Interoceptive accuracy and interoceptive sensibility in individuals with alcohol use disorder-Different phenomena with different clinical correlations?

Drug discrimination learning: Interoceptive stimulus control of behavior and its implications for regulated and dysregulated drug intake

Drug discrimination research has generated rich evidence for the capacity of interoceptive drug stimuli to control behavior by serving as discriminative cues. Owing to its neuropharmacological specificity, drug discrimination learning has been widely used to characterize the stimulus effects and neuropharmacological underpinning of drugs. Apart from such utility, discriminative drug stimuli may help regulate drug use by disambiguating conditioned associations and post-intake outcomes. First, this review summarizes the evidence supporting interoceptive regulation of drug intake from the literature of exteroceptive discriminative control of drug-related behavior, effects of drug priming, and self-titration of drug intake. Second, an overview of interoceptive control of reward-seeking and the animal model of discriminated goal-tracking is provided to illustrate interoceptive stimulus control of the initiation and patterning of drug intake. Third, we highlight the importance of interoceptive control of aversion-avoidance in the termination of drug-use episodes and describe the animal model of discriminated taste avoidance that supports such a position. In bridging these discriminative functions of drug stimuli, we propose that interoceptive drug stimuli help regulate intake by disambiguating whether intake will be rewarding, nonrewarding, or aversive. The reflection and discussion on current theoretical formulations of interoceptive control of drug intake may further scientific advances to improve animal models to study the mechanisms by which interoceptive stimuli regulate drug intake, as well as how alterations of interoceptive processes may contribute to the transition to dysregulated drug use.

Assessment on interoceptive awareness on alcohol use and gambling disorders reveals dissociable interoceptive abilities linked to external and internal dependencies: Practical use of Body Perception Questionnaire Very Short Form (BPQ-VSF) in clinical settings

Interoception is one of the pivotal cognitive functions for mechanisms of our body awareness, and malfunction of the interoceptive network is thought to be associated with mental illness, including addiction. Within addictive disorders, substance-based and non-substance-based addictions are known to hold dissociable reward systems. However, little is known about how interoceptive awareness between these addiction sub-types would differ. Subjective interoceptive awareness was assessed among patients with alcohol use disorder (n = 50) who were subsequently hospitalized or remained out-patient and gambling addiction (n = 41) by the Body Awareness component of the Japanese version of the Body Perception Questionnaire (BPQ-VSFBA-J) and compared them against healthy control (n = 809). Both addiction groups showed significantly lower BPQ than the control, with no substantial differences between inpatients and outpatients for alcohol samples. Notably, BPQ scores for gambling patients were significantly lower than those for the alcohol group. This evidence may suggest a putative role of interoceptive ability on the severity of behavioral addiction over substance-based addiction.

Where alcohol use disorder meets interoception: A meta-analytic view on structural and functional neuroimaging data

Alcohol use disorder (AUD) has been associated with changes in the processing of internal body signals, known as interoception. Changes in brain structure, particularly in the insula, are thought to underlie impaired interoception. As studies specifically investigating this association are largely lacking, this analysis takes an approach that compares meta-analytic results on interoception with recently published meta-analytic results on gray matter reduction in AUD. A systematic literature search identified 25 eligible interoception studies. Activation likelihood estimation (ALE) was used to test for spatial convergence of study results. Overlap between interoception and AUD clusters was tested using conjunction analysis. Meta-analytic connectivity modeling (MACM) and resting-state functional connectivity were used to identify the functional network of interoception and to test where this network overlapped with AUD meta-analytic clusters. The results were characterized using behavioral domain analysis. The interoception ALE identified a cluster in the left middle insula. There was no overlap with clusters of reduced gray matter in AUD. MACM analysis of the interoception cluster revealed a large network located in the insulae, thalami, basal nuclei, cingulate and medial frontal cortices, and pre- and postcentral gyri. Resting state analysis confirmed this result, showing the strongest connections to nodes of the salience- and somatomotor network. Five of the eight clusters that showed a structural reduction in AUD were located within these networks. The behavioral profiles of these clusters were suggestive of higher-level processes such as salience control, somatomotor functions, and skin sensations. The results suggest an altered salience mapping of interoceptive signals in AUD, consistent with current models. Connections to the somatomotor network may be related to action control and integration of skin sensations. Mindfulness-based interventions, pleasurable touch, and (deep) transcranial magnetic stimulation may be targeted interventions that reduce interoceptive deficits in AUD and thus contribute to drug use reduction and relapse prevention.

