwatch, as well as more extensive integration of the biocueing intervention with a digital treatment platform. It would be relevant to gain a better understanding of which individuals would benefit most from an additional biocueing intervention.
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Affiliation(s)
| | | | - Anne Monsanto
- Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Thérèse van Amelsvoort
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands
| | - Arne Popma
- Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Monique W. M. Jaspers
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC-Location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Matthijs L. Noordzij
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | | | - Mario Alvarez-Jimenez
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
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13
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Schillings C, Karanassios G, Schulte N, Schultchen D, Pollatos O. The Effects of a 3-Week Heartbeat Perception Training on Interoceptive Abilities. Front Neurosci 2022; 16:838055. [PMID: 35615275 PMCID: PMC9124832 DOI: 10.3389/fnins.2022.838055] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 04/07/2022] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Christine Schillings
- Department of Clinical and Health Psychology, Faculty of Engineering, Computer Science and Psychology, Institute of Psychology and Education, University of Ulm, Ulm, Germany
- *Correspondence: Christine Schillings,
| | - Georgios Karanassios
- Department of Clinical and Health Psychology, Faculty of Engineering, Computer Science and Psychology, Institute of Psychology and Education, University of Ulm, Ulm, Germany
| | - Niklas Schulte
- Department of Work and Organizational Psychology, Faculty of Engineering, Compurter Science and Psychology, Institute of Psychology and Education, University of Ulm, Ulm, Germany
| | - Dana Schultchen
- Department of Clinical and Health Psychology, Faculty of Engineering, Computer Science and Psychology, Institute of Psychology and Education, University of Ulm, Ulm, Germany
| | - Olga Pollatos
- Department of Clinical and Health Psychology, Faculty of Engineering, Computer Science and Psychology, Institute of Psychology and Education, University of Ulm, Ulm, Germany
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14
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Khalsa SS, Berner LA, Anderson LM. Gastrointestinal Interoception in Eating Disorders: Charting a New Path. Curr Psychiatry Rep 2022; 24:47-60. [PMID: 35061138 PMCID: PMC8898253 DOI: 10.1007/s11920-022-01318-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Abnormal interoception has been consistently observed across eating disorders despite limited inclusion in diagnostic conceptualization. Using the alimentary tract as well as recent developments in interoceptive neuroscience and predictive processing as a guide, the current review summarizes evidence of gastrointestinal interoceptive dysfunction in eating disorders. RECENT FINDINGS Eating is a complex process that begins well before and ends well after food consumption. Abnormal prediction and prediction-error signals may occur at any stage, resulting in aberrant gastrointestinal interoception and dysregulated gut sensations in eating disorders. Several interoceptive technologies have recently become available that can be paired with computational modeling and clinical interventions to yield new insights into eating disorder pathophysiology. Illuminating the neurobiology of gastrointestinal interoception in eating disorders requires a new generation of studies combining experimental probes of gut physiology with computational modeling. The application of such techniques within clinical trials frameworks may yield new tools and treatments with transdiagnostic relevance.
