Taking time to feel our body: Steady increases in heartbeat perception accuracy and decreases in alexithymia over 9 months of contemplative mental training

Interoceptive training with real-time haptic versus visual heartbeat feedback

The perception of signals from within the body, known as interoception, is increasingly recognized as a prerequisite for physical and mental health. This study is dedicated to the development of effective technological approaches for enhancing interoceptive abilities. We provide evidence of the effectiveness and practical feasibility of a novel real-time haptic heartbeat supplementation technology combining principles of biofeedback and sensory augmentation. In a randomized controlled study, we applied the developed naturalistic haptic feedback on a group of 30 adults, while another group of 30 adults received more traditional real-time visual heartbeat feedback. A single session of haptic, but not visual heartbeat feedback resulted in increased interoceptive accuracy and confidence, as measured by the heart rate discrimination task, and in a shift of attention toward the body. Participants rated the developed technology as more helpful and pleasant than the visual feedback, thus indicating high user satisfaction. The study highlights the importance of matching sensory characteristics of the feedback provided to the natural bodily prototype. Our work suggests that real-time haptic feedback might be a superior approach for strengthening the mind-body connection in interventions for physical and mental health.

Emotions in search of words: Does alexithymia predict treatment outcome in chronic musculoskeletal pain?

Chronic pain, with its complex and multidimensional nature, poses significant challenges in identifying effective long-term treatments. There is growing scientific interest in how psychopathological and personality dimensions may influence the maintenance and development of chronic pain. This longitudinal study aimed to investigate whether alexithymia can predict the improvement of pain severity following a treatment-as-usual programme for chronic musculoskeletal pain over and above psychological cofactors (emotional distress, catastrophizing, and self-efficacy). A consecutive sample of 129 patients with diagnosed chronic musculoskeletal pain referred to two tertiary care centres was recruited and treated for 16 weeks. Clinical pain, psychological distress, self-efficacy, catastrophizing, and alexithymia were assessed with validated self-report measures at the first medical visit (T0) and at 16-week follow-up (T1). Compared with non-responder patients (n = 72, 55.8%), those who responded (i.e., reduction of >30% in pain severity; n = 57, 44.2%) reported an overall improvement in psychological variables except alexithymia. Alexithymia showed relative stability between baseline and follow-up within the entire sample and remained a significant predictor of treatment outcome even when other predictive cofactors (i.e., pain interference, depressive symptoms, and catastrophizing) were considered simultaneously. Our results suggest that identifying patients with a co-occurrence between alexithymia, depressive symptoms, catastrophizing, and the stressful experience of chronic pain can be clinically relevant in pain prevention and intervention programs.

Effects of a Chatbot-Based Intervention on Stress and Health-Related Parameters in a Stressed Sample: Randomized Controlled Trial

BACKGROUND

Stress levels and the prevalence of mental disorders in the general population have been rising in recent years. Chatbot-based interventions represent novel and promising digital approaches to improve health-related parameters. However, there is a lack of research on chatbot-based interventions in the area of mental health.

OBJECTIVE

The aim of this study was to investigate the effects of a 3-week chatbot-based intervention guided by the chatbot ELME, specifically with respect to the ability to reduce stress and improve various health-related parameters in a stressed sample.

METHODS

In this multicenter two-armed randomized controlled trial, 118 individuals with medium to high stress levels were randomized to the intervention group (n=59) or the treatment-as-usual control group (n=59). The ELME chatbot guided participants of the intervention group through 3 weeks of training based on the topics stress, mindfulness, and interoception, with practical and psychoeducative elements delivered in two daily interactive intervention sessions via a smartphone (approximately 10-20 minutes each). The primary outcome (perceived stress) and secondary outcomes (mindfulness; interoception or interoceptive sensibility; subjective well-being; and emotion regulation, including the subfacets reappraisal and suppression) were assessed preintervention (T1), post intervention (T2; after 3 weeks), and at follow-up (T3; after 6 weeks). During both conditions, participants also underwent ecological momentary assessments of stress and interoceptive sensibility.

RESULTS

There were no significant changes in perceived stress (β03=-.018, SE=.329; P=.96) and momentary stress. Mindfulness and the subfacet reappraisal significantly increased in the intervention group over time, whereas there was no change in the subfacet suppression. Well-being and momentary interoceptive sensibility increased in both groups over time.

CONCLUSIONS

To gain insight into how the intervention can be improved to achieve its full potential for stress reduction, besides a longer intervention duration, specific sample subgroups should be considered. The chatbot-based intervention seems to have the potential to improve mindfulness and emotion regulation in a stressed sample. Future chatbot-based studies and interventions in health care should be designed based on the latest findings on the efficacy of rule-based and artificial intelligence-based chatbots.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00027560; https://drks.de/search/en/trial/DRKS00027560.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-doi.org/10.3389/fdgth.2023.1046202.

