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Solano Durán P, Morales JP, Huepe D. Interoceptive awareness in a clinical setting: the need to bring interoceptive perspectives into clinical evaluation. Front Psychol 2024; 15:1244701. [PMID: 38933585 PMCID: PMC11199726 DOI: 10.3389/fpsyg.2024.1244701] [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: 06/23/2023] [Accepted: 04/26/2024] [Indexed: 06/28/2024] Open
Abstract
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.
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Affiliation(s)
- Paola Solano Durán
- Center for Social and Cognitive Neuroscience (CSCN), School of Psychology, Universidad Adolfo Ibáñez, Santiago de Chile, Chile
- Oficina de Equidad de Género, Instituto Tecnológico de Costa Rica, Cartago, Costa Rica
| | - Juan-Pablo Morales
- Facultad de Educación Psicología y Familia, Universidad Finis Terrae, Santiago, Chile
- University of Sydney Business School, Darlington, NSW, Australia
| | - David Huepe
- Center for Social and Cognitive Neuroscience (CSCN), School of Psychology, Universidad Adolfo Ibáñez, Santiago de Chile, Chile
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2
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Reilly EE, Brown TA, Frank GKW. Perceptual Dysfunction in Eating Disorders. Curr Top Behav Neurosci 2024. [PMID: 38730196 DOI: 10.1007/7854_2024_470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
Eating disorders (EDs) are characterized by abnormal responses to food and weight-related stimuli and are associated with significant distress, impairment, and poor outcomes. Because many of the cardinal symptoms of EDs involve disturbances in perception of one's body or abnormal affective or cognitive reactions to food intake and how that affects one's size, there has been longstanding interest in characterizing alterations in sensory perception among differing ED diagnostic groups. Within the current review, we aimed to critically assess the existing research on exteroceptive and interoceptive perception and how sensory perception may influence ED behavior. Overall, existing research is most consistent regarding alterations in taste, visual, tactile, and gastric-specific interoceptive processing in EDs, with emerging work indicating elevated respiratory and cardiovascular sensitivity. However, this work is far from conclusive, with most studies unable to speak to the precise etiology of observed perceptual differences in these domains and disentangle these effects from affective and cognitive processes observed within EDs. Further, existing knowledge regarding perceptual disturbances in EDs is limited by heterogeneity in methodology, lack of multimodal assessment protocols, and inconsistent attention to different ED diagnoses. We propose several new avenues for improving neurobiology-informed research on sensory processing to generate actionable knowledge that can inform the development of innovative interventions for these serious disorders.
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Affiliation(s)
- Erin E Reilly
- Department of Psychiatry and Behavioral Science, University of California, San Francisco, San Francisco, CA, USA
| | - Tiffany A Brown
- Department of Psychology, Auburn University, Auburn, AL, USA
| | - Guido K W Frank
- Department of Psychiatry, University of California, San Diego, CA, USA.
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3
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Gagliardi M. The role of developmental caregiving programming in modulating our affiliation tendency and the vulnerability to social anxiety and eating disorders. Front Psychol 2024; 14:1259415. [PMID: 38239461 PMCID: PMC10794631 DOI: 10.3389/fpsyg.2023.1259415] [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: 09/19/2023] [Accepted: 12/01/2023] [Indexed: 01/22/2024] Open
Abstract
Attachment is the evolutionarily-established process through which humans create bonds with others to receive care from them. The phenomenon is as essential to our physical survival as it is to our psychological development. An increasing number of studies demonstrates that in sensitive periods during the early years of life, our brain circuitry is programmed in the interactions with our caregivers, with the imprinting of information over multiple attachment dimensions. Adopting a basic brain-computer analogy, we can think of this knowledge as the psycho-social firmware of our mind. According to a recently proposed extension of the classical three-dimensional view, one attachment dimension - somaticity - concerns the caregiver's task of reflecting and confirming the child's (internal) states - such as sensations, emotions, and representations - to support the child's ability to identify and define those entities autonomously. Relying on multidisciplinary evidence - from neuroscientific, developmental, evolutionary, and clinical sources - we suggest that somaticity (H1) has the adaptive function to modulate our tendency to comply and affiliate with a reference group but also (H2) increases the vulnerability to developing Social Anxiety (SA) and Eating Disorders (EDs). We evaluate H1-H2, (1) indicating the evolutionary role of somaticity in modulating our affiliation tendency to optimize the ancestral threat-opportunity balance coming from infectious diseases and (2) showing the deep connection between SA-EDs and the features most closely related to somaticity - interoception and parenting style. Finally, we discuss three relevant implications of H1-H2: (A) Bringing into research focus the adaptive role of our firmware knowledge system versus the hardware (neural substrate) and software (higher cognition) ones. (B) Complementing the well-grounded Objectification and Allocentric Lock Theories, allowing us to integrate multiple levels of explanation on the etiology of psychopathology. (C) Suggesting the design of new psychological treatments. While not aiming to prove H1-H2, our analysis supports them and encourages their direct testing.
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4
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Naraindas AM, Moreno M, Cooney SM. Beyond Gender: Interoceptive Sensibility as a Key Predictor of Body Image Disturbances. Behav Sci (Basel) 2023; 14:25. [PMID: 38247677 PMCID: PMC10812832 DOI: 10.3390/bs14010025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/20/2023] [Accepted: 12/25/2023] [Indexed: 01/23/2024] Open
Abstract
Body image disturbance (BID) involves negative attitudes towards shape and weight and is associated with lower levels of interoceptive sensibility (IS) (the subjective perceptions of internal bodily states). This association is considered a risk factor for developing eating disorders (EDs) and is linked to altered sensorimotor representations of the body (i.e., body schema). BIDs manifest across genders and are currently understudied in men. This study investigated gender-related differences in BID and its relationship to the body schema and IS. Data were collected from 86 men and 86 women. BID was assessed using questionnaires measuring self-objectification, state, and trait body dissatisfaction. IS was measured via the MAIA-2. The body schema was indexed via an embodied mental rotation task. Results showed that women reported higher BID than men across all scales. Gender differences in sub-components of interoceptive sensibility were found. Overall, both gender and interoceptive sensibility predicted BID. However, interoceptive sensibility exhibited its own unique association with BID beyond the influence of gender. BID, IS and gender were not significant predictors of performance in the body schema task. Therefore, while gender predicts differences in BID and interoceptive sensibility, there was no evidence of gender-related differences in body schema.
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Affiliation(s)
| | | | - Sarah M. Cooney
- School of Psychology, University College Dublin, D04 F6X4 Dublin, Ireland;
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5
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Colle L, Hilviu D, Boggio M, Toso A, Longo P, Abbate-Daga G, Garbarini F, Fossataro C. Abnormal sense of agency in eating disorders. Sci Rep 2023; 13:14176. [PMID: 37648816 PMCID: PMC10469170 DOI: 10.1038/s41598-023-41345-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 08/24/2023] [Indexed: 09/01/2023] Open
Abstract
The feeling of controlling one's own actions and, through them, impacting the external environment (i.e. Sense of Agency-SoA) can be relevant in the eating disorders (EDs) symptomatology. Yet, it has been poorly investigated. This study aims to implicitly assess SoA exploiting the Sensory Attenuation paradigm in two groups of EDs patients (Anorexia Nervosa Restrictive and Anorexia Nervosa Binge-Purging or Bulimia Nervosa) compared to a control group. We find that controls perceive self-generated stimuli as less intense than other-generated ones showing the classic pattern of sensory attenuation. By contrast, EDs patients show the opposite pattern, with self-generated perceived as more intense than other-generated stimuli. This result indicates an alteration of the implicit component of the feeling of control in EDs patients, thus suggesting a potential implication of these results for the clinical practice and the treatment of EDs symptomatology.