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Affiliation(s)
- Sahib S. Khalsa
- grid.417423.70000 0004 0512 8863Laureate Institute for Brain Research, 6655 South Yale Ave, Tulsa, OK 74136 USA ,grid.267360.60000 0001 2160 264XOxley College of Health Sciences, University of Tulsa, Tulsa, OK USA
| | - Laura A. Berner
- grid.59734.3c0000 0001 0670 2351Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Lisa M. Anderson
- grid.17635.360000000419368657Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN USA
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15
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GAD: Over-reactive and unstable mood. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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16
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Al Zoubi O, Misaki M, Bodurka J, Kuplicki R, Wohlrab C, Schoenhals WA, Refai HH, Khalsa SS, Stein MB, Paulus MP, Feinstein JS. Taking the body off the mind: Decreased functional connectivity between somatomotor and default-mode networks following Floatation-REST. Hum Brain Mapp 2021; 42:3216-3227. [PMID: 33835628 PMCID: PMC8193533 DOI: 10.1002/hbm.25429] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 03/08/2021] [Accepted: 03/10/2021] [Indexed: 12/19/2022] Open
Abstract
Floatation‐Reduced Environmental Stimulation Therapy (REST) is a procedure that reduces stimulation of the human nervous system by minimizing sensory signals from visual, auditory, olfactory, gustatory, thermal, tactile, vestibular, gravitational, and proprioceptive channels, in addition to minimizing musculoskeletal movement and speech. Initial research has found that Floatation‐REST can elicit short‐term reductions in anxiety, depression, and pain, yet little is known about the brain networks impacted by the intervention. This study represents the first functional neuroimaging investigation of Floatation‐REST, and we utilized a data‐driven exploratory analysis to determine whether the intervention leads to altered patterns of resting‐state functional connectivity (rsFC). Healthy participants underwent functional magnetic resonance imaging (fMRI) before and after 90 min of Floatation‐REST or a control condition that entailed resting supine in a zero‐gravity chair for an equivalent amount of time. Multivariate Distance Matrix Regression (MDMR), a statistically‐stringent whole‐brain searchlight approach, guided subsequent seed‐based connectivity analyses of the resting‐state fMRI data. MDMR identified peak clusters of rsFC change between the pre‐ and post‐float fMRI, revealing significant decreases in rsFC both within and between posterior hubs of the default‐mode network (DMN) and a large swath of cortical tissue encompassing the primary and secondary somatomotor cortices extending into the posterior insula. The control condition, an active form of REST, showed a similar pattern of reduced rsFC. Thus, reduced stimulation of the nervous system appears to be reflected by reduced rsFC within the brain networks most responsible for creating and mapping our sense of self.
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Affiliation(s)
- Obada Al Zoubi
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA.,University of Oklahoma, Tulsa, Oklahoma, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Masaya Misaki
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
| | - Jerzy Bodurka
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA.,University of Oklahoma, Tulsa, Oklahoma, USA
| | - Rayus Kuplicki
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
| | | | - William A Schoenhals
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA.,University of Tulsa, Tulsa, Oklahoma, USA
| | | | - Sahib S Khalsa
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA.,University of Tulsa, Tulsa, Oklahoma, USA
| | - Murray B Stein
- University of California San Diego, San Diego, California, USA
| | - Martin P Paulus
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA.,University of Tulsa, Tulsa, Oklahoma, USA
| | - Justin S Feinstein
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA.,University of Tulsa, Tulsa, Oklahoma, USA
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17
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Using bodily postures to reduce anxiety and improve interoception: A comparison between powerful and neutral poses. PLoS One 2020; 15:e0242578. [PMID: 33296377 PMCID: PMC7725306 DOI: 10.1371/journal.pone.0242578] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 11/04/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Previous research has shown that anxiety syndromes are highly prevalent among university students. Effective treatments are needed to reduce the burden of anxiety in this population. Powerful postures have been found to impact affective states, as well as interoception (i.e. the ability to perceive inner bodily signals). However, no previous study has compared the effects of powerful- and neutral postures in regards to anxiety and interoceptive ability. METHODS The first part of the study measured the single-session effect of adopting powerful- vs. neutral postures on students' (n = 57) interoceptive ability and state anxiety. The second part of the study measured the effect of adopting powerful or neutral postures twice daily for two weeks, on individuals' interoceptive ability and trait anxiety. RESULTS State anxiety decreased in both conditions whereas interoceptive accuracy only increased in the power posing condition after a single session. Interoceptive accuracy increased in both groups after two weeks of training. LIMITATIONS The study included no comparison to a condition where individuals adopted their natural (i.e. usual) bodily posture. CONCLUSIONS Embodiment interventions that include elements of adopting an open or expansive bodily posture whilst maintaining a self-focus, can help to reduce state anxiety and improve interoceptive accuracy in student populations. Power posing does not seem to be superior to holding a neutral posture to improve interoceptive accuracy or anxiety. One reason therefore could be that both conditions include the manipulation of self-focus and a postural change that diverges from individuals' normal posture.