Increased wakefulness as measured by the WAKE-16 is related to mindfulness and emotional self-regulation in experienced Buddhist meditators

INTRODUCTION

We tested and validated the German version of a new instrument for measuring "wakefulness," defined as "an expansive, higher-functioning, and stable state of being in which a person's vision of and relationship to the world are transformed, along with their subjective experience, their sense of identity and their conceptual outlook" (Taylor, 2017, p. 22).

METHODS

In order to test the construct validity of the new instrument (Inventory of Secular/Spiritual Wakefulness; WAKE-16), we performed a parametric comparison between a group of expert meditators (n=36) with a history of predominantly meditating in silence and demographically matched non-meditators (n=36) for the WAKE-16 and two conceptually related questionnaires of mindfulness and emotion regulation.

RESULTS

Significantly higher scores for the meditators on the WAKE-16 indicate construct validity of the new instrument. Meditators scored higher on the two mindfulness subscales "presence" and "acceptance," as well as on the SEE subscales of emotion regulation and body-related symbolization of emotions. Within the group of meditators, there were significant correlations between wakefulness and mindfulness, accepting one's own emotions, and experiencing overwhelming emotions. The only significant correlation in non-meditators was found between wakefulness and accepting one's own emotions.

DISCUSSION

The new instrument shows construct validity by discriminating between the two groups. Correlations between wakefulness and related psychological constructs indicate convergent validity. Future studies could attempt to increase discriminatory accuracy of the definition of wakefulness, as well as finding objective methods of measuring.

Disrupted interoceptive awareness by auditory distractor: Difficulty inferring the internal bodily states?

Recent studies have associated interoceptive awareness, the perception of internal bodily sensations, with a predictive mechanism of perception across all sensory modalities. According to the framework, volitional attention plays a pivotal role in interoceptive awareness by prioritizing interoceptive sensations over exteroceptive ones. Consequently, it is hypothesized that the presence of irrelevant stimuli would disrupt the attentional modulation and interoceptive awareness, which remains untested. In this study, we investigated if interoceptive awareness is diminished by unrelated auditory distractors to validate the proposed perceptual framework. A total of 30 healthy human volunteers performed the heartbeat counting task both with and without auditory distractors. Additionally, we measured participant's psychophysiological traits related to interoception, including the high-frequency component of heart rate variability (HF-HRV) and trait interoceptive sensibility. The results showed that interoceptive accuracy, confidence, and heartbeat intensity decreased in the presence of distractor sound. Moreover, individuals with higher HF-HRV and a greater tendency to worry about bodily states experienced a more pronounced distractor effect on interoceptive awareness. These results provide support for the perceptual mechanism of interoceptive awareness in terms of the predictive process, highlighting the impact of relative precision across interoceptive and exteroceptive signals on perceptual experiences.

Interoceptive abilities impairment correlates with emotional eating and taste abnormalities in children with overweight and obesity

Weight problems in children are associated with emotional eating, which has been linked to interoceptive abilities. Previous research also shows altered olfactory and gustatory perception in children with obesity and overweight. Therefore, we aimed to investigate the connection of alterations in olfactory and gustatory perception to interoceptive abilities and emotional eating among children with obesity and overweight. 23 children with overweight and obesity and age-matched controls with normal weight (12-16 years old) underwent olfactory and gustatory testing. Interoceptive abilities were assessed, focusing on interoceptive accuracy and interoceptive sensibility. Children with overweight and obesity showed significantly higher accuracy for detection of sweet taste, but descriptively lower accuracy for all other taste qualities compared to normal weight children. We found no changes in olfactory abilities in children with overweight and obesity. Emotional eating scores were elevated for children with overweight and obesity, and interoceptive accuracy scores were significantly lower. In both groups, interoceptive accuracy was inversely correlated with emotional eating. Our results support prior findings of altered gustatory abilities in children with overweight and obesity. The observed link between impaired interoceptive processes and heightened emotional eating in this group implies that interventions for overweight in children could benefit from targeting interoceptive abilities. This study provides meaningful grounds for further investigations into the roles of taste, emotional eating, and interoceptive abilities for overweight in children and adolescents.

The effect of 10-week long yoga training on interoceptive abilities: cross-sectional and longitudinal investigation of cardiac and gastric accuracy

Based on their characteristics, it is likely that mind-body techniques develop interoception, the perception of bodily state. Nevertheless, findings on mindfulness, meditation, yoga, and body scan techniques are inconclusive. Additionally, the methodological scope is not exhaustive, neither in terms of the intervention nor the applied measure of interoception. This study investigated for the first time the effect of regular yoga training on cardiac and gastric perceptual ability (measured with the mental heartbeat tracking task