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Affiliation(s)
- Livia Colle
- Department of Psychology, University of Turin, Turin, Italy
| | - Dize Hilviu
- Department of Psychology, University of Turin, Turin, Italy
| | - Monica Boggio
- Department of Psychology, University of Turin, Turin, Italy
| | - Alessandra Toso
- Department of Neuroscience, University of Turin, AOU Città della Salute e della Scienza, Turin, Italy
| | - Paola Longo
- Department of Neuroscience, University of Turin, AOU Città della Salute e della Scienza, Turin, Italy
| | - Giovanni Abbate-Daga
- Department of Neuroscience, University of Turin, AOU Città della Salute e della Scienza, Turin, Italy
| | | | - Carlotta Fossataro
- MANIBUS Lab, Department of Psychology, University of Turin, Turin, Italy.
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6
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Malighetti C, Sansoni M, Gaudio S, Matamala-Gomez M, Di Lernia D, Serino S, Riva G. From Virtual Reality to Regenerative Virtual Therapy: Some Insights from a Systematic Review Exploring Inner Body Perception in Anorexia and Bulimia Nervosa. J Clin Med 2022; 11:jcm11237134. [PMID: 36498708 PMCID: PMC9737310 DOI: 10.3390/jcm11237134] [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: 09/09/2022] [Revised: 11/10/2022] [Accepted: 11/20/2022] [Indexed: 12/02/2022] Open
Abstract
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.
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Affiliation(s)
- Clelia Malighetti
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 20100 Milan, Italy
| | - Maria Sansoni
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 20100 Milan, Italy
- Correspondence: ; Tel.: +39-02-72-343-863
| | - Santino Gaudio
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Husargatan 3, 75237 Uppsala, Sweden
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Viale Montpellier 1, 00133 Rome, Italy
| | - Marta Matamala-Gomez
- Department of Psychology, Mind and Behavior Technological Center, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milan, Italy
| | - Daniele Di Lernia
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 20100 Milan, Italy
| | - Silvia Serino
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 20100 Milan, Italy
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Via Magnasco 2, 20149 Milan, Italy
- Humane Technology Lab, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 20100 Milan, Italy
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7
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Adams KL, Edwards A, Peart C, Ellett L, Mendes I, Bird G, Murphy J. The association between anxiety and cardiac interoceptive accuracy: A systematic review and meta-analysis. Neurosci Biobehav Rev 2022; 140:104754. [DOI: 10.1016/j.neubiorev.2022.104754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 11/25/2022]
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8
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Crucianelli L, Enmalm A, Ehrsson HH. Interoception as independent cardiac, thermosensory, nociceptive, and affective touch perceptual submodalities. Biol Psychol 2022; 172:108355. [PMID: 35597523 DOI: 10.1016/j.biopsycho.2022.108355] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 05/04/2022] [Accepted: 05/09/2022] [Indexed: 11/19/2022]
Abstract
Interoception includes signals from inner organs and thin afferents in the skin, providing information about the body's physiological state. However, the functional relationships between interoceptive submodalities are unclear, and thermosensation as skin-based interoception has rarely been considered. We used five tasks to examine the relationships among cardiac awareness, thermosensation, affective touch, and nociception. Thermosensation was probed with a classic temperature detection task and the new dynamic thermal matching task, where participants matched perceived moving thermal stimuli in a range of colder/warmer stimuli around thermoneutrality. We also examined differences between hairy and non-hairy skin and found superior perception of dynamic temperature and static cooling on hairy skin. Notably, no significant correlations were observed across interoceptive submodality accuracies (except for cold and pain perception in the palm), which indicates that interoception at perceptual levels should be conceptualised as a set of relatively independent processes and abilities rather than a single construct. DATA AVAILABILITY STATEMENT: Data of this study are available as a supplementary file.
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Affiliation(s)
- Laura Crucianelli
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Adam Enmalm
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - H Henrik Ehrsson
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
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9
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Food Consciousness Intervention Improves Interoceptive Sensitivity and Expression of Exteroception in Women. Nutrients 2022; 14:nu14030450. [PMID: 35276809 PMCID: PMC8837977 DOI: 10.3390/nu14030450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/06/2022] [Accepted: 01/10/2022] [Indexed: 02/05/2023] Open
Abstract
The perception of the body’s internal state (interoception) and the perception and processing of environmental sensory stimuli (exteroception) act together to modulate adaptive behaviour, including eating behaviour, and are related to bodyweight control. This study evaluated the impact of the Food and Nutrition Education Program with Sensory and Cognitive Exercises on interoceptive sensitivity and on the expression of exteroceptive perception in women who experienced difficulty in controlling their body weight. Thirty-seven women were randomized into two groups and evaluated at two moments: before and after the intervention or before and after a 3- to 4-week waiting period. A heartbeat tracking task was used for interoception evaluation. Participants were asked to write a text describing three foods after tasting them for exteroception evaluation. After the intervention, the participants showed an increase in interoceptive sensitivity, and an increase in the expression of exteroceptive stimuli perception through a semantic assessment of their writing related to the tasting experience. In addition, the results point to a possible connection between the mechanisms governing interoception and exteroception. This work brings important contributions to the search for strategies capable of promoting the perception and integration of physiological and environmental stimuli in food consumption.
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10
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Baiano C, Job X, Santangelo G, Auvray M, Kirsch LP. Interactions between interoception and perspective-taking: Current state of research and future directions. Neurosci Biobehav Rev 2021; 130:252-262. [PMID: 34400177 DOI: 10.1016/j.neubiorev.2021.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/22/2021] [Accepted: 08/07/2021] [Indexed: 01/10/2023]
Abstract
Interoception, the sense of the physiological state of the body, and perspective-taking, the ability to take another's point of view, are two fundamental components contributing to our perception and interaction with the external world. However, whether the perception of our inner body influences how we perceive the external world and other people remains poorly understood. Here, we review recent behavioural and neuroimaging evidence investigating the links between dimensions of interoception (i.e., accuracy, sensibility and awareness) and perspective-taking (i.e., affective, cognitive and visual). So far, only a limited subset of these dimensions has been investigated together and the results suggest that interoceptive abilities may only interact with perspective-taking when embodied mental transformations are required. Furthermore, mainly the emotional aspects of perspective-taking are related to interoception, influencing the ability to empathise with others. Future research should systematically investigate the links between all dimensions of interoception and perspective-taking to provide full understanding of the specific role interoception has on how we perceive the world and take another's point of view.
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Affiliation(s)
- Chiara Baiano
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy.
| | - Xavier Job
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden; Institut des Systèmes Intelligents et de Robotique, Sorbonne Université, Paris, France
| | - Gabriella Santangelo
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Malika Auvray
- Institut des Systèmes Intelligents et de Robotique, Sorbonne Université, Paris, France.
| | - Louise P Kirsch
- Institut des Systèmes Intelligents et de Robotique, Sorbonne Université, Paris, France.