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18
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Khalsa SS, Moseman SE, Yeh HW, Upshaw V, Persac B, Breese E, Lapidus RC, Chappelle S, Paulus MP, Feinstein JS. Reduced Environmental Stimulation in Anorexia Nervosa: An Early-Phase Clinical Trial. Front Psychol 2020; 11:567499. [PMID: 33123048 PMCID: PMC7573249 DOI: 10.3389/fpsyg.2020.567499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/02/2020] [Indexed: 12/25/2022] Open
Abstract
Reduced Environmental Stimulation Therapy (REST) alters the balance of sensory input to the nervous system by systematically attenuating sensory signals from visual, auditory, thermal, tactile, vestibular, and proprioceptive channels. Previous research from our group has shown that REST via floatation acutely reduces anxiety and blood pressure (BP) while simultaneously heightening interoceptive awareness in clinically anxious populations. Anorexia nervosa (AN) is an eating disorder characterized by elevated anxiety, distorted body representation, and abnormal interoception, raising the question of whether REST might positively impact these symptoms. However, this approach has never been studied in eating disorders, and it is unknown whether exposure to floatation REST might worsen AN symptoms. To examine these possibilities, we conducted an open-label study to investigate the safety and tolerability of REST in AN. We also explored the acute impact of REST on BP, affective symptoms, body image disturbance, and interoception. Twenty-one partially weight-restored AN outpatients completed a protocol involving four sequential sessions of REST: reclining in a zero-gravity chair, floating in an open pool, and two sessions of floating in an enclosed pool. All sessions were 90 min, approximately 1 week apart. We measured orthostatic BP before and immediately after each session (primary outcome), in addition to collecting BP readings every 10 min during the session using a wireless waterproof system as a secondary outcome measure. Each participant's affective state, awareness of interoceptive sensations, and body image were assessed before and after every session (exploratory outcomes). There was no evidence of orthostatic hypotension following floating, and no adverse events (primary outcome). Secondary analyses revealed that REST induced statistically significant reductions in BP (p < 0.001; Cohen's d, 0.2-0.5), anxiety (p < 0.001; Cohen's d, >1) and negative affect (p < 0.01; Cohen's d, >0.5), heightened awareness of cardiorespiratory (p < 0.01; Cohen's d, 0.2-0.5) but not gastrointestinal sensations, and reduced body image dissatisfaction (p < 0.001; Cohen's d, >0.5). The findings from this initial trial suggest that individuals with AN can safely tolerate the physical effects of REST via floatation. Future randomized controlled trials will need to investigate whether these initial observations of improved anxiety, interoception, and body image disturbance occur in acutely ill AN populations. Clinical Trial Registration ClinicalTrials.gov; Identifier: NCT02801084 (April 01, 2016).
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Affiliation(s)
- Sahib S Khalsa
- Laureate Institute for Brain Research (LIBR), Tulsa, OK, United States.,Oxley College of Health Sciences, The University of Tulsa, Tulsa, OK, United States
| | | | - Hung-Wen Yeh
- Laureate Institute for Brain Research (LIBR), Tulsa, OK, United States.,Children's Mercy Health System, Kansas City, MO, United States
| | - Valerie Upshaw
- Laureate Institute for Brain Research (LIBR), Tulsa, OK, United States
| | - Beth Persac
- Laureate Eating Disorders Program, Tulsa, OK, United States
| | - Eric Breese
- Laureate Institute for Brain Research (LIBR), Tulsa, OK, United States
| | - Rachel C Lapidus
- Laureate Institute for Brain Research (LIBR), Tulsa, OK, United States.,Department of Psychology, The University of Tulsa, Tulsa, OK, United States
| | | | - Martin P Paulus
- Laureate Institute for Brain Research (LIBR), Tulsa, OK, United States.,Oxley College of Health Sciences, The University of Tulsa, Tulsa, OK, United States
| | - Justin S Feinstein
- Laureate Institute for Brain Research (LIBR), Tulsa, OK, United States.,Oxley College of Health Sciences, The University of Tulsa, Tulsa, OK, United States
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19
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Paoletti P, Ben-Soussan TD. Reflections on Inner and Outer Silence and Consciousness Without Contents According to the Sphere Model of Consciousness. Front Psychol 2020; 11:1807. [PMID: 32903475 PMCID: PMC7435012 DOI: 10.3389/fpsyg.2020.01807] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/30/2020] [Indexed: 01/06/2023] Open
Abstract
In the current hypothesis paper, we propose that focusing attention on silence can be used as a paradigm conceptually similar to sensory deprivation, to study consciousness without content. We briefly overview recent influential models of consciousness and consider how they assess the relationship between consciousness and contents. After discussing the strengths and weaknesses of current models, we suggest an extension based on the Sphere Model of Consciousness (SMC) and introduce new definitions for identification and self-awareness as states of consciousness. We further compare Paoletti's theoretical model for the development of self with other influential models, highlighting similarities and differences. We conclude with a discussion of how attentional focus on silence can be empirically tested.
