Gender differences in interoceptive accuracy and emotional ability: An explanation for incompatible findings

Interoceptive awareness in a clinical setting: the need to bring interoceptive perspectives into clinical evaluation

Interoceptive awareness (IA) is crucial to understanding mental health. The Multidimensional Assessment of Interoceptive Awareness (MAIA) scale, available in approximately 30 languages, has gained global recognition for its research applicability. This review highlights the critical importance of integrating IA evaluation in clinical settings, advocating for the MAIA scale's potential as a screening tool. Through an examination of academic databases, including Scopus, PubMed, Google Scholar, and J-STOR, our analysis spans seven mental health domains: eating disorders (ED), depression, stress, anxiety, autism spectrum disorder (ASD), chronic pain, and suicide ideation (SI). Thirty-eight studies showed links between several dimensions of IA with different disorders. That is, ED was related to Body Trust and Self-Regulation; anxiety to Body Listening, Emotional Awareness, and Self-Regulation; depression to Noticing and Emotional Awareness; ASD to Trusting, Emotional Awareness, and Noticing; chronic pain to Not-Worrying and Self-Regulation; and SI with Trusting. These insights hold profound implications for both clinical practice and mental health research. Integrating IA assessments into standard clinical protocols has the potential to improve our understanding of pathology, enrich patient care, and enhance therapeutic strategies.

Sex differences in patient-reported outcome measure of psychotic symptoms in schizophrenia

PURPOSE

to study sex differences in self-reported symptoms measured with the Scale of Patient-Reported Impact of Symptoms in Schizophrenia (PRISS), to investigated sex differences in the degree of agreements between self-reported symptoms and clinical symptoms assessed by professionals, and to identify which clinical and sociodemographic variables predicted a greater presence of self-reported symptoms split by sex.

METHODS

161 patients (37 females; 124 males), aged between 18 and 65 years, with a diagnosis of schizophrenia assisted in non-acute mental health services at four mental health catchment areas in Andalucia and Catalonia were included. The PRISS scale was administered to asses self-reported symptoms.

RESULTS

males reported higher presence of excitement, grandiosity, motor retardation and poor attention) than women. There was less agreement in the presence of psychotic symptoms in men than in women when comparing self-reported symptoms and clinical symptoms assessed by professionals. Finally, in men the predictors variables for the greater presence of self-perceived symptoms were greater psychotic symptomatology and more disability, while in women were greater presence of alogia and higher doses of chlorpromazine.

CONCLUSIONS

Assessing and being aware of the self-perceived symptoms of patients with schizophrenia should be considered in the clinic, especially in men, as there appears to be a lack of agreement on certain items. This would allow treatments to be more focused on patients' need by sex, and would make them feel part of the therapeutic process, improving their therapeutic adherence, evolution and quality of life.

Probing corporeal awareness in women through virtual reality induction of embreathment illusion

We capitalized on the respiratory bodily illusion that we discovered in a previous study and called 'Embreathment' where we showed that breathing modulates corporeal awareness in men. Despite the relevance of the issue, no such studies are available in women. To bridge this gap, we tested whether the synchronization of avatar-participant respiration patterns influenced females' bodily awareness. We collected cardiac and respiratory interoceptive measures, administered body (dis)satisfaction questionnaires, and tracked participants' menstrual cycles via a mobile app. Our approach allowed us to characterize the 'Embreathment' illusion in women, and explore the relationships between menstrual cycle, interoception and body image. We found that breathing was as crucial as visual appearance in eliciting feelings of ownership and held greater significance than any other cue with respect to body agency in both women and men. Moreover, a positive correlation between menstrual cycle days and body image concerns, and a negative correlation between interoceptive sensibility and body dissatisfaction were found, confirming that women's body dissatisfaction arises during the last days of menstrual cycle and is associated with interoception. These findings have potential implications for corporeal awareness alterations in clinical conditions like eating disorders and schizophrenia.

The relationship between mindfulness and athletes' mental skills may be explained by emotion regulation and self-regulation

BACKGROUND

Although numerous psychological determinants of sports success have been identified in the scientific literature, research on the contribution of mindfulness and interoceptive awareness to sports achievements remains limited. This study investigates the relationship between self-reported mental skills determining sports success (i.e., flow state, attention, technique, sensitivity to error, commitment, and achievement), state mindfulness for physical activity (of the mind and the body), and interoceptive awareness (including scales of noticing, not distracting, not worrying, attention regulation, emotional awareness, self-regulation, body listening, and trusting).

METHODS

A cross-sectional online survey was conducted on a sample of elite athletes in speed skating (n = 54) and university students of physical education (n = 102) representing various sports disciplines and competitive levels. The Sports Success Scale (SSS), the State Mindfulness Scale for Physical Activity (SMS-PA), and the Multidimensional Assessment of Interoceptive Awareness (MAIA-2) were used to assess psychological determinants of athletic achievements, state mindfulness, and interoceptive sensitivity, respectively.

RESULTS

Our findings indicate some small-to-moderate differences in particular dimensions of psychological traits related to sports success, mindfulness, and interoceptive awareness between athletes of different genders, groups, and competitive levels. A chain mediation model showed that the relationship between body mindfulness and psychological variables determining sports success is fully explained by two dimensions of interoception: self-regulation and attention regulation.

CONCLUSIONS

Cultivating the mindfulness state of the body can improve self-regulation and attention regulation, which in turn may increase the mental skills required for successful sports participation. Therefore, mental training should focus primarily on body mindfulness, attention regulation, and self-regulation to improve the mental skills responsible for athletes' sports achievements. In addition, individual differences in athletes' gender, sports discipline, and level of sports competition should be considered during mental training.

Interoception: Where do we go from here?