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11
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van Dyck Z, Schulz A, Blechert J, Herbert BM, Lutz APC, Vögele C. Gastric interoception and gastric myoelectrical activity in bulimia nervosa and binge-eating disorder. Int J Eat Disord 2021; 54:1106-1115. [PMID: 32400920 PMCID: PMC8359291 DOI: 10.1002/eat.23291] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 03/29/2020] [Accepted: 04/29/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Identifying factors that control food intake is crucial to the understanding and treatment of eating disorders characterized by binge eating. In healthy individuals, stomach distension plays an important role in the development of satiation, but gastric sensations might be overridden in binge eating. The present study investigated the perception of gastric signals (i.e., gastric interoception) and gastric motility in patients experiencing binge-eating episodes, that is, bulimia nervosa (BN) and binge-eating disorder (BED). METHOD Twenty-nine patients with BN or BED (ED group) and 32 age-, sex-, and BMI-matched healthy controls (HC group) participated in the study. The onset of satiation and stomach fullness were assessed using a novel 2-step water load test (WLT-II). Gastric myoelectrical activity (GMA) was measured by electrogastrography (EGG) before and after ingestion of noncaloric water. RESULTS Individuals in the ED group drank significantly more water until reporting satiation during the WLT-II. The percentage of normal gastric myoelectrical power was significantly smaller in the ED group compared to HC, and negatively related to the number of objective binge-eating episodes per week in patients with BN or BED. Power in the bradygastria range was greater in ED than in HC participants. DISCUSSION Patients with EDs have a delayed response to satiation compared to HC participants, together with abnormal GMA. Repeated binge-eating episodes may induce disturbances to gastric motor function.
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Affiliation(s)
- Zoé van Dyck
- Institute for Health and Behaviour, Department of Behavioural and Cognitive SciencesUniversity of LuxembourgEsch‐sur‐AlzetteLuxembourg
| | - André Schulz
- Institute for Health and Behaviour, Department of Behavioural and Cognitive SciencesUniversity of LuxembourgEsch‐sur‐AlzetteLuxembourg
| | - Jens Blechert
- Centre for Cognitive Neuroscience and Department of PsychologyUniversity of SalzburgSalzburgAustria
| | - Beate M. Herbert
- Department of Clinical Psychology and PsychotherapyEberhard‐Karls‐University of TübingenTübingenGermany
| | - Annika P. C. Lutz
- Institute for Health and Behaviour, Department of Behavioural and Cognitive SciencesUniversity of LuxembourgEsch‐sur‐AlzetteLuxembourg
| | - Claus Vögele
- Institute for Health and Behaviour, Department of Behavioural and Cognitive SciencesUniversity of LuxembourgEsch‐sur‐AlzetteLuxembourg
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12
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Flasbeck V, Bamberg C, Brüne M. Short-Term Fasting and Ingestion of Caloric Drinks Affect Heartbeat-Evoked Potentials and Autonomic Nervous System Activity in Males. Front Neurosci 2021; 15:622428. [PMID: 34267619 PMCID: PMC8276132 DOI: 10.3389/fnins.2021.622428] [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: 10/29/2020] [Accepted: 05/20/2021] [Indexed: 11/24/2022] Open
Abstract
Central nervous systems receive and process information from the internal and external environment to maintain homeostasis. This includes interoceptive awareness of the organism’s nutritional state. Whenever food supply is required, feelings of hunger initiate the search for and the consumption of appropriate amounts of nutrients. How this is physiologically regulated in humans has been subjected to research into interoceptive awareness of body states during fasting and food consumption. However, there is no research on the distinct effects of carbohydrate or protein intake on interoception. Therefore, we aimed to investigate the impact of fasting and consumption of standardized carbohydrate and protein shakes on interoception in a repeated-measures cross-over design in a sample of 37 healthy, normal weight males. As a physiological correlate of interoception, we measured heartbeat-evoked potentials (HEPs), which are suggested to reflect the cortical representation of cardiac signals, during eight-minutes resting state EEG-recordings. After a 16-hour fasting period, the HEP amplitudes were lower over right central and parietal electrodes and increased after ingestion of the nutritional shake. Exploratory analyses indicated that the difference between fasting and satiety was more prominent at carbohydrate compared protein testing days. Correlation analyses with heart rate variability (HRV) suggested that high cardiac sympathetic activity is related to lower HEP amplitudes. Furthermore, cardiac sympathetic activity and stress indices decreased from before to after the intervention, whereas HRV increased. Together, this study shows for the first time that fasting and the intake of a nutritional shake affects cardiac measures of autonomic nervous system functioning and the neural correlates of cardiac interoception. These findings could be relevant for diets and psychosomatic disorders, including eating disorders.
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Affiliation(s)
- Vera Flasbeck
- Division of Social Neuropsychiatry and Evolutionary Medicine, Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Christoph Bamberg
- Division of Social Neuropsychiatry and Evolutionary Medicine, Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Martin Brüne
- Division of Social Neuropsychiatry and Evolutionary Medicine, Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
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13
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DeVille DC, Erchull MJ, Mailloux JR. Intuitive eating mediates the relationship between interoceptive accuracy and eating disorder risk. Eat Behav 2021; 41:101495. [PMID: 33713922 DOI: 10.1016/j.eatbeh.2021.101495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 02/20/2021] [Accepted: 02/25/2021] [Indexed: 10/22/2022]
Abstract
Research supports an association between altered interoceptive accuracy, or the ability to accurately monitor sensations from the body, and disordered eating. However, the behavioral mechanism through which interoceptive accuracy may influence eating behaviors is unclear. Intuitive eating, the ability to regulate food intake according to visceral cues of hunger and satiety, is positively related to interoceptive accuracy and negatively related to disordered eating. Therefore, we hypothesized that interoceptive accuracy would be negatively associated with intuitive eating which would, in turn, influence eating disorder risk. A mediation analysis was performed to test this hypothesis in a sample of 41 undergraduate women who completed a heartbeat counting task to assess interoceptive accuracy, followed by self-report measures of intuitive eating ability and eating disorder risk. We found that eating for physical rather than emotional reasons and reliance on hunger and satiety cues, two aspects of intuitive eating, mediated the relationship between interoceptive accuracy and eating disorder risk. Although further research is necessary, it is possible that findings regarding the association between interoceptive accuracy and intuitive eating may inform the development of eating disorder prevention efforts.
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Affiliation(s)
- Danielle C DeVille
- University of Mary Washington, Department of Psychological Science, 1301 College Avenue, Fredericksburg, VA 22401, United States; University of Tulsa, Department of Psychology, 800 S. Tucker Drive, Tulsa, OK 74104, United States
| | - Mindy J Erchull
- University of Mary Washington, Department of Psychological Science, 1301 College Avenue, Fredericksburg, VA 22401, United States.
| | - Jennifer R Mailloux
- University of Mary Washington, Department of Psychological Science, 1301 College Avenue, Fredericksburg, VA 22401, United States.
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14
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Herbert BM. Interoception and Its Role for Eating, Obesity, and Eating Disorders. EUROPEAN JOURNAL OF HEALTH PSYCHOLOGY 2020. [DOI: 10.1027/2512-8442/a000062] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. The importance of the sense of ourselves from within for understanding adaptive behavior and psychopathology has been increasingly recognized during the last decades. Interoception builds the foundation of our embodied self and dysfunctional interoception lies at the core of many psychosomatic disorders. Eating is fundamental for survival with consequences for health and well-being. It is deeply grounded in homoeostatic and allostatic psychophysiological needs and is driven by interoceptive signals of the body. This narrative review summarizes a selection of empirical findings and draws conclusions on the role of interoception in eating behavior, body weight, and eating disorders. Beyond disordered eating behavior, eating disorders are characterized by impairment of the sense of self, with dysfunctional interoception at its core. Predictive coding accounts are addressed to integrate conclusions and to underline the relevance of interventions to modify interoception.