Recognition of others' interoceptive states in those with and without eating disorders

BACKGROUND

The ability to recognize one's own emotions is associated with one's ability to recognize others' emotions. Beyond the domain of emotion, however, the relationship between recognition of one's own internal states (interoception) and others' interoceptive states has not been investigated, either in the typical population or clinical groups with interoceptive difficulties (e.g. eating disorders; EDs).

METHOD

This study investigated recognition of one's own and others' internal states in adults with and without eating disorders, using a high frequency visual noise paradigm. Participants completed self-report measures of interoception, alexithymia (difficulties recognising one's own emotional internal states) and ED symptomatology, and the Heartbeat Counting Task measure of cardiac interoceptive accuracy.

RESULTS

Alexithymia was significantly negatively correlated with recognition of others' interoceptive states. EDs were not associated with difficulties recognising others' interoceptive states.

CONCLUSIONS

The ability to recognise one's own emotional internal states is associated with the recognition of others' interoceptive states, which may contribute to social skills and the ability to care for others.

Mind your heart to bear the weight: Cardiac interoception predicts action-related visual perception when wearing a heavy backpack

Visual perception can be modulated by the physiological potential for action. For instance, it was famously shown that a geographical slant appears steeper when wearing a heavy backpack than not wearing any. However, those results are not always replicated. In the present exploratory study, we test the hypothesis that the backpack weight's effect on perception relies on the ability of the cognitive system to integrate the physiological constraint's change rather than the change itself. Young adults (n = 54) wore an electrocardiogram monitor and completed a computerised task in which photographs of real geographical slants were displayed on a screen while wearing a heavy versus light backpack. The activity of the vagus nerve, as an index of physiological adaptability, was recorded as a proxy of the physiological state during the task. The participants also completed an interoception task assessing one's ability to detect his or her own heartbeat as the index of integration ability of the cognitive system. While Bayesian analyses revealed no difference in angle estimation between carrying a heavy versus light backpack, the results indicated that interoception predicted less accurate angle estimation only when wearing a heavy backpack. In contrast, there was anecdotal evidence that vagal activity changes predicted visual perception. Interoception might thus play a crucial role in the interplay between the physiological potential for action and action-related visual perception.

Interoception, alexithymia, and anxiety among individuals with alcohol use disorder

Background

Interoception (i.e., the ability to recognize bodily signals), alexithymia (i.e., the inability to recognize emotional states) and negative affect (i.e., unpleasant feelings such as anxiety) have been associated with alcohol use disorder (AUD). Previous research suggests that interoception may underlie alexithymia, which in turn may be associated with negative affectivity. However, this remains to be empirically tested. This study investigates whether alexithymia mediates the association between interoception and anxiety and whether this association differs across individuals with AUD and a healthy control (HC) comparison group.

Methods

The AUD group consisted of 99 participants enrolled in an 8-week abstinence-based inpatient treatment program. The HC group included 103 healthy individuals. The heartbeat counting task (HCT) was used to assess interoception (cardiac interoceptive accuracy). The Toronto Alexithymia Scale (TAS-20) was used to assess alexithymia. The Brief Symptom Inventory (BSI) was used to assess anxiety.

Results

The moderated mediation model with interoception as the predictor, alexithymia as the mediator, and negative affect (i.e., state anxiety) as the dependent variable was tested. The analysis showed that the conditional indirect effect of interoception on anxiety via alexithymia was significant for individuals with AUD [ab = -0.300, bootstrap 95% CI = (-0.618, -0.088)], as well as for HCs [ab = -0.088, bootstrap 95% CI = (-0.195, -0.014)]; however, the conditional indirect effect significantly differed across HCs and individuals with AUD. Namely, the mediated effect was greater among individuals with AUD compared to the HC group.

Conclusion

The results suggests that interoceptive impairment contributes to greater negative affect (i.e., state anxiety) via alexithymia especially for individuals with AUD. Improving emotion recognition via therapeutic methods focused on strengthening interoceptive abilities could improve outcomes for individuals receiving treatment for AUD.

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

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

Interoception Within the Context of Impulsivity and Addiction

Purpose of Review

The goal of this review is to examine the relationship between impulsivity and interoception in addiction, to summarize the current understanding of the topic, identify any gaps in knowledge, and provide directions for future research.