In recent years, there has been a significant rise in interest in interoception, the processing of internal bodily signals. This interest has been coupled by increased concerns regarding the measurement and conceptualisation of interoception. Focusing on cardiac interoceptive accuracy, I outline what I believe to be the most pressing issues in the field of interoception-specifically the continued reliance on the heartbeat counting task. I then provide an overview of what I believe to be more general limitations concerning how we measure and conceptualise individual differences in interoception and suggestions for a way forward. Specifically, I believe that by moving beyond single measurements, establishing optimal levels of interoceptive accuracy, and refocusing from accuracy to propensity, we may be able to uncover the real-life relevance of interoceptive abilities.

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

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

Interoceptive awareness in a Norwegian population: psychometric properties of the Multidimensional Assessment of Interoceptive Awareness (MAIA) 2

BACKGROUND

Interoception plays a vital role in human cognition and emotion and is an increasingly important part of clinical studies of mind-body approaches and mental health. Interoceptive awareness (IA) encompasses numerous mind-body components and can be assessed by employing a self-report measure such as the Multidimensional Assessment of Interoceptive Awareness (MAIA), which has been adapted and validated across several countries and is used in experimental and clinical settings. In this study, the MAIA-2, which was developed due to the psychometric shortages of MAIA, was thoroughly translated, and its psychometric features were examined in a sample of 306 Norwegian-speaking participants (81% females, ages 16 through 66 plus).

METHODS

The participants completed the MAIA-2 Norwegian version (MAIA-2-N) and the COOP/WONCA Functional Assessment Charts measuring psychological, physical, and overall health. The following psychometric qualities of the MAIA-2 were investigated: factor structure, internal consistency, and the moderating role of gender.

RESULTS

Confirmatory Factor Analysis (CFA) revealed that an 8-factor model of MAIA-2-N provided the best fit. Also, a bifactor model revealed a proper fit. Good internal consistency and a moderating role of gender, age, and education on the relationships between certain MAIA-2-N factors and health were observed.

CONCLUSIONS

The MAIA-2-N is an adequate measure of IA in Norwegian-speaking individuals. The factor-structure corresponds with the original MAIA-2 and it shows good internal consistency. Some moderating effects of gender were observed, particularly related to the relationship between IA and physical and psychological state, with the physical state/fitness more closely linked to IA in males and psychological state in females.

Association of Hypnotizability, Interoception, and Emotion

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

Self-reported interoceptive accuracy and interoceptive attention differentially correspond to measures of visual attention and self-regard

Background

Interoception, the perception of bodily functions and sensations, is a crucial contributor to cognition, emotion, and well-being. However, the relationship between these three processes is not well understood. Further, it is increasingly clear that dimensions of interoception differentially corresponds to these processes, yet this is only recently being explored. The present study addresses two important questions: Are subjective interoceptive accuracy and interoceptive attention related to self-regard and well-being? And are they related to exteroceptive (visual) attention?

Methods

Participants (N = 98; 29% women; aged 23-64 years) completed: a battery of questionnaires to assess subjective accuracy (how well one predicts bodily sensations), interoceptive attention (a tendency to notice bodily signals), self-regard (self-esteem, self-image, life satisfaction), state negative affect (depression, anxiety, and stress), a self-esteem Implicit Association Task (a measure of implicit self-esteem), and a flanker task to assess visual selective attention. Subjective interoceptive accuracy and attention served as dependent variables. Correlations and principal component analysis was used to establish correlations among variables and determine how, or whether, these measures are associated with subjective interoceptive accuracy or attention.

Results

Greater scores on measures of self-regard, implicit self-esteem, cognition and lower negative affect were broadly associated with greater subjective interoceptive accuracy. Conversely, only explicit self-esteem, satisfaction with life, and self-image corresponded to subjective interoceptive attention. An exploratory analysis with a more inclusive scale of interoceptive attention was conducted. Results of this exploratory analysis showed that the broader measure was a stronger correlate to self-regard than subjective interoceptive accuracy, though it, too, did not correlate with visual attention. In short, both subjective interoceptive accuracy and attention corresponded to well-being and mental health, but only accuracy was associated with exteroceptive attention.

Conclusion

These results add to a growing literature suggesting different dimensions of (subjective) interoception differentially correspond to indices of well-being. The links between exteroceptive and interoceptive attention, and their association with merit further study.

From Virtual Reality to Regenerative Virtual Therapy: Some Insights from a Systematic Review Exploring Inner Body Perception in Anorexia and Bulimia Nervosa

Despite advances in our understanding of the behavioral and molecular factors that underlie the onset and maintenance of Eating Disorders (EDs), it is still necessary to optimize treatment strategies and establish their efficacy. In this context, over the past 25 years, Virtual Reality (VR) has provided creative treatments for a variety of ED symptoms, including body dissatisfaction, craving, and negative emotions. Recently, different researchers suggested that EDs may reflect a broader impairment in multisensory body integration, and a particular VR technique-VR body swapping-has been used to repair it, but with limited clinical results. In this paper, we use the results of a systematic review employing PRISMA guidelines that explore inner body perception in EDs (21 studies included), with the ultimate goal to analyze the features of multisensory impairment associated with this clinical condition and provide possible solutions. Deficits in interoception, proprioception, and vestibular signals were observed across Anorexia and Bulimia Nervosa, suggesting that: (a) alteration of inner body perception might be a crucial feature of EDs, even if further research is needed and; (b) VR, to be effective with these patients, has to simulate/modify both the external and the internal body. Following this outcome, we introduce a new therapeutic approach-Regenerative Virtual Therapy-that integrates VR with different technologies and clinical strategies to regenerate a faulty bodily experience by stimulating the multisensory brain mechanisms and promoting self-regenerative processes within the brain itself.