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Affiliation(s)
- Beate M. Herbert
- Clinical Psychology & Psychotherapy, Department of Psychology, Eberhard Karls University of Tübingen, Germany
- Psychology School, University of Applied Sciences Fresenius, Munich, Germany
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15
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Increased anticipatory brain response to pleasant touch in women remitted from bulimia nervosa. Transl Psychiatry 2020; 10:236. [PMID: 32669557 PMCID: PMC7363900 DOI: 10.1038/s41398-020-00916-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 06/22/2020] [Accepted: 06/30/2020] [Indexed: 01/24/2023] Open
Abstract
Bulimia nervosa (BN) is characterized by affective instability and dysregulated behaviors (binge eating, fasting, self-induced vomiting) that disrupt bodily homeostasis. Mechanisms underlying dysregulation in BN are unclear, although altered reward responsivity, anticipatory processing of environmental cues, and interoception (detection and integration of body-state signals to regulate behavior) have been implicated in BN pathophysiology. We aimed to determine whether BN is associated with ineffectively predicting body state or integrating predicted experience with actual experience by examining neural response to anticipation and experience of affective touch, a pleasant interoceptive stimulus that acts on sensory and emotional systems to guide behavior. During fMRI, we administered soft strokes to the palm and forearm in women remitted from BN (RBN; N = 23) and control women (CW; N = 25). A Group (RBN/CW) × Condition (anticipation/touch) interaction was found in the right dorsal caudate; both CW and RBN had increased activation during touch compared with anticipation, with RBN demonstrating marginally greater anticipatory response than CW. For RBN, those individuals who showed greater anticipatory response in the dorsal caudate also reported higher levels of harm avoidance. RBN individuals relative to CW showed greater activation in left putamen and insula during the anticipation but not when experiencing an affective touch. This increase during anticipation rather than the actual experience of the affective touch is consistent with a top-down preparatory process which is associated with harm avoidance and is similar to what has been observed in anxious individuals. This aberrant signal integration could disrupt feedback processing, serving to maintain disordered behavior.
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16
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Sacchetti S, Mirams L, McGlone F, Cazzato V. Self-focused attention enhances tactile sensitivity in women at risk from eating disorders. Sci Rep 2020; 10:11614. [PMID: 32669580 PMCID: PMC7363881 DOI: 10.1038/s41598-020-68500-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 06/23/2020] [Indexed: 11/13/2022] Open
Abstract
We examined whether alterations in body perception in EDs extend to the integration of exteroceptive visual and tactile information. Moreover, we investigated the effect of self-focused attention on the ability to correctly detect tactile stimuli. Twenty-seven women reporting low ED symptoms, versus 26 women reporting high ED symptoms, undertook a modified version of the Somatic Signal Detection Task (SSDT), which involved detecting tactile stimuli on the cheek in the presence or absence of a concomitant light. The SSDT was completed while looking at a photograph of one’s own face, another female face, and a scrambled face. Heart rate and skin conductance were recorded continuously during the SSDT. Although ED symptoms were not associated with an overall increased tendency to misperceive touch in the presence of a light, High ED participants were differentially affected by self-focused attention. For the High ED group, physiological arousal, and tactile sensitivity (d′) were increased when self-focused attention was augmented. For the Low ED group, sensitivity (d′) and physiological arousal were higher in the control conditions. We suggest that in those with High ED symptoms, attention to the bodily self may exacerbate a predisposition to focusing on external rather than internal bodily information.
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Affiliation(s)
- Sofia Sacchetti
- School of Psychology, Liverpool John Moores University, Room 3.13, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK.
| | - Laura Mirams
- School of Psychology, Liverpool John Moores University, Room 3.13, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK
| | - Francis McGlone
- School of Psychology, Liverpool John Moores University, Room 3.13, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK
| | - Valentina Cazzato
- School of Psychology, Liverpool John Moores University, Room 3.13, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK
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17
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There are no short-term longitudinal associations among interoceptive accuracy, external body orientation, and body image dissatisfaction. CLINICAL PSYCHOLOGY IN EUROPE 2020; 2:e2701. [PMID: 36397825 PMCID: PMC9645487 DOI: 10.32872/cpe.v2i2.2701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 01/11/2020] [Indexed: 11/30/2022] Open
Abstract
Background Objectification theory assumes that individuals with low level of interoceptive accuracy may develop an external orientation for information concerning their body. Past research has found associations between interoceptive accuracy and body image concerns. We aimed to explore temporal relationships between the tendency to monitor one's body from a third-party perspective, body image dissatisfaction, and interoceptive accuracy. Method In a short longitudinal research, 38 Hungarian and 59 Norwegian university students completed the Schandry heartbeat tracking task and filled out baseline and follow-up questionnaires assessing private body consciousness, body surveillance, and body image dissatisfaction 8 weeks apart. Results Interoceptive accuracy and indicators of external body orientation did not predict body image dissatisfaction after controlling for gender, nationality, and body image dissatisfaction at baseline. Similarly, body surveillance was not predicted by baseline levels of interoceptive accuracy and body image dissatisfaction. Conclusion Contrary to the tenets of objectification theory, body image dissatisfaction and body surveillance are not predicted by interoceptive accuracy over a short period of time among young individuals. Past research suggests that an individual's ability to detect their own internal signals may have important implications for body monitoring and body image. We did not find the expected temporal associations among interoceptive accuracy and body image-related variables. Culture and gender were predictors of body image dissatisfaction, an important consideration when designing interventions targeting body image concerns.
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18
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Martin E, Dourish C, Rotshtein P, Spetter M, Higgs S. Interoception and disordered eating: A systematic review. Neurosci Biobehav Rev 2019; 107:166-191. [DOI: 10.1016/j.neubiorev.2019.08.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/16/2019] [Accepted: 08/22/2019] [Indexed: 12/11/2022]
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19
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Crespi B, Dinsdale N. Autism and psychosis as diametrical disorders of embodiment. Evol Med Public Health 2019; 2019:121-138. [PMID: 31402979 PMCID: PMC6682708 DOI: 10.1093/emph/eoz021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/11/2019] [Indexed: 12/12/2022] Open
Abstract
Humans have evolved an elaborate system of self-consciousness, self-identity, self-agency, and self-embodiment that is grounded in specific neurological structures including an expanded insula. Instantiation of the bodily self has been most-extensively studied via the 'rubber hand illusion', whereby parallel stimulation of a hidden true hand, and a viewed false hand, leads to the felt belief that the false hand is one's own. Autism and schizophrenia have both long been regarded as conditions centrally involving altered development of the self, but they have yet to be compared directly with regard to the self and embodiment. Here, we synthesize the embodied cognition literature for these and related conditions, and describe evidence that these two sets of disorders exhibit opposite susceptibilities from typical individuals to the rubber hand illusion: reduced on the autism spectrum and increased in schizophrenia and other psychotic-affective conditions. Moreover, the opposite illusion effects are mediated by a consilient set of associated phenomena, including empathy, interoception, anorexia risk and phenotypes, and patterns of genetic correlation. Taken together, these findings: (i) support the diametric model of autism and psychotic-affective disorders, (ii) implicate the adaptive human system of self-embodiment, and its neural bases, in neurodevelopmental disorders, and suggest new therapies and (iii) experimentally ground Bayesian predictive coding models with regard to autism compared with psychosis. Lay summary: Humans have evolved a highly developed sense of self and perception of one's own body. The 'rubber hand illusion' can be used to test individual variation in sense of self, relative to connection with others. We show that this illusion is reduced in autism spectrum disorders, and increased in psychotic and mood disorders. These findings have important implications for understanding and treatment of mental disorders.