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Affiliation(s)
| | - Tal Dotan Ben-Soussan
- Research Institute for Neuroscience, Education and Didactics, Patrizio Paoletti Foundation, Assisi, Italy
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20
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Paulus MP, Feinstein JS, Khalsa SS. An Active Inference Approach to Interoceptive Psychopathology. Annu Rev Clin Psychol 2020; 15:97-122. [PMID: 31067416 DOI: 10.1146/annurev-clinpsy-050718-095617] [Citation(s) in RCA: 159] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Interoception refers to the process by which the nervous system senses and integrates signals originating from within the body, providing a momentary mapping of the body's internal landscape and its relationship to the outside world. Active inference is based on the premise that afferent sensory input to the brain is constantly shaped and modified by prior expectations. In this review we propose that interoceptive psychopathology results from two primary interoceptive dysfunctions: First, individuals have abnormally strong expectations of the situations that elicit bodily change (i.e., hyperprecise priors), and second, they have great difficulty adjusting these expectations when the environment changes (i.e., context rigidity). Here we discuss how these dysfunctions potentially manifest in mental illness and how interventions aimed at altering interoceptive processing can help the brain create a more realistic model of its internal state.
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Affiliation(s)
- Martin P Paulus
- Laureate Institute for Brain Research, Tulsa, Oklahoma 74136, USA;
| | - Justin S Feinstein
- Laureate Institute for Brain Research, Tulsa, Oklahoma 74136, USA; .,Oxley College of Health Sciences, University of Tulsa, Tulsa, Oklahoma 74119, USA
| | - Sahib S Khalsa
- Laureate Institute for Brain Research, Tulsa, Oklahoma 74136, USA; .,Oxley College of Health Sciences, University of Tulsa, Tulsa, Oklahoma 74119, USA
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21
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Pfeifer E, Wittmann M. Waiting, Thinking, and Feeling: Variations in the Perception of Time During Silence. Front Psychol 2020; 11:602. [PMID: 32300325 PMCID: PMC7142212 DOI: 10.3389/fpsyg.2020.00602] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 03/13/2020] [Indexed: 11/13/2022] Open
Abstract
Research on the perception of silence has led to insights regarding its positive effects on individuals. We conducted a series of studies during which individuals were exposed to several minutes of silence in different contexts. Participants were introduced to different social and environmental settings, either in a seminar room at a university or in a city garden, alone or in a group. Instructions across studies varied, as participants were exposed to real waiting situations, were asked to just think and to explicitly experience the time interval without further instructions or following a session of Depth Relaxation Music Therapy (DRMT)/Hypnomusictherapy (HMT). Silence was judged to significantly increase relaxation, improve mood states, and alter the perception of time and the orientation toward the present moment. We controlled for influences of trait variables, such as impulsivity, mindfulness, daydreaming, and time perspective. Findings empirically demonstrate that exposure to silence can be effective in therapeutic and educational contexts to promote relaxation and well-being.