Research Findings

Interoception may be a contributing factor to impulsive behaviour and, thus, addiction. Substance abuse can negatively impact the brain's ability to process interoceptive information and impact the reward system, leading to decreased sensitivity to natural rewards and increased sensitivity to drugs. There is potential for new therapies, such as mindfulness, interoceptive training, brain stimulation, or vagal nerve stimulation to target both impulsivity and interoception in the treatment of addiction.

Summary

Despite a growing interest in interoception in addiction research, further research is needed to better understand the role of interoception in addiction and to develop new methods for studying how individuals with addiction process and perceive internal bodily sensations.

Alexithymia and Alcohol Use: Evaluating the Role of Interoceptive Sensibility with the Revised Multidimensional Assessment of Interoceptive Awareness

Alexithymia has been linked to risky or problematic alcohol use, with a common interpretation invoking deficient emotion regulation and use of alcohol to cope with distress. An alternative explanation positing a general deficit of interoception in alexithymia suggested that poor awareness of internal cues of overconsumption may promote excessive drinking. The present study assessed predictions based on these hypotheses in 337 young adult alcohol users recruited online. Participants completed validated questionnaire indices of alcohol use, alexithymia, emotion regulation, interoceptive sensibility, and sensitivity to reward and punishment. Alcohol use was positively correlated with alexithymia and reward sensitivity, and negatively correlated with emotion regulation as expected, but was uncorrelated with interoceptive sensibility. Alexithymia was not significantly correlated with most dimensions of interoceptive sensibility but was highly negatively correlated with emotion regulation. Hierarchical regression controlling for demographic variables indicated that alexithymia, emotion regulation, sex, and sensitivity to reward and punishment were significant predictors of alcohol use levels. Bootstrapped mediation test controlling for all other variables indicated mediation of the association between alexithymia and alcohol use by deficient emotion regulation but not interoceptive sensibility. Results supported the emotion regulation deficit interpretation of the association of alexithymia with alcohol use. Limitations concerning interoception measurement, online samples, self-report measures, cross-sectional designs, and collection of data during the COVID-19 pandemic are discussed. Future research could follow up on these findings by testing interoceptive accuracy in addition to interoceptive sensibility in relation to alexithymia and alcohol use.

Relationship of Interoceptive Accuracy With Risky Decision-Making and Treatment Outcomes in Male Patients With Alcohol Use Disorder

Abstract. Lower levels of interoceptive awareness (IA) may be present in individuals with substance use disorder (SUD), and damage to related brain regions caused by substance use may disrupt IA. Disturbance in the bodily feedback system may fail to engage in effective decision-making. This study focused on the premise that interoceptive accuracy (IAc), as the primary construct of IA, is implicated in SUD and that poor IAc is linked to risky decision-making and adversely affects treatment outcomes. Eighty-five patients with alcohol use disorder (AUD) (current severity: moderate or severe) and 87 healthy control subjects were enrolled in the present study. All participants performed the heart rate tracking task and a computerized version of the Iowa gambling task (IGT). Characteristics of patients’ addiction profiles were assessed with the Addiction Profile Index (API) Clinical Form. IAc and IGT scores of patients with AUD were lower than healthy controls. IGT scores of patients with low IAc were lower than those of patients with high IAc and decreased IAc is predictive of decreased IGT scores. No significant differences were determined in treatment outcomes at 3, 6, and 12 months after hospitalization between the low-IAc and high-IAc patient groups. Our results suggest that IAc is implicated in AUD and that poor IAc is predictive of increased risky decision-making. Risky decision-making that results in substance use may be partly related to a deficit in the interoceptive ability to guide behavior. Focus on IAc without reference to complex clinical case presentations in AUD makes it difficult to draw any definitive conclusions about the role of IAc in clinical outcomes.

What do measures of self-report interoception measure? Insights from a systematic review, latent factor analysis, and network approach

Recent conceptualizations of interoception suggest several facets to this construct, including "interoceptive sensibility" and "self-report interoceptive scales", both of which are assessed with questionnaires. Although these conceptual efforts have helped move the field forward, uncertainty remains regarding whether current measures converge on their measurement of a common construct. To address this question, we first identified -via a systematic review- the most cited questionnaires of interoceptive sensibility. Then, we examined their correlations, their overall factorial structure, and their network structure in a large community sample (n = 1003). The results indicate that these questionnaires tap onto distinct constructs, with low overall convergence and interrelationships between questionnaire items. This observation mitigates the interpretation and replicability of findings in self-report interoception research. We call for a better match between constructs and measures.