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Affiliation(s)
- Bernard Crespi
- Department of Biological Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - Natalie Dinsdale
- Department of Biological Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
- Department of Psychology, University of Saskatchewan, Saskatoon, SK, Canada
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20
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Schultchen D, Bayer J, Kühnel J, Melchers KG, Pollatos O. Interoceptive accuracy is related to long‐term stress via self‐regulation. Psychophysiology 2019; 56:e13429. [DOI: 10.1111/psyp.13429] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 05/24/2019] [Accepted: 05/29/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Dana Schultchen
- Clinical and Health Psychology, Institute of Psychology and Education Ulm University Ulm Germany
| | - Julia Bayer
- Clinical and Health Psychology, Institute of Psychology and Education Ulm University Ulm Germany
- Work and Organizational Psychology, Institute of Psychology and Education Ulm University Ulm Germany
| | - Jana Kühnel
- Work and Organizational Psychology, Institute of Psychology and Education Ulm University Ulm Germany
| | - Klaus G. Melchers
- Work and Organizational Psychology, Institute of Psychology and Education Ulm University Ulm Germany
| | - Olga Pollatos
- Clinical and Health Psychology, Institute of Psychology and Education Ulm University Ulm Germany
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21
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Altered anticipation and processing of aversive interoceptive experience among women remitted from bulimia nervosa. Neuropsychopharmacology 2019; 44:1265-1273. [PMID: 30840983 PMCID: PMC6785154 DOI: 10.1038/s41386-019-0361-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/10/2019] [Accepted: 02/12/2019] [Indexed: 11/08/2022]
Abstract
Bulimia nervosa (BN) is characterized by dysregulated intake of food, which may indicate homeostatic imbalance. Critically important for homeostatic regulation is interoception, or the sensing and processing of body-relevant information. A well-documented link between avoidance of unpleasant body sensations and BN symptoms suggests that aversive interoceptive experiences may be particularly relevant to BN pathophysiology. This study examined whether individuals with a history of BN show aberrant neural processing of aversive interoceptive stimuli. Using a cued inspiratory breathing load paradigm, we compared women remitted from BN (RBN; n = 24; to reduce the confounding effects of active bulimic symptoms) and control women (CW; n = 25). During breathing load anticipation, the RBN group, relative to CW, showed increased activation in mid-insula, superior frontal gyrus, putamen, dorsal anterior cingulate, posterior cingulate, and amygdala. However, over the course of the aversive experience, neural activation in RBN relative to CW showed an aberrant decline in most of these regions. Exploratory analyses indicated that greater activation during breathing load anticipation was associated with past bulimic symptom severity and the duration of symptom remission. An exaggerated anticipatory response and an abnormally decreasing response during aversive homeostatic perturbations may promote hallmark bulimic behaviors-binge eating, dietary restriction, and purging. Our findings support a role for homeostatic instability in BN, and these altered patterns of brain activation may serve as novel targets for pharmacological, neuromodulatory, and behavioral interventions.
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22
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Weineck F, Messner M, Hauke G, Pollatos O. Improving interoceptive ability through the practice of power posing: A pilot study. PLoS One 2019; 14:e0211453. [PMID: 30730938 PMCID: PMC6366763 DOI: 10.1371/journal.pone.0211453] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 01/15/2019] [Indexed: 12/20/2022] Open
Abstract
Interoception refers to the detection and perception of signals from the inner body. Deficits in this domain have been linked to psychopathologies, prompting the search for strategies to improve this ability. Preliminary studies have shown that interoception could be enhanced through the manipulation of subjective feelings of power. We tested the effects of adopting powerful postures on different facets of interoception. Firstly, we measured the impact of a single power posing session on interoceptive ability in 41 healthy females. Then, the same participants were randomly assigned to two conditions (daily power posing practice vs. no practice). After one week the conditions alternated. Interoceptive accuracy, measured by the heartbeat tracking task, interoceptive sensibility, measured by the Body Perception Questionnaire (BPQ) and confidence ratings, as well as subjective feelings of power were assessed at baseline, after a single power posing session and after one week of training. A single power posing session significantly increased individuals' interoceptive accuracy. Also, power posing reduced individuals' scores on the BPQ after one week of daily practice and increased subjective feelings of power after one session and one week of daily practice. These findings suggest that adopting powerful postures has the potential to increase interoceptive accuracy, as well as subjective feelings of power, and to reduce interoceptive sensibility, measured by questionnaire.
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Affiliation(s)
- Felicitas Weineck
- Department of Clinical and Health Psychology, Ulm University, Ulm, Germany
- * E-mail:
| | - Matthias Messner
- Department of Clinical and Health Psychology, Ulm University, Ulm, Germany
| | - Gernot Hauke
- Department of Clinical and Health Psychology, Ulm University, Ulm, Germany
- Embodiment Resources Academy (ERA), Munich, Germany
| | - Olga Pollatos
- Department of Clinical and Health Psychology, Ulm University, Ulm, Germany
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23
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Quadt L, Critchley HD, Garfinkel SN. The neurobiology of interoception in health and disease. Ann N Y Acad Sci 2018; 1428:112-128. [PMID: 29974959 DOI: 10.1111/nyas.13915] [Citation(s) in RCA: 186] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/30/2018] [Accepted: 06/05/2018] [Indexed: 12/13/2022]
Abstract
Interoception is the sensing of internal bodily sensations. Interoception is an umbrella term that encompasses (1) the afferent (body-to-brain) signaling through distinct neural and humoral (including immune and endocrine) channels; (2) the neural encoding, representation, and integration of this information concerning internal bodily state; (3) the influence of such information on other perceptions, cognitions, and behaviors; (4) and the psychological expression of these representations as consciously accessible physical sensations and feelings. Interoceptive mechanisms ensure physiological health through the cerebral coordination of homeostatic reflexes and allostatic responses that include motivational behaviors and associated affective and emotional feelings. Furthermore, the conscious, unitary sense of self in time and space may be grounded in the primacy and lifelong continuity of interoception. Body-to-brain interactions influence physical and mental well-being. Consequently, we show that systematic investigation of how individual differences, and within-individual changes, in interoceptive processing can contribute to the mechanistic understanding of physical and psychological disorders. We present a neurobiological overview of interoception and describe how interoceptive impairments at different levels relate to specific physical and mental health conditions, including sickness behaviors and fatigue, depression, eating disorders, autism, and anxiety. We frame these findings in an interoceptive predictive processing framework and highlight potential new avenues for treatments.
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Affiliation(s)
- Lisa Quadt
- Department of Psychiatry and Neuroscience, Brighton and Sussex Medical School (BSMS), Trafford Centre, University of Sussex, Brighton, United Kingdom
| | - Hugo D Critchley
- Department of Psychiatry and Neuroscience, Brighton and Sussex Medical School (BSMS), Trafford Centre, University of Sussex, Brighton, United Kingdom.,Sackler Centre for Consciousness Science, University of Sussex, Brighton, United Kingdom
| | - Sarah N Garfinkel
- Department of Psychiatry and Neuroscience, Brighton and Sussex Medical School (BSMS), Trafford Centre, University of Sussex, Brighton, United Kingdom.,Sackler Centre for Consciousness Science, University of Sussex, Brighton, United Kingdom
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24
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Jenkinson PM, Taylor L, Laws KR. Self-reported interoceptive deficits in eating disorders: A meta-analysis of studies using the eating disorder inventory. J Psychosom Res 2018; 110:38-45. [PMID: 29764604 DOI: 10.1016/j.jpsychores.2018.04.005] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 04/16/2018] [Accepted: 04/17/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE An impairment of the ability to sense the physiological condition of the body - interoception - has long been proposed as central to the onset and maintenance of eating disorders. More recent attention to this topic has generally indicated the presence of interoceptive deficits in individuals with an eating disorder diagnosis; however, possible links with specific diagnosis, BMI, age, illness duration, depression, and alexithymia remain unclear from individual studies. This meta-analysis aimed to provide a necessary quantitative overview of self-reported interoceptive deficits in eating disorder populations, and the relationship between these deficits and the previously mentioned factors. METHODS Using a random effects model, our meta-analysis assessed the magnitude of differences in interoceptive abilities as measured using the Eating Disorder Inventory in 41 samples comparing people with eating disorders (n = 4308) and healthy controls (n = 3459). Follow-up and moderator analysis was conducted, using group comparisons and meta-regressions. RESULTS We report a large pooled effect size of 1.62 for eating disorders with some variation between diagnostic groups. Further moderator analysis showed that BMI, age and alexithymia were significant predictors of overall effect size. CONCLUSION This meta-analysis is the first to confirm that large interoceptive deficits occur in a variety of eating disorders and crucially, in those who have recovered. These deficits may be useful in identifying and distinguishing eating disorders. Future research needs to consider both objective and subjective measures of interoception across different types of eating disorders and may fruitfully examine interoception as a possible endophenotype and target for treatment.