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Affiliation(s)
- Eric Pfeifer
- Catholic University of Applied Sciences, Freiburg, Germany
| | - Marc Wittmann
- Institute for Frontier Areas of Psychology and Mental Health, Freiburg, Germany
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22
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Schoeller F, Haar A, Jain A, Maes P. Enhancing human emotions with interoceptive technologies. Phys Life Rev 2019; 31:310-319. [DOI: 10.1016/j.plrev.2019.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 10/20/2019] [Accepted: 10/22/2019] [Indexed: 01/31/2023]
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23
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Fridman J, Barrett LF, Wormwood JB, Quigley KS. Applying the Theory of Constructed Emotion to Police Decision Making. Front Psychol 2019; 10:1946. [PMID: 31572250 PMCID: PMC6749088 DOI: 10.3389/fpsyg.2019.01946] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 08/08/2019] [Indexed: 11/23/2022] Open
Abstract
Law enforcement personnel commonly make decisions in stressful circumstances, where the costs associated with errors are high and sometimes fatal. In this paper, we apply a powerful theoretical approach, the theory of constructed emotion (TCE), to understand decision making under evocative circumstances. This theory posits that the primary purpose of a brain is to predictively regulate physiological resources to coordinate the body's motor activity and learning in the short term, and to meet the body's needs for growth, survival, and reproduction in the long term. This process of managing the brain and body's energy needs, called allostasis, is based on the premise that a brain anticipates bodily needs and attempts to meet those needs before they arise (e.g., vestibular activity that raises sympathetic nervous system activity before standing), because this is more efficient than responding to energetic needs after the fact. In this view, all mental events-cognition, emotion, perception, and action-are shaped by allostasis, and thus all decision making is embodied, predictive, and concerned with balancing energy needs. We also posit a key role for the autonomic nervous system (ANS) in regulating short-term energy expenditures, such that the ANS influences experience and behavior under stressful circumstances, including police decision making. In this paper, we first explain the core features of the TCE, and then offer insights for understanding police decision making in complex, real-world situations. In so doing, we describe how the TCE can be used to guide future studies of realistic decision making in occupations in which people commonly make decisions in evocative situations or under time pressure, such as in law enforcement.
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Affiliation(s)
- Joseph Fridman
- Department of Psychology, Northeastern University, Boston, MA, United States
| | - Lisa Feldman Barrett
- Department of Psychology, Northeastern University, Boston, MA, United States
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Jolie B. Wormwood
- Department of Psychology, University of New Hampshire, Durham, NH, United States
| | - Karen S. Quigley
- Department of Psychology, Northeastern University, Boston, MA, United States
- Edith Nourse Rogers Memorial Veterans Hospital, Center for Healthcare Organization and Implementation Research, Bedford, MA, United States
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24
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King ML. The neural correlates of well-being: A systematic review of the human neuroimaging and neuropsychological literature. COGNITIVE, AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2019; 19:779-796. [PMID: 31062291 PMCID: PMC6713599 DOI: 10.3758/s13415-019-00720-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
What it means to be well and to achieve well-being is fundamental to the human condition. Scholars of many disciplines have attempted to define well-being and to investigate the behavioral and neural correlates of well-being. Despite many decades of inquiry into well-being, much remains unknown. The study of well-being has evolved over time, shifting in focus and methodology. Many recent investigations into well-being have taken a neuroscientific approach to try to bolster understanding of this complex construct. A growing body of literature has directly examined the association between well-being and the brain. The current review synthesizes the extant literature regarding the neural correlates of trait-like well-being (i.e., the propensity to live according to one's true nature). Although reported associations between well-being and the brain varied, some notable patterns were evidenced in the literature. In particular, the strongest and most consistent association emerged between well-being and the anterior cingulate cortex. In addition, patterns of association between well-being and the orbitofrontal cortex, posterior cingulate cortex, superior temporal gyrus, and thalamus emerged. These regions largely comprise the salience and default mode networks, suggesting a possible relationship between well-being and brain networks involved in the integration of relevant and significant stimuli. Various methodological concerns are addressed and recommendations for future research are discussed.