Mindfulness-Based Interventions for the Treatment of Aberrant Interoceptive Processing in Substance Use Disorders

Altered interoception, or the processing of bodily signals, has been argued to play a role in the development and maintenance of substance use disorders (SUD). Therefore, interoceptive interventions focusing on bodily awareness, such as mindfulness meditation, may improve treatment outcomes for individuals with SUD. Here we review: (1) subjective, behavioral and brain evidence for altered interoceptive processing in SUD, focusing on insular and anterior cingulate cortices (INS, ACC), key regions for interoceptive processing; (2) research highlighting links between mindfulness and brain function; and (3) extant brain research investigating mindfulness-based interventions in SUD. SUD tend to be characterized by heightened INS and ACC responses to drug cues but blunted interoceptive awareness and attenuated INS and ACC responses during tasks involving bodily attention and/or perturbations. In contrast, mindfulness interventions in healthy individuals are linked to enhanced INS and ACC responses and heightened interoceptive awareness. It is crucial for future research to identify: (1) whether mindfulness-based treatments are efficacious across substance classes; (2) what particular approaches and dosages show the largest effect sizes in enhancing INS and ACC function to non-drug stimuli and reducing responsivity to substance cues, thereby improving SUD treatment outcomes (reducing drug craving and relapse).

Decision-making, interoceptive awareness and mindful attention awareness in male patients with alcohol use disorder

INTRODUCTION

Decision-making deficits in individuals with alcohol use disorder (AUD) may be partly related to their decreased interoceptive awareness (IA), which is associated with some aspects of mindfulness.

METHODS

52 abstinent male inpatients with AUD (current severity: moderate or severe) and 52 healthy male volunteers performed the heart rate tracking task and a computerised version of the Iowa gambling task (IGT). Trait mindfulness was evaluated with the mindful attention awareness scale (MAAS).

RESULTS

Heartbeat perception (HBP), MAAS, and IGT scores of patients with AUD were significantly lower than those of healthy controls. The difference between groups with respect to IGT scores did not remain significant after controlling for the covariates, and HBP scores were linked significantly to the subjects' IGT performance. HBP scores significantly predicted IGT scores of both the overall sample and patients. MAAS scores did not correlate significantly with HBP and IGT scores in either the patient or control group.

CONCLUSION

It is possible that IA plays a role in decision-making and decreased interoceptive accuracy is a predictor of impaired decision-making in individuals with AUD. More empirical data are needed to develop a better insight into the relationship between IA and multi-dimensional nature of mindfulness.

Alcohol use and interoception - A narrative review

Interoception, defined as the ability to perceive and interpret body signals, may play an important role in alcohol use disorder (AUD). Earlier studies suggested an association between interoception impairment and known risk factors for AUD (e.g., alexithymia, emotion dysregulation, impulsivity, pain). Neurobiological studies show that the neurotoxicity of alcohol affects various elements of the interoceptive system (especially the insula) at structural and functional levels, with differential short/long term impacts. Conversely, primary interoceptive impairments may promote alcohol consumption and foster the evolution towards addiction. Despite convincing evidence demonstrating that interoception impairment may be an important contributor to the development and course of AUD, only a few studies directly evaluated interoceptive abilities in AUD. The research shows that interoceptive accuracy, the objective component of interoception, is lower in AUD individuals, and is correlated with craving and emotion dysregulation. Interoceptive sensibility is in turn higher in AUD individuals compared to healthy controls. Moreover, there is evidence that therapy focused on improving the ability to sense signals from the body in addiction treatment is effective. However, important methodological limitations in interoceptive measures persist, and it is therefore necessary to further investigate the associations between interoception and AUD.