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Affiliation(s)
- Paul M Jenkinson
- School of Life and Medical Sciences, University of Hertfordshire, UK.
| | - Lauren Taylor
- School of Life and Medical Sciences, University of Hertfordshire, UK
| | - Keith R Laws
- School of Life and Medical Sciences, University of Hertfordshire, UK
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25
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Klabunde M, Collado D, Bohon C. An interoceptive model of bulimia nervosa: A neurobiological systematic review. J Psychiatr Res 2017; 94:36-46. [PMID: 28651098 PMCID: PMC6026544 DOI: 10.1016/j.jpsychires.2017.06.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/18/2017] [Accepted: 06/19/2017] [Indexed: 12/12/2022]
Abstract
The objective of our study was to examine the neurobiological support for an interoceptive sensory processing model of bulimia nervosa (BN). To do so, we conducted a systematic review of interoceptive sensory processing in BN, using the PRISMA guidelines. We searched PsychInfo, Pubmed, and Web of Knowledge databases to identify biological and behavioral studies that examine interoceptive detection in BN. After screening 390 articles for inclusion and conducting a quality assessment of articles that met inclusion criteria, we reviewed 41 articles. We found that global interoceptive sensory processing deficits may be present in BN. Specifically there is evidence of abnormal brain function, structure and connectivity in the interoceptive neural network, in addition to gastric and pain processing disturbances. These results suggest that there may be a neurobiological basis for global interoceptive sensory processing deficits in BN that remain after recovery. Data from taste and heart beat detection studies were inconclusive; some studies suggest interoceptive disturbances in these sensory domains. Discrepancies in findings appear to be due to methodological differences. In conclusion, interoceptive sensory processing deficits may directly contribute to and explain a variety of symptoms present in those with BN. Further examination of interoceptive sensory processing deficits could inform the development of treatments for those with BN.
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Affiliation(s)
- Megan Klabunde
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States.
| | - Danielle Collado
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Cara Bohon
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
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26
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Getting to the heart of the matter: Does aberrant interoceptive processing contribute towards emotional eating? PLoS One 2017; 12:e0186312. [PMID: 29045451 PMCID: PMC5646794 DOI: 10.1371/journal.pone.0186312] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 09/28/2017] [Indexed: 11/22/2022] Open
Abstract
According to estimates from Public Health England, by 2034 70% of adults are expected to be overweight or obese, therefore understanding the underpinning aetiology is a priority. Eating in response to negative affect contributes towards obesity, however, little is known about the underlying mechanisms. Evidence that visceral afferent signals contribute towards the experience of emotion is accumulating rapidly, with the emergence of new influential models of ‘active inference’. No longer viewed as a ‘bottom up’ process, new interoceptive facets based on ‘top down’ predictions have been proposed, although at present it is unclear which aspects of interoception contribute to aberrant eating behaviour and obesity. Study one examined the link between eating behaviour, body mass index and the novel interoceptive indices; interoceptive metacognitive awareness (IAw) and interoceptive prediction error (IPE), as well as the traditional measures; interoceptive accuracy (IAc) and interoceptive sensibility (IS). The dissociation between these interoceptive indices was confirmed. Emotional eaters were characterised by a heightened interoceptive signal but reduced meta-cognitive awareness of their interoceptive abilities. In addition, emotional eating correlated with IPE; effects that could not be accounted for by differences in anxiety and depression. Study two confirmed the positive association between interoceptive accuracy and emotional eating using a novel unbiased heartbeat discrimination task based on the method of constant stimuli. Results reveal new and important mechanistic insights into the processes that may underlie problematic affect regulation in overweight populations.
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27
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Fischer D, Messner M, Pollatos O. Improvement of Interoceptive Processes after an 8-Week Body Scan Intervention. Front Hum Neurosci 2017; 11:452. [PMID: 28955213 PMCID: PMC5601051 DOI: 10.3389/fnhum.2017.00452] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 08/25/2017] [Indexed: 01/23/2023] Open
Abstract
Objective: Interoceptive processes are defined as ability to detect sensations arising within the body. There is a growing body of research investigating ways of improving interoceptive processes. One promising approach increasing the attention to bodily sensations is the body scan (BS), a method stemming from mindfulness-based stress reduction. Research so far revealed only heterogenous findings of meditational practice and mindfulness-based stress reduction on interoceptive processes. Even more importantly, there is no study considering the effect of an 8-week BS intervention on interoceptive processes and the distinguishable subdomains of interoception. Therefore, the main objective of this research is to examine the effects of a BS intervention on different interoceptive subdomains over 8 weeks of training in two different samples. Methods: In study 1, healthy participants executed a 20 min standardized audiotaped BS in the BS intervention group (n = 25) each day over 8 weeks. The control group (n = 24) listened to an audio book for the same amount of time. In study 2, the BS group (n = 18) was compared to an inactive control group (n = 18). In both studies, three measurement points were realized and interoceptive accuracy (IAc) – using a heartbeat perception task – as well as interoceptive sensibility (IS) – using confidence ratings for the heartbeat perception task and the subscale ‘interoceptive awareness’ of the Eating Disorder Inventory-2 (EDI-2) – were assessed. Results: In study 1, we found, as a descriptive trend, IAc and confidence ratings to be increased irrespective of the condition. However, post hoc analysis revealed a significant improvement of IAc between T1 and T3 in the BS intervention only. IS revealed to be unaffected by the interventions. In study 2, we observed a significant positive effect of the BS intervention on IAc and confidence ratings compared to the inactive controls. As in study 1, IS (EDI-2) was unaffected by the intervention. Discussion: The results highlight the fact that interoception can be improved by long-term interventions focusing on bodily signals. Further studies might focus on clinical samples showing deficits in interoceptive processes and could use other bodily systems for measurement (e.g., respiratory signals) as well methods manipulating body ownership.
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Affiliation(s)
- Dana Fischer
- Department of Clinical and Health Psychology, Institute of Psychology and Education, Ulm UniversityUlm, Germany
| | - Matthias Messner
- Department of Clinical and Health Psychology, Institute of Psychology and Education, Ulm UniversityUlm, Germany
| | - Olga Pollatos
- Department of Clinical and Health Psychology, Institute of Psychology and Education, Ulm UniversityUlm, Germany
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28
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Westwood H, Kerr-Gaffney J, Stahl D, Tchanturia K. Alexithymia in eating disorders: Systematic review and meta-analyses of studies using the Toronto Alexithymia Scale. J Psychosom Res 2017; 99:66-81. [PMID: 28712432 PMCID: PMC5986724 DOI: 10.1016/j.jpsychores.2017.06.007] [Citation(s) in RCA: 174] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 06/07/2017] [Accepted: 06/09/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The aim of this review was to synthesise the literature on the use of the Toronto Alexithymia Scale (TAS) in eating disorder populations and Healthy Controls (HCs) and to compare TAS scores in these groups. METHOD Electronic databases were searched systematically for studies using the TAS and meta-analyses were performed to statistically compare scores on the TAS between individuals with eating disorders and HCs. RESULTS Forty-eight studies using the TAS with both a clinical eating disorder group and HCs were identified. Of these, 44 were included in the meta-analyses, separated into: Anorexia Nervosa; Anorexia Nervosa, Restricting subtype; Anorexia Nervosa, Binge-Purge subtype, Bulimia Nervosa and Binge Eating Disorder. For all groups, there were significant differences with medium or large effect sizes between the clinical group and HCs, with the clinical group scoring significantly higher on the TAS, indicating greater difficulty with identifying and labelling emotions. CONCLUSION Across the spectrum of eating disorders, individuals report having difficulties recognising or describing their emotions. Given the self-report design of the TAS, research to develop and evaluate treatments and clinician-administered assessments of alexithymia is warranted.
