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Jeune SC, Graziano P, Campa A, Coccia CC. Interoception and self-regulation of eating behaviors and weight status in college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024:1-12. [PMID: 38442359 DOI: 10.1080/07448481.2024.2319200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 02/08/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE To determine the associations between interoception, self-regulation, eating behaviors, and weight status among college students. PARTICIPANTS 229 female undergraduates, predominantly classified as Juniors (51.1%) and identified as Hispanic/Latinx (75%) with a mean age of 23.4 (SD = 6.3), were examined. METHODS Cross-sectional data using baseline measures from a larger, longitudinal study, were examined. Confirmatory factor analyses and structural equation modeling were conducted to test hypotheses. RESULTS Interoception was directly associated to self-regulation. Interoception and self-regulation were inversely associated with non-purposeful eating. Non-purposeful eating was directly associated with weight status. CONCLUSION This study provided empirical evidence on the associations between interoception, self-regulation, eating behaviors, and weight status. Our results support the need for programs that target college students' cognitive skills to reduce unhealthy eating behaviors and optimize weight status. Future interventions are needed to enhance interoception and self-regulation skills so that college students can be more purposeful in their eating habits.
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Affiliation(s)
- Shanté C Jeune
- Department of Health Sciences, University of Central Florida, Orlando, Florida, USA
| | - Paulo Graziano
- Department of Psychology, Florida International University, Miami, Florida, USA
| | - Adriana Campa
- Department of Dietetics and Nutrition, Florida International University, Miami, Florida, USA
| | - Catherine C Coccia
- Department of Dietetics and Nutrition, Florida International University, Miami, Florida, USA
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2
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Seabury T, Benton D, Young HA. Interoceptive differences in elite sprint and long-distance runners: A multidimensional investigation. PLoS One 2023; 18:e0278067. [PMID: 36696380 PMCID: PMC9876362 DOI: 10.1371/journal.pone.0278067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 11/08/2022] [Indexed: 01/26/2023] Open
Abstract
Interoception, the process of detecting and interpreting bodily sensations, may facilitate self-regulation and thereby play a crucial role in achieving elite performance in competitive sports. However, there is a lack of research conducted in world-class athletes. In the present research, two studies examined self-reported (interoceptive sensibility) and behavioural (interoceptive accuracy) interoception in elite (top 100 ranking) sprint and long-distance runners, and non-athletes. Study 1 used the Multidimensional Assessment of Interoceptive Awareness Questionnaire. Sprinters reported having better regulation of attention to internal sensations, greater emotional awareness, better self-regulation, and reported a greater propensity to listen to their body for insight, than distance runners. Compared to non-athletes, sprinters and distance runners had more bodily trust, attention regulation, and self-regualtion. Additionally, elite athletes reported lower emotional awareness, self-regulation, and body listening. Study 2 examined cardioception using two tasks: The Heartbeat Counting Task, and The Heartbeat Detection Task. Elite and non-elite runners performed the tasks under two conditions; in silence, and whilst listening to pre-recorded crowd noise that simulated the live sounds of spectators during a sporting event. Sprinters and distance runners were able to maintain heartbeat detection accuracy when distracted, whereas non-athletes could not. Across both tasks, compared to non-athletes, sprinters and distance runners were more confident than non-athletes in their interoceptive percept. Additionally, elite athletes compared to non-elite athletes were less accurate when counting their heartbeat and were characterised by a higher interoceptive prediction error. Athletic populations have altered interoceptive abilities.