Interoception and alcohol: Mechanisms, networks, and implications

Interoception refers to the perception of the internal state of the body and is increasingly being recognized as an important factor in mental health disorders. Drugs of abuse produce powerful interoceptive states that are upstream of behaviors that drive and influence drug intake, and addiction pathology is impacted by interoceptive processes. The goal of the present review is to discuss interoceptive processes related to alcohol. We will cover physiological responses to alcohol, how interoceptive states can impact drinking, and the recruitment of brain networks as informed by clinical research. We also review the molecular and brain circuitry mechanisms of alcohol interoceptive effects as informed by preclinical studies. Finally, we will discuss emerging treatments with consideration of interoception processes. As our understanding of the role of interoception in drug and alcohol use grows, we suggest that the convergence of information provided by clinical and preclinical studies will be increasingly important. Given the complexity of interoceptive processing and the multitude of brain regions involved, an overarching network-based framework can provide context for how focused manipulations modulate interoceptive processing as a whole. In turn, preclinical studies can systematically determine the roles of individual nodes and their molecular underpinnings in a given network, potentially suggesting new therapeutic targets and directions. As interoceptive processing drives and influences motivation, emotion, and subsequent behavior, consideration of interoception is important for our understanding of processes that drive ongoing drinking and relapse.

Sex differences in interoceptive accuracy: A meta-analysis

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

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

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

Meta-analysis of grey matter changes and their behavioral characterization in patients with alcohol use disorder

Alcohol Use Disorder (AUD) is associated with reductions in grey matter (GM) volume which can lead to changes in numerous brain functions. The results of previous studies on altered GM in AUD differ considerably in the regions identified. Three meta-analyses carried out between 2014 and 2017 yielded different results. The present study includes the considerable amount of newer research and delivers a state-of-the art meta-analysis in line with recently published guidelines. Additionally, we behaviorally characterized affected regions using fMRI metadata and identified related brain networks by determining their meta-analytic connectivity patterns. Twenty-seven studies with 1,045 AUD patients and 1,054 healthy controls were included in the analysis and analyzed by means of Anatomical Likelihood Estimation (ALE). GM alterations were identified in eight clusters covering different parts of the cingulate and medial frontal gyri, paracentral lobes, left post- and precentral gyri, left anterior and right posterior insulae and left superior frontal gyrus. The behavioral characterization associated these regions with specific cognitive, emotional, somatosensory and motor functions. Moreover, the clusters represent nodes within behaviorally relevant brain networks. Our results suggest that GM reduction in AUD could disrupt network communication responsible for the neurocognitive impairments associated with high chronic alcohol consumption.

Perceptual insensitivity to the modulation of interoceptive signals in depression, anxiety, and substance use disorders

This study employed a series of heartbeat perception tasks to assess the hypothesis that cardiac interoceptive processing in individuals with depression/anxiety (N = 221), and substance use disorders (N = 136) is less flexible than that of healthy individuals (N = 53) in the context of physiological perturbation. Cardiac interoception was assessed via heartbeat tapping when: (1) guessing was allowed; (2) guessing was not allowed; and (3) experiencing an interoceptive perturbation (inspiratory breath hold) expected to amplify cardiac sensation. Healthy participants showed performance improvements across the three conditions, whereas those with depression/anxiety and/or substance use disorder showed minimal improvement. Machine learning analyses suggested that individual differences in these improvements were negatively related to anxiety sensitivity, but explained relatively little variance in performance. These results reveal a perceptual insensitivity to the modulation of interoceptive signals that was evident across several common psychiatric disorders, suggesting that interoceptive deficits in the realm of psychopathology manifest most prominently during states of homeostatic perturbation.

Linking perception of bodily states and cognitive control: the role of interoception in impulsive behaviour

Interoception and impulsivity are two multi-dimensional constructs and although the role of interoception in impulsiveness has been previously reported, it is not clear whether their different facets are related to each other. In the present study, we aimed at bridging this gap by investigating the relationships between interoception and impulsivity in the light of their multi-dimensional nature. To this aim, we conducted a cross-task comparison and assessed in the same sample of healthy participants, interoceptive accuracy, by the heartbeat perception task, interoceptive sensibility, by a self-reported measure, "hot" impulsivity, by a behavioural task of risk taking, and "cool" impulsivity, by a go/no-go task. Also, we assessed trait impulsivity by a self-report measure. We found that interoceptive sensibility contributed to "hot" impulsivity, while interoceptive accuracy was related to non-planning trait impulsivity. These findings underscore the need to investigate at a finer grain the relationships between these two complex, multi-dimensional constructs.

The synergistic effect between interoceptive accuracy and alcohol use disorder status on pain sensitivity

BACKGROUND

Interoceptive accuracy and pain sensitivity are both risk factors in the development of alcohol use disorder (AUD). However, the synergistic association between these two factors has not been investigated in an AUD sample. Therefore, the aim of the current study was to investigate whether the association between interoceptive accuracy and sensitivity to pain differed across AUD status.