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Affiliation(s)
- Heather Westwood
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Psychological Medicine, London, UK.
| | - Jess Kerr-Gaffney
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Psychological Medicine, London, UK.
| | - Daniel Stahl
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Biostatistics, London, UK.
| | - Kate Tchanturia
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Psychological Medicine, London, UK; South London and Maudsley NHS Trust, National Eating Disorders Service, Psychological Medicine Clinical Academic Group, UK; Ilia State University, Tbilisi, Georgia.
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29
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Brown TA, Berner LA, Jones MD, Reilly EE, Cusack A, Anderson LK, Kaye WH, Wierenga CE. Psychometric Evaluation and Norms for the Multidimensional Assessment of Interoceptive Awareness (MAIA) in a Clinical Eating Disorders Sample. EUROPEAN EATING DISORDERS REVIEW 2017; 25:411-416. [PMID: 28714581 DOI: 10.1002/erv.2532] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 05/12/2017] [Accepted: 05/30/2017] [Indexed: 11/09/2022]
Abstract
Altered interoceptive awareness (IA) has been implicated in the pathophysiology of eating disorders; however, few comprehensive self-report measures of IA exist in eating disorders. The present study sought to validate the Multidimensional Assessment of Interoceptive Awareness (MAIA), originally developed to assess IA in individuals practicing mind-body therapies, in an eating disorder sample. Adult and adolescent patients (n = 376) completed assessments upon admission to a partial hospital programme. Analyses examined the factor structure of the MAIA, scale means, scale-scale correlations, internal consistency and construct validity. Analyses also examined associations between MAIA subscales and eating disorder symptoms. Results supported the original eight-factor structure of the MAIA. Internal consistency was acceptable, and the scales converged with associated measures. Importantly, Not Distracting, Self-regulation, Body Listening and Trusting were most strongly associated with eating disorder symptoms. Results support use of the MAIA among eating disorders and provide further support for the relevance of IA in eating disorders. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Tiffany A Brown
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Laura A Berner
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Michelle D Jones
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Erin E Reilly
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Anne Cusack
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Leslie K Anderson
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Walter H Kaye
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Christina E Wierenga
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
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From the body’s viscera to the body’s image: Is there a link between interoception and body image concerns? Neurosci Biobehav Rev 2017; 77:237-246. [DOI: 10.1016/j.neubiorev.2017.03.017] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 03/13/2017] [Accepted: 03/31/2017] [Indexed: 01/30/2023]
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Gueguen J, Piot MA, Orri M, Gutierre A, Le Moan J, Berthoz S, Falissard B, Godart N. Group Qigong for Adolescent Inpatients with Anorexia Nervosa: Incentives and Barriers. PLoS One 2017; 12:e0170885. [PMID: 28152083 PMCID: PMC5289494 DOI: 10.1371/journal.pone.0170885] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 01/12/2017] [Indexed: 01/28/2023] Open
Abstract
Background Qigong is a mind-body intervention focusing on interoceptive awareness that appears to be a promising approach in anorexia nervosa (AN). In 2008, as part of our multidimensional treatment program for adolescent inpatients with AN, we began a weekly qigong workshop that turned out to be popular among our adolescent patients. Moreover psychiatrists perceived clinical benefits that deserved further exploration. Methods and findings A qualitative study therefore sought to obtain a deeper understanding of how young patients with severe AN experience qigong and to determine the incentives and barriers to adherence to qigong, to understanding its meaning, and to applying it in other contexts. Data were collected through 16 individual semi-structured face-to-face interviews and analyzed with the interpretative phenomenological analysis method. Eleven themes emerged from the analysis, categorized in 3 superordinate themes describing the incentives and barriers related to the patients themselves (individual dimension), to others (relational dimension), and to the setting (organizational dimension). Individual dimensions associated with AN (such as excessive exercise and mind-body cleavage) may curb adherence, whereas relational and organizational dimensions appear to provide incentives to join the activity in the first place but may also limit its post-discharge continuation. Once barriers are overcome, patients reported positive effects: satisfaction associated with relaxation and with the experience of mind-body integration. Conclusions Qigong appears to be an interesting therapeutic tool that may potentiate psychotherapy and contribute to the recovery process of patients with AN. Further analysis of the best time window for initiating qigong and of its place in overall management might help to overcome some of the barriers, limit the risks, and maximize its benefits.
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Affiliation(s)
- Juliette Gueguen
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Paris, France
- Univ. Paris-Descartes, Paris, France
- * E-mail:
| | - Marie-Aude Piot
- Univ. Paris-Descartes, Paris, France
- Psychiatry Unit, Institut Mutualiste Montsouris, Paris, France
| | - Massimiliano Orri
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Paris, France
- Univ. Paris-Descartes, Paris, France
| | - Andrea Gutierre
- Psychiatry Unit, Institut Mutualiste Montsouris, Paris, France
| | | | - Sylvie Berthoz
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Paris, France
- Psychiatry Unit, Institut Mutualiste Montsouris, Paris, France
| | - Bruno Falissard
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Paris, France
- Univ. Paris-Descartes, Paris, France
| | - Nathalie Godart
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Paris, France
- Psychiatry Unit, Institut Mutualiste Montsouris, Paris, France
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Pollatos O, Herbert BM, Mai S, Kammer T. Changes in interoceptive processes following brain stimulation. Philos Trans R Soc Lond B Biol Sci 2016; 371:rstb.2016.0016. [PMID: 28080973 DOI: 10.1098/rstb.2016.0016] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2016] [Indexed: 01/25/2023] Open
Abstract
The processing and perception of individual internal bodily signals (interoception) has been differentiated to comprise different levels and processes involved. The so-called heartbeat-evoked potential (HEP) offers an additional possibility to examine automatic processing of cardiac signals. Knowledge on neural structures potentially supporting different facets of interoception is still sparse. One way to get insights into neuroanatomical function is to manipulate the activity of different brain structures. In this study, we used repetitive transcranial magnetic stimulation (rTMS) and a continuous theta-burst protocol to inhibit specific central locations of the interoceptive network including the right anterior insula and the right somatosensory cortices and assessed effects on interoceptive facets and the HEP in 18 male participants. Main results were that inhibiting anterior insula resulted in a significant decline in cardiac and respiratory interoceptive accuracy (IAc) and in a consistent decrease in perception confidence. Continuous theta-burst stimulation (cTBS) over somatosensory cortices reduced only cardiac IAc and affected perception confidence. Inhibiting right anterior insula and right somatosensory cortices increased interoceptive sensibility and reduced the HEP amplitude over frontocentral locations. Our findings strongly suggest that cTBS is an effective tool to investigate the neural network supporting interoceptive processes.This article is part of the themed issue 'Interoception beyond homeostasis: affect, cognition and mental health'.