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Affiliation(s)
- Marcie L King
- Department of Psychological and Brain Sciences, University of Iowa, W311 Seashore Hall, Iowa City, IA, 52242, USA.
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25
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Khalsa SS, Feinstein JS, Simmons WK, Paulus MP. Taking Aim at Interoception's Role in Mental Health. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2019; 3:496-498. [PMID: 29884279 DOI: 10.1016/j.bpsc.2018.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 04/19/2018] [Indexed: 10/14/2022]
Affiliation(s)
- Sahib S Khalsa
- Laureate Institute for Brain Research, and the Oxley College of Health Sciences, University of Tulsa, Tulsa, Oklahoma.
| | - Justin S Feinstein
- Laureate Institute for Brain Research, and the Oxley College of Health Sciences, University of Tulsa, Tulsa, Oklahoma
| | - W Kyle Simmons
- Laureate Institute for Brain Research, and the Oxley College of Health Sciences, University of Tulsa, Tulsa, Oklahoma
| | - Martin P Paulus
- Laureate Institute for Brain Research, and the Oxley College of Health Sciences, University of Tulsa, Tulsa, Oklahoma
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26
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Perceptual phenomena in destructured sensory fields: Probing the brain’s intrinsic functional architectures. Neurosci Biobehav Rev 2019; 98:265-286. [DOI: 10.1016/j.neubiorev.2019.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 01/13/2019] [Accepted: 01/14/2019] [Indexed: 12/20/2022]
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27
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Mehling WE, Acree M, Stewart A, Silas J, Jones A. The Multidimensional Assessment of Interoceptive Awareness, Version 2 (MAIA-2). PLoS One 2018; 13:e0208034. [PMID: 30513087 PMCID: PMC6279042 DOI: 10.1371/journal.pone.0208034] [Citation(s) in RCA: 228] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 11/09/2018] [Indexed: 12/22/2022] Open
Abstract
Interoception, the process by which the nervous system senses, interprets, and integrates signals originating from within the body, has become major research topic for mental health and in particular for mind-body interventions. Interoceptive awareness here is defined as the conscious level of interoception with its multiple dimensions potentially accessible to self-report. The Multidimensional Assessment of Interoceptive Awareness (MAIA) is an 8-scale state-trait questionnaire with 32 items to measure multiple dimensions of interoception by self-report and was published in November 2012. Its numerous applications in English and other languages revealed low internal consistency reliability for two of its scales. This study's objective was to improve these scales and the psychometrics of the MAIA by adding three new items to each of the two scales and evaluate these in a new sample. Data were collected within a larger project that took place as part of the Live Science residency programme at the Science Museum London, UK, where visitors to the museum (N = 1,090) completed the MAIA and the six additional items. Based on exploratory factor analysis in one-half of the adult participants and Cronbach alphas, we discarded one and included five of the six additional items into a Version 2 of the MAIA and conducted confirmatory factor analysis in the other half of the participants. The 8-factor model of the resulting 37-item MAIA-2 was confirmed with appropriate fit indices (RMSEA = 0.055 [95% CI 0.052-0.058]; SRMR = 0.064) and improved internal consistency reliability. The MAIA-2 is public domain and available (www.osher.ucsf.edu/maia) for interoception research and the evaluation of clinical mind-body interventions.
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Affiliation(s)
- Wolf E. Mehling
- University of California San Francisco, Department of Family and Community Medicine, San Francisco, CA, United States of America
- University of California San Francisco, Osher Center for Integrative Medicine, San Francisco, CA, United States of America
| | - Michael Acree
- University of California San Francisco, Osher Center for Integrative Medicine, San Francisco, CA, United States of America
| | - Anita Stewart
- University of California San Francisco, Institute for Health and Aging, San Francisco, CA, United States of America
| | - Jonathan Silas
- Middlesex University London, School of Science & Technology, Department of Psychology, London, United Kingdom
| | - Alexander Jones
- Middlesex University London, School of Science & Technology, Department of Psychology, London, United Kingdom
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28
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Khalsa SS, Adolphs R, Cameron OG, Critchley HD, Davenport PW, Feinstein JS, Feusner JD, Garfinkel SN, Lane RD, Mehling WE, Meuret AE, Nemeroff CB, Oppenheimer S, Petzschner FH, Pollatos O, Rhudy JL, Schramm LP, Simmons WK, Stein MB, Stephan KE, Van den Bergh O, Van Diest I, von Leupoldt A, Paulus MP. Interoception and Mental Health: A Roadmap. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2018; 3:501-513. [PMID: 29884281 PMCID: PMC6054486 DOI: 10.1016/j.bpsc.2017.12.004] [Citation(s) in RCA: 401] [Impact Index Per Article: 66.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 11/20/2017] [Accepted: 12/10/2017] [Indexed: 12/29/2022]
Abstract
Interoception refers to the process by which the nervous system senses, interprets, and integrates signals originating from within the body, providing a moment-by-moment mapping of the body's internal landscape across conscious and unconscious levels. Interoceptive signaling has been considered a component process of reflexes, urges, feelings, drives, adaptive responses, and cognitive and emotional experiences, highlighting its contributions to the maintenance of homeostatic functioning, body regulation, and survival. Dysfunction of interoception is increasingly recognized as an important component of different mental health conditions, including anxiety disorders, mood disorders, eating disorders, addictive disorders, and somatic symptom disorders. However, a number of conceptual and methodological challenges have made it difficult for interoceptive constructs to be broadly applied in mental health research and treatment settings. In November 2016, the Laureate Institute for Brain Research organized the first Interoception Summit, a gathering of interoception experts from around the world, with the goal of accelerating progress in understanding the role of interoception in mental health. The discussions at the meeting were organized around four themes: interoceptive assessment, interoceptive integration, interoceptive psychopathology, and the generation of a roadmap that could serve as a guide for future endeavors. This review article presents an overview of the emerging consensus generated by the meeting.
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Affiliation(s)
- Sahib S Khalsa
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, Oklahoma; Oxley College of Health Sciences, University of Tulsa, Tulsa, Oklahoma.
| | - Ralph Adolphs
- California Institute of Technology, Pasadena, California
| | - Oliver G Cameron
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Hugo D Critchley
- Sackler Centre for Consciousness Science, University of Sussex, Brighton, United Kingdom
| | - Paul W Davenport
- Department of Physiology, University of Florida, Gainesville, Florida
| | - Justin S Feinstein
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, Oklahoma; Oxley College of Health Sciences, University of Tulsa, Tulsa, Oklahoma
| | - Jamie D Feusner
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California
| | - Sarah N Garfinkel
- Sackler Centre for Consciousness Science, University of Sussex, Brighton, United Kingdom
| | - Richard D Lane
- Department of Psychiatry, University of Arizona, Tucson, Arizona
| | - Wolf E Mehling
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
| | - Alicia E Meuret
- Department of Psychology, Southern Methodist University, Dallas, Texas
| | - Charles B Nemeroff
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, Florida
| | | | - Frederike H Petzschner
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich, Zurich, Switzerland
| | - Olga Pollatos
- Department of Clinical and Health Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Jamie L Rhudy
- Department of Psychology, University of Tulsa, Tulsa, Oklahoma
| | - Lawrence P Schramm
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland; Department of Neuroscience, Johns Hopkins University, Baltimore, Maryland
| | - W Kyle Simmons
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, Oklahoma; Oxley College of Health Sciences, University of Tulsa, Tulsa, Oklahoma
| | - Murray B Stein
- Department of Psychiatry, University of California, San Diego, San Diego, California
| | - Klaas E Stephan
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich, Zurich, Switzerland
| | | | - Ilse Van Diest
- Department of Health Psychology, University of Leuven, Leuven, Belgium
| | | | - Martin P Paulus
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, Oklahoma
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