METHODS

The study group included 165 individuals diagnosed with AUD (88.1% men) and 110 healthy controls (HCs; 74.5% men). Interoceptive accuracy was assessed with the Schandry Task. The Pain Sensitivity Questionnaire was utilized to measure sensitivity to pain. Anxiety, biological sex, and age were included as covariates in a model examining the role of AUD status as a moderator in the association between interoceptive accuracy and pain sensitivity.

RESULTS

A significant interaction was found between interoceptive accuracy and AUD status (b = -4.580, 95% CI = [-8.137, -1.022], p = 0.012, ΔR² = 0.032). Findings indicate that interoceptive accuracy was negatively associated with pain sensitivity among individuals with AUD, while there was a trend for an opposite association among healthy controls.

CONCLUSION

We hypothesize that persistent alcohol drinking may contribute to disruption of the normative association between interoception and pain. Future studies should be conducted to develop knowledge on this association and to investigate its possible therapeutic significance and implications.

Interoceptive Awareness, Decision-Making and Impulsiveness in Male Patients with Alcohol or Opioid Use Disorder

BACKGROUND

The present study was prepared on the assumption that interoceptive awareness (IA) and decision-making processes are implicated in addiction, and that somatic feedback plays an important role in decision-making.

METHODS

The study participants included 80 abstinent male inpatients with alcohol use disorder (n = 40) or opioid use disorder (n = 40) according to DSM-5 criteria (current severity: moderate or severe), along with 40 healthy male volunteers. All participants performed the heart rate tracking task as an objective physiological performance measure of IA and a computerized version of the Iowa gambling task (IGT) as a validated measure of decision-making. Impulsiveness was assessed using the Barratt Impulsiveness Scale 11 (BIS-11). Craving was evaluated with the Penn Alcohol Craving Scale (PACS) or Substance Craving Scale (SCS).

RESULTS

(1) Heartbeat perception (HBP) and IGT scores were similar between the patients with alcohol or opioid addiction, being significantly lower than those in the control group, and the difference remained significant even when controlling for the factors that were significant in bivariate analyses; (2) HBP scores of patients correlated significantly with IGT scores, even when controlling the effect of the related variables; (3) BIS-11 scores of patients negatively correlated significantly with HBP scores and did not correlate significantly with IGT scores; and (4) PACS/SCS scores did not correlate significantly with HBP and IGT scores.

CONCLUSIONS

Our findings support the hypothesis that IA and decision-making processes are implicated in addiction and that decreased IA is associated with impaired decision-making.

Deter the emotions: Alexithymia, impulsivity and their relationship to binge drinking

Introduction

The relevance of both emotion processing and impulsivity to alcohol use and misuse is increasingly recognised, yet there is a scarcity of studies addressing their reciprocal interaction. The present study aimed to examine the role that difficulties in emotion processing and trait impulsivity play in explaining binge drinking pattern of alcohol use in student population. We looked at binge drinking, as it is a risk factor to later alcohol abuse and is a common alcohol drinking habit among students. Alexithymia (from Greek as "deter/repel emotions"), a difficulty in identifying and describing feelings in self and others is increasingly recognised as a feature of alcohol misuse.

Methods

One-hundred and seventy-four student alcohol drinkers were assessed for their drinking habits (Alcohol Use Questionnaire), as well as for alexithymia (Toronto Alexithymia Scale) and impulsivity trait (Barratt Impulsiveness Scale); facial emotional expression judgements were also tested.

Results

A direct relationships between, both, alexithymia and impulsivity, and binge drinking was found. When combined, trait impulsivity partially mediated the relationship between alexithymia and binge drinking. Facial emotional expression judgements also showed a relationship with binge drinking.

Conclusions

These findings highlight the importance of both emotion processing and impulsivity in understanding binge drinking and indicate potential routes for prevention and intervention techniques, especially towards those who may be at risk of later alcohol abuse.