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Affiliation(s)
- Olga Pollatos
- Clinical and Health Psychology, Institute of Psychology and Education, Ulm University, Albert Einstein Allee 41, Ulm, Germany
| | - Beate M Herbert
- Clinical Psychology and Psychotherapy, Department of Psychology, Eberhard Karls University of Tübingen, 72076 Tübingen, Germany
| | - Sandra Mai
- Clinical and Health Psychology, Institute of Psychology and Education, Ulm University, Albert Einstein Allee 41, Ulm, Germany
| | - Thomas Kammer
- Section for Neurostimulation, Department of Psychiatry, Ulm University, 89075 Ulm, Germany
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Pollatos O, Herbert BM, Berberich G, Zaudig M, Krauseneck T, Tsakiris M. Atypical Self-Focus Effect on Interoceptive Accuracy in Anorexia Nervosa. Front Hum Neurosci 2016; 10:484. [PMID: 27729855 PMCID: PMC5037175 DOI: 10.3389/fnhum.2016.00484] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 09/13/2016] [Indexed: 11/23/2022] Open
Abstract
Background: Interoceptive abilities are known to be affected in anorexia nervosa (AN). Previous studies could show that private self-focus can enhance interoceptive accuracy (IAcc) in healthy participants. As body dissatisfaction is high in AN, confrontation with bodily features such as the own face might have a directly opposed effect in AN. Whether patients with AN can benefit from self-focus in their IAcc and whether this pattern changes over the time-course of cognitive behavioral therapy was investigated in this study. Methods: Fifteen patients with AN from the Psychosomatic Clinic in Windach were assessed three times in the time course of a standardized cognitive-behavioral therapy. They were compared to 15 controls, recruited from Ulm University and tested in a comparable setting. Both groups performed the heartbeat perception task assessing IAcc under two conditions either enhancing (“Self”) or decreasing (“Other”) self-focused attention. Furthermore, body dissatisfaction was assessed by a subscale of the Eating Disorder (ED) Inventory 2. Results: Patients with AN scored higher in IAcc when watching others’ faces as compared to one’s own face while performing the heartbeat perception task. The opposite pattern was observed in controls. IAcc remained reduced in AN as compared to controls in the time-course of cognitive-behavioral therapy, while body-dissatisfaction improved in AN. High body dissatisfaction was related to poorer IAcc in the “Self” condition. Conclusions: Our findings suggest that using self-focused attention reduces IAcc in AN while the opposite pattern was observed in controls. Confronting anorexic patients with bodily features might increase body-related avoidance and therefore decrease IAcc. The current study introduces a new perspective concerning the role of interoceptive processes in AN and generates further questions regarding the therapeutic utility of methods targeting self-focus in the treatment of AN.
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Affiliation(s)
- Olga Pollatos
- Clinical and Health Psychology, Institute of Psychology and Education, Ulm University Ulm, Germany
| | - Beate M Herbert
- Department of Psychology, Clinical Psychology and Psychotherapy, Eberhard Karls University of Tübingen Tübingen, Germany
| | | | | | - Till Krauseneck
- Klinik WindachWindach, Germany; kbo-Isar-Amper-Klinikum gemeinnützige GmbHMunich-Haar, Germany
| | - Manos Tsakiris
- Laboratory of Action and Body, Department of Psychology, Royal Holloway, University of London Egham, UK
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Khalsa SS, Lapidus RC. Can Interoception Improve the Pragmatic Search for Biomarkers in Psychiatry? Front Psychiatry 2016; 7:121. [PMID: 27504098 PMCID: PMC4958623 DOI: 10.3389/fpsyt.2016.00121] [Citation(s) in RCA: 178] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 06/21/2016] [Indexed: 01/04/2023] Open
Abstract
Disrupted interoception is a prominent feature of the diagnostic classification of several psychiatric disorders. However, progress in understanding the interoceptive basis of these disorders has been incremental, and the application of interoception in clinical treatment is currently limited to panic disorder. To examine the degree to which the scientific community has recognized interoception as a construct of interest, we identified and individually screened all articles published in the English language on interoception and associated root terms in Pubmed, Psychinfo, and ISI Web of Knowledge. This search revealed that interoception is a multifaceted process that is being increasingly studied within the fields of psychiatry, psychology, neuroscience, and biomedical science. To illustrate the multifaceted nature of interoception, we provide a focused review of one of the most commonly studied interoceptive channels, the cardiovascular system, and give a detailed comparison of the most popular methods used to study cardiac interoception. We subsequently review evidence of interoceptive dysfunction in panic disorder, depression, somatic symptom disorders, anorexia nervosa, and bulimia nervosa. For each disorder, we suggest how interoceptive predictions constructed by the brain may erroneously bias individuals to express key symptoms and behaviors, and outline questions that are suitable for the development of neuroscience-based mental health interventions. We conclude that interoception represents a viable avenue for clinical and translational research in psychiatry, with a well-established conceptual framework, a neural basis, measurable biomarkers, interdisciplinary appeal, and transdiagnostic targets for understanding and improving mental health outcomes.
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Affiliation(s)
- Sahib S Khalsa
- Laureate Institute for Brain Research (LIBR), Tulsa, OK, USA; Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, USA
| | - Rachel C Lapidus
- Laureate Institute for Brain Research (LIBR), Tulsa, OK, USA; Department of Psychology, University of Tulsa, Tulsa, OK, USA
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Fischer D, Berberich G, Zaudig M, Krauseneck T, Weiss S, Pollatos O. Interoceptive Processes in Anorexia Nervosa in the Time Course of Cognitive-Behavioral Therapy: A Pilot Study. Front Psychiatry 2016; 7:199. [PMID: 28018249 PMCID: PMC5156660 DOI: 10.3389/fpsyt.2016.00199] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 11/29/2016] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Previous studies report reduced interoceptive abilities in anorexia nervosa (AN) using various methods. Recent research suggests that different levels of interoceptive processes aiming at different subdomains of interoceptive abilities must be further distinguished as these levels can be differentially affected. Two important levels refer to interoceptive accuracy (IA) derived from objective performance tasks such as the heartbeat detection task and interoceptive sensibility (IS) as assessed by self-report. There is a lack of studies investigating both IA and IS in AN and examining them in the time course of therapy. The aim of this pilot study was to evaluate the different interoceptive processes - especially IA and IS - in the time course of therapy. METHODS Fifteen patients with AN (restricting type) from the Psychosomatic Clinic in Windach were investigated three times (T1, T2, T3) during a standardized cognitive-behavioral therapy and compared with 15 matched healthy controls assessed at Ulm University in a comparable design. All participants performed the heartbeat detection task examining IA and completed standard psychological assessments including an assessment of IS. RESULTS Patients with AN showed a significantly decreased weight, higher levels of depression, and both reduced IA and IS compared to healthy controls at T1. Following therapy, patients recovered in terms of weight and depression symptomatology. A descriptive trend for recovering from IA and IS was observed. DISCUSSION Our findings suggest that interoceptive deficits are present in recovered patients. Therefore, further investigations are needed with more patients, differentiating between relapsed and recovered patients, and more specific training methods to improve interoceptive processes.
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Affiliation(s)
- Dana Fischer
- Clinical and Health Psychology, Institute of Psychology and Education, Ulm University , Ulm , Germany
| | | | | | - Till Krauseneck
- Klinikum Windach a. Ammersee, Windach, Germany; kbo-Isar-Amper-Klinikum, Munich-Haar, Germany
| | - Sarah Weiss
- Clinical and Health Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany; AMC - Wolfart Klinik, Zentrum für Adipositas- und Metabolische Chirurgie, Munich-Gräfelfing, Germany
| | - Olga Pollatos
- Clinical and Health Psychology, Institute of Psychology and Education, Ulm University , Ulm , Germany
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