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Putica A, Felmingham KL, Garrido MI, O'Donnell ML, Van Dam NT. A predictive coding account of value-based learning in PTSD: Implications for precision treatments. Neurosci Biobehav Rev 2022; 138:104704. [PMID: 35609683 DOI: 10.1016/j.neubiorev.2022.104704] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 04/05/2022] [Accepted: 05/17/2022] [Indexed: 10/18/2022]
Abstract
While there are a number of recommended first-line interventions for posttraumatic stress disorder (PTSD), treatment efficacy has been less than ideal. Generally, PTSD treatment models explain symptom manifestation via associative learning, treating the individual as a passive organism - acted upon - rather than self as agent. At their core, predictive coding (PC) models introduce the fundamental role of self-conceptualisation and hierarchical processing of one's sensory context in safety learning. This theoretical article outlines how predictive coding models of emotion offer a parsimonious framework to explain PTSD treatment response within a value-based decision-making framework. Our model integrates the predictive coding elements of the perceived: self, world and self-in the world and how they impact upon one or more discrete stages of value-based decision-making: (1) mental representation; (2) emotional valuation; (3) action selection and (4) outcome valuation. We discuss treatment and research implications stemming from our hypotheses.
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Affiliation(s)
- Andrea Putica
- Phoenix Australia Centre for Post-traumatic Mental Health, Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia.
| | - Kim L Felmingham
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC, Australia
| | - Marta I Garrido
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC, Australia
| | - Meaghan L O'Donnell
- Phoenix Australia Centre for Post-traumatic Mental Health, Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Nicholas T Van Dam
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC, Australia
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Bohlen L, Shaw R, Cerritelli F, Esteves JE. Osteopathy and Mental Health: An Embodied, Predictive, and Interoceptive Framework. Front Psychol 2021; 12:767005. [PMID: 34777176 PMCID: PMC8578726 DOI: 10.3389/fpsyg.2021.767005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/06/2021] [Indexed: 11/13/2022] Open
Abstract
Globally, mental and musculoskeletal disorders present with high prevalence, disease burden, and comorbidity. In order to improve the quality of care for patients with persistent physical and comorbid mental health conditions, person-centered care approaches addressing psychosocial factors are currently advocated. Central to successful person-centered care is a multidisciplinary collaboration between mental health and musculoskeletal specialists underpinned by a robust therapeutic alliance. Such a collaborative approach might be found in osteopathy, which is typically utilized to treat patients with musculoskeletal disorders but may arguably also benefit mental health outcomes. However, research and practice exploring the reputed effect of osteopathy on patients with mental health problems lack a robust framework. In this hypothesis and theory article, we build upon research from embodied cognition, predictive coding, interoception, and osteopathy to propose an embodied, predictive and interoceptive framework that underpins osteopathic person-centered care for individuals with persistent physical and comorbid mental health problems. Based on the premise that, for example, chronic pain and comorbid depression are underlined by overly precise predictions or imprecise sensory information, we hypothesize that osteopathic treatment may generate strong interoceptive prediction errors that update the generative model underpinning the experience of pain and depression. Thus, physical and mental symptoms may be reduced through active and perceptual inference. We discuss how these theoretical perspectives can inform future research into osteopathy and mental health to reduce the burden of comorbid psychological factors in patients with persistent physical symptoms and support person-centered multidisciplinary care in mental health.
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Affiliation(s)
- Lucas Bohlen
- Osteopathic Research Institute, Osteopathie Schule Deutschland, Hamburg, Germany
| | - Robert Shaw
- Scandinavian College of Osteopathy, Gothenburg, Sweden
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Ultimo, NSW, Australia
| | - Francesco Cerritelli
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Ultimo, NSW, Australia
- Clinical-based Human Research Department, Foundation COME Collaboration, Pescara, Italy
| | - Jorge E. Esteves
- Clinical-based Human Research Department, Foundation COME Collaboration, Pescara, Italy
- Research Department, University College of Osteopathy, London, United Kingdom
- International College of Osteopathic Medicine, Malta, Italy
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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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Individual differences in sensory and expectation driven interoceptive processes: a novel paradigm with implications for alexithymia, disordered eating and obesity. Sci Rep 2021; 11:10065. [PMID: 33980896 PMCID: PMC8115295 DOI: 10.1038/s41598-021-89417-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 04/20/2021] [Indexed: 11/21/2022] Open
Abstract
Those with disordered eating and/or obesity often express difficulties in sensing or interpreting what is happening in the body (interoception). However, research is hindered by conceptual confusion, concerns surrounding domain specificity, and an inability to distinguish sensory (bottom-up) and expectation driven (top-down) interoceptive processes. A paradigm was therefore developed from an active inference perspective. Novel indices were computed and examined in those with alexithymia: a personality associated with interoceptive deficits and disordered eating. The paradigm successfully identified individuals driven by sensations rather than expectations: alexithymia was characterized by attenuated prior precision (a larger divergence between pre-prandial and post-prandial satiety, and low expectation confidence), and increased prediction error (a higher correlation between changes in hunger and blood glucose, and greater rebound hunger after a sensory incongruent drink). In addition, those with a higher BMI were less confident and had a larger anticipated satiety divergence. These findings demonstrate the need to move beyond existing paradigms such as the Satiety Quotient and Heartbeat Counting Task which may have limited our understanding of eating behaviour.
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7
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Using bodily postures to reduce anxiety and improve interoception: A comparison between powerful and neutral poses. PLoS One 2020; 15:e0242578. [PMID: 33296377 PMCID: PMC7725306 DOI: 10.1371/journal.pone.0242578] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 11/04/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Previous research has shown that anxiety syndromes are highly prevalent among university students. Effective treatments are needed to reduce the burden of anxiety in this population. Powerful postures have been found to impact affective states, as well as interoception (i.e. the ability to perceive inner bodily signals). However, no previous study has compared the effects of powerful- and neutral postures in regards to anxiety and interoceptive ability. METHODS The first part of the study measured the single-session effect of adopting powerful- vs. neutral postures on students' (n = 57) interoceptive ability and state anxiety. The second part of the study measured the effect of adopting powerful or neutral postures twice daily for two weeks, on individuals' interoceptive ability and trait anxiety. RESULTS State anxiety decreased in both conditions whereas interoceptive accuracy only increased in the power posing condition after a single session. Interoceptive accuracy increased in both groups after two weeks of training. LIMITATIONS The study included no comparison to a condition where individuals adopted their natural (i.e. usual) bodily posture. CONCLUSIONS Embodiment interventions that include elements of adopting an open or expansive bodily posture whilst maintaining a self-focus, can help to reduce state anxiety and improve interoceptive accuracy in student populations. Power posing does not seem to be superior to holding a neutral posture to improve interoceptive accuracy or anxiety. One reason therefore could be that both conditions include the manipulation of self-focus and a postural change that diverges from individuals' normal posture.
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Weineck F, Hauke G, Lindemann H, Lachenmeir K, Schnebel A, Karačić M, Meule A, Voderholzer U, Pollatos O. Using bodily postures in the treatment of anorexia nervosa: Effects of power posing on interoception and affective states. EUROPEAN EATING DISORDERS REVIEW 2020; 29:216-231. [PMID: 33252788 DOI: 10.1002/erv.2813] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 11/03/2020] [Accepted: 11/13/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Power posing involves the adoption of an expansive bodily posture. This study examined whether power posing could benefit individuals with anorexia nervosa (AN) and women with normal weight in regards to interoceptive ability and affective states. METHOD Participants included 50 inpatients and outpatients with AN as well as 51 normal-weight women. Interoceptive accuracy (IAcc), measured by the heartbeat tracking task and interoceptive sensibility (IS), measured by confidence ratings, were assessed at baseline, after a single power posing session and after 1 week of daily training. Also, the short-term effects of power posing on subjective feelings of dominance, pleasantness, and arousal were investigated. RESULTS Both groups increased in their IAcc after one power posing session. Also, there was a significant main effect of time on feelings of dominance and pleasantness in the short-term. Women with AN displayed lower levels of IS, dominance, and pleasantness as well as higher levels of arousal than women without AN. DISCUSSION These findings suggest that power posing has the potential to increase IAcc, subjective feelings of power and pleasant affect in the short-term. Further research should investigate which mechanisms foster the effectiveness of this intervention to tailor it to the needs of women with AN.
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Affiliation(s)
- Felicitas Weineck
- Department of Clinical and Health Psychology, Ulm University, Ulm, Germany
| | - Gernot Hauke
- Department of Clinical and Health Psychology, Ulm University, Ulm, Germany
| | - Hanna Lindemann
- Department of Physical Medicine and Rehabilitation, Ludwig Maximilian University, Munich, Germany
| | - Karin Lachenmeir
- Treatment Center for Eating Disorders (TCE), Dritter Orden Hospital, Munich, Germany
| | | | | | - Adrian Meule
- Schön Klinik Roseneck, Prien am Chiemsee, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Ulrich Voderholzer
- Schön Klinik Roseneck, Prien am Chiemsee, Germany
- Department of Psychiatry and Psychotherapy, University Freiburg, Freiburg, Germany
| | - Olga Pollatos
- Department of Clinical and Health Psychology, Ulm University, Ulm, Germany
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Kube T, Berg M, Kleim B, Herzog P. Rethinking post-traumatic stress disorder - A predictive processing perspective. Neurosci Biobehav Rev 2020; 113:448-460. [PMID: 32315695 DOI: 10.1016/j.neubiorev.2020.04.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 12/15/2022]
Abstract
Predictive processing has become a popular framework in neuroscience and computational psychiatry, where it has provided a new understanding of various mental disorders. Here, we apply the predictive processing account to post-traumatic stress disorder (PTSD). We argue that the experience of a traumatic event in Bayesian terms can be understood as a perceptual hypothesis that is subsequently given a very high a-priori likelihood due to its (life-) threatening significance; thus, this hypothesis is re-selected although it does not fit the actual sensory input. Based on this account, we re-conceptualise the symptom clusters of PTSD through the lens of a predictive processing model. We particularly focus on re-experiencing symptoms as the hallmark symptoms of PTSD, and discuss the occurrence of flashbacks in terms of perceptual and interoceptive inference. This account provides not only a new understanding of the clinical profile of PTSD, but also a unifying framework for the corresponding pathologies at the neurobiological level. Finally, we derive directions for future research and discuss implications for psychological and pharmacological interventions.
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Affiliation(s)
- Tobias Kube
- Harvard Medical School, Program in Placebo Studies, Beth Israel Deaconess Medical Center, Brookline Avenue 330, Boston, MA, 02115, USA; University of Koblenz-Landau, Pain and Psychotherapy Research Lab, Ostbahnstr. 10, 76829 Landau, Germany.
| | - Max Berg
- Philipps-University of Marburg, Department of Psychology, Division of Clinical Psychology and Psychological Treatment Gutenbergstraße 18, D-35032, Marburg, Germany
| | - Birgit Kleim
- University of Zurich, Department of Psychology, Binzmühlestrasse 14, Box 8, CH-8050, Zurich, Switzerland; Psychiatric University Hospital (PUK), Lenggstrasse 31, CH-8032, Zurich, Switzerland
| | - Philipp Herzog
- Philipps-University of Marburg, Department of Psychology, Division of Clinical Psychology and Psychological Treatment Gutenbergstraße 18, D-35032, Marburg, Germany; University of Greifswald, Department of Psychology, Clinical Psychology and Psychotherapy, Franz-Mehring-Straße 47, D-17489, Greifswald, Germany; Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, D-23562, Lübeck, Germany
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10
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Kube T, Schwarting R, Rozenkrantz L, Glombiewski JA, Rief W. Distorted Cognitive Processes in Major Depression: A Predictive Processing Perspective. Biol Psychiatry 2020; 87:388-398. [PMID: 31515055 DOI: 10.1016/j.biopsych.2019.07.017] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/11/2019] [Accepted: 07/18/2019] [Indexed: 01/04/2023]
Abstract
The cognitive model of depression has significantly influenced the understanding of distorted cognitive processes in major depression; however, this model's conception of cognition has recently been criticized as possibly too broad and unspecific. In this review, we connect insights from cognitive neuroscience and psychiatry to suggest that the traditional cognitive model may benefit from a reformulation that takes current Bayesian models of the brain into account. Appealing to a predictive processing account, we explain that healthy human learning is normally based on making predictions and experiencing discrepancies between predicted and actual events or experiences. We present evidence suggesting that this learning mechanism is distorted in depression: current research indicates that people with depression tend to negatively reappraise or disregard positive information that disconfirms negative expectations, thus resulting in sustained negative predictions and biased learning. We also review the neurophysiological correlates of such deficits in processing prediction errors in people with depression. Synthesizing these findings, we propose a novel mechanistic model of depression suggesting that people with depression have the tendency to predominantly expect negative events or experiences, which they subjectively feel confirmed due to reappraisal of disconfirming evidence, thus creating a self-reinforcing negative feedback loop. Computationally, we consider too much precision afforded to negative prior beliefs as the main candidate of pathology, accompanied by an attenuation of positive prediction errors. We conclude by outlining some directions for future research into the understanding of the behavioral and neurophysiological underpinnings of this model and point to clinical implications of it.
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Affiliation(s)
- Tobias Kube
- Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Koblenz-Landau, Landau, Germany; Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, Philipps-University of Marburg, Marburg, Germany; Program in Placebo Studies, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
| | - Rainer Schwarting
- Department of Behavioral Neuroscience, Faculty of Psychology, Philipps-University of Marburg, Marburg, Germany
| | - Liron Rozenkrantz
- Program in Placebo Studies, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Julia Anna Glombiewski
- Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Koblenz-Landau, Landau, Germany; Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, Philipps-University of Marburg, Marburg, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, Philipps-University of Marburg, Marburg, Germany
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12
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Keep your interoceptive streams under control: An active inference perspective on anorexia nervosa. COGNITIVE AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2020; 20:427-440. [DOI: 10.3758/s13415-020-00777-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Kube T, Rozenkrantz L, Rief W, Barsky A. Understanding persistent physical symptoms: Conceptual integration of psychological expectation models and predictive processing accounts. Clin Psychol Rev 2020; 76:101829. [PMID: 32062101 DOI: 10.1016/j.cpr.2020.101829] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/23/2020] [Accepted: 01/23/2020] [Indexed: 01/11/2023]
Abstract
Persistent physical symptoms (PPS) are distressing, difficult to treat, and pose a major challenge to health care providers and systems. In this article, we review two disparate bodies of literature on PPS to provide a novel integrative model of this elusive condition. First, we draw on the clinical-psychological literature on the role of expectations to suggest that people with PPS develop dysfunctional expectations about health and disease that become increasingly immune to disconfirmatory information (such as medical reassurance) through cognitive reappraisal. Second, we invoke neuroscientific predictive processing accounts and propose that the psychological process of 'cognitive immunization' against disconfirmatory evidence corresponds, at the neurobiological and computational level, to too much confidence (i.e. precision) afforded to prior predictions. This can lead to an attenuation of disconfirming sensory information so that strong priors override benign bodily signals and make people believe that something serious is wrong with the body. Combining these distinct accounts provides a unifying framework for persistent physical symptoms and shifts the focus away from their causes to the sustaining mechanisms that prevent symptoms from subsiding spontaneously. Based on this integrative model, we derive new avenues for future research and discuss implications for treating people with PPS in clinical practice.
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Affiliation(s)
- Tobias Kube
- Harvard Medical School, Program in Placebo Studies, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115, USA; Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Gutenbergstr. 18, 35032 Marburg, Germany; Pain and Psychotherapy Research Lab, University of Koblenz-Landau, Ostbahnstr. 10, 76829 Landau, Germany.
| | - Liron Rozenkrantz
- Harvard Medical School, Program in Placebo Studies, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115, USA; Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Gutenbergstr. 18, 35032 Marburg, Germany
| | - Arthur Barsky
- Harvard Medical School, Program in Placebo Studies, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115, USA; Department of Psychiatry, Harvard Medical School, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA 02115, USA
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A consideration of physiological regulation from the perspective of Bayesian enactivism. Physiol Behav 2020; 214:112758. [PMID: 31785272 DOI: 10.1016/j.physbeh.2019.112758] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 11/11/2019] [Accepted: 11/25/2019] [Indexed: 12/17/2022]
Abstract
How the animal regulates its internal environment is a central question in physiology. In recent years, the account of biological functions known as Bayesian enactivism has been extended from neuroscience to address processes of physiological regulation. Enactivism understands sensory action cycles of perception and behaviour to entail expectations of the causes of sensations received from the environment. Enactivism is Bayesian in that the organism strives to update expectations to better match the sensations it experiences through actions. The review starts with a brief examination of the historical development of the concepts of homeostasis, homeorhesis and allostasis. To better align the historical concepts of physiological regulation with Bayesian enactivism it is suggested that homeorhesis and allostasis function as opposing effectors modulating, respectively, robustness and plasticity of phenotype to render homeostatic balance of the animal with its changing environment. In this formulation, the expectations of the environment embedded within the form and functions of the animal that develop under homeorhetic control during morphogenesis and morphostasis are updated by allostasis to better match the animal's phenotype with its contemporary environment. Just as morphogens shape development and persistence of anatomical form during morphogenesis and morphostasis, anticipatory behaviours can be understood to structure the animal's pattern of environmental engagement in a manner that shapes the development and persistence of homeostasis. Further empirical and theoretical analyses should help clarify whether homeorhesis and allostasis are aspects of a common underlying process or are opposing effectors mediating a Bayesian dialogue between expectation and experience.
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15
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Autonomic adaptations mediate the effect of hydration on brain functioning and mood: Evidence from two randomized controlled trials. Sci Rep 2019; 9:16412. [PMID: 31712590 PMCID: PMC6848126 DOI: 10.1038/s41598-019-52775-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 10/23/2019] [Indexed: 12/30/2022] Open
Abstract
Dehydration (water loss >2.0% of body weight) has significant negative effects on physical and mental performance. In two studies the effects of minor hypo-hydration (water loss <1.0% of body weight) on CNS function, mood and cardiovascular functioning were measured. Study 1: On two mornings twelve male participants were exposed to a temperature of 30 °C for four hours and either did or did not drink two 150 ml glasses of water during that time. Study 2: Fifty-six (25 M) individuals were exposed to the same 30 °C environment and randomly allocated to either drink (2 × 150 ml) or not drink. When not given water 0.59% (Study 1) and 0.55% (Study 2) bodyweight was lost. Participant’s heart rate variability (HRV) was measured, and they rated their thirst and mood. In study 1, participants participated in an fMRI protocol during which they completed a modified version of the Paced Auditory Serial Addition Test (PASAT), at the end of which they rated its difficulty. Decreases in fMRI BOLD activity in the orbito-frontal cortex, ventral cingulate gyrus, dorsal cingulate cortex, hypothalamus, amygdala, right striatum, post-central gyrus and superior parietal cortex were observed when participants were hypo-hydrated. These deactivations were associated with reduced HRV, greater perceived effort, and more anxiety. In study 2 declines in HRV were found to mediate the effect of hypo-hydration on ratings of anxiety. These data are discussed in relation to a model that describes how autonomic regulatory and interoceptive processes may contribute to the affective consequences of minor hypo-hydration.
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