The Role of Impulsivity Facets on the Incidence and Development of Alcohol Use Disorders

Alcohol Use Disorder (AUD) is a chronic relapsing disorder defined according to the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5; American Psychiatric Association 2013), "by a cluster of behavioural and physical symptoms, which can include, withdrawal, tolerance and craving". Social, emotional, behavioural and cognitive factors are important contributors to AUD. Impulsivity, a multifaceted behavioural concept, defined as a predisposition for rapid and unplanned actions, without considering potential negative consequences of these actions, represents an important such factor. In this chapter, research on the role of distinct impulsivity dimensions in different severity stages of alcohol use is presented.Increased self-reported (trait) impulsivity and an inability to wait, as well as difficulty to adjust behaviour appropriately following a failure to withhold a response are observed across the spectrum of alcohol-use severities. Research on temporal impulsivity (inability to delay gratification) consistently shows deficits in more severe alcohol users. Data on temporal impulsivity in early stages of alcohol use are less consistent, with some studies showing no differences between high and moderate drinkers, while others indicating increased impulsivity in high alcohol users. Data on reflexion impulsivity are currently limited to draw conclusions. Recent research is also presented suggesting the importance of perception and interpretation of physiological and emotional signals on alcohol use behaviour highlighting the necessity of comprehensive integration of the field of the study of emotion and interoception with impulsivity research.

Childhood Trauma, Emotion Regulation, and Pain in Individuals With Alcohol Use Disorder

Introduction: Several studies have confirmed that the experience of childhood trauma, poor emotion regulation, as well as the experience of physical pain may contribute to the development and poor treatment outcomes of alcohol use disorder (AUD). However, little is known about how the joint impact of these experiences may contribute to AUD. Objectives: To analyze associations between childhood trauma, emotion regulation, and pain in individuals with AUD. Methods: The study sample included 165 individuals diagnosed with AUD. The Childhood Trauma Questionnaire (CTQ) was used to investigate different types of trauma during childhood (physical, emotional, and sexual abuse and neglect), the Brief Symptom Inventory was used to assess anxiety symptoms, the Difficulties in Emotion Regulation Scale (DERS) was used to assess emotional dysregulation, and the Pain Resilience Scale and Pain Sensitivity Questionnaire were used to measure self-reported pain tolerance and sensitivity. Results: Childhood emotional abuse (CTQ subscale score) was positively associated with anxiety, anxiety was positively associated with emotional dysregulation, and emotional dysregulation was negatively associated with pain tolerance. Accordingly, there was support for a significant indirect negative association between childhood emotional abuse and pain tolerance. The serial mediation statistical procedure demonstrated that anxiety and emotional dysregulation mediated the effect of childhood emotional abuse on pain resilience among individuals with AUD. Conclusions: Targeting emotional dysregulation and physical pain that can result from childhood trauma may have particular therapeutic utility among individuals treated for AUD.

Association Between Interoception and Emotion Regulation in Individuals With Alcohol Use Disorder

INTRODUCTION

Sensing body-related information includes interoceptive sensibility (the tendency to focus on internal body sensations) and accuracy (precision in perceiving real internal processes). Interoception and emotion regulation have both been linked to alcohol use disorder (AUD). However, the association between these factors have not been investigated within a clinical group of individuals with AUD.

OBJECTIVES

The current study examines associations between emotion regulation and interoceptive accuracy and sensibility among individuals with AUD and healthy controls (HCs).

METHODS

The sample comprised 165 individuals meeting criteria for AUD and 110 HCs. Interoceptive sensibility was assessed with a self-report measure (the Private Body Consciousness subscale) and interoceptive accuracy - with a behavioral measure (the Schandry test). Emotion regulation domains: non-acceptance of negative emotions, inability to engage in goal-directed behaviors when experiencing negative emotions, difficulties controlling impulsive behaviors when experiencing negative emotions, limited access to effective emotion regulation strategies, and lack of own emotional awareness and clarity were assessed with the Difficulties in Emotion Regulation Scale (DERS). Associations between interoception and emotion regulation were assessed while controlling for sleep problems, depressive symptoms, age, and sex.

RESULTS

Higher interoceptive accuracy was negatively associated with DERS subscale of non-acceptance of negative emotions in the AUD group (but not in the HC group). Higher interoceptive sensibility was significantly associated with problems in controlling impulsive behaviors when experiencing negative emotions. This association was moderated by symptoms of AUD. Higher interoceptive sensibility was associated with higher emotional awareness, but only in the HC group.

CONCLUSIONS

Individuals with AUD who are more interoceptively accurate may be more effective in regulating their emotions. On the other hand, individuals with AUD who are more interoceptively sensible, may have problems with controlling their behaviors while experiencing negative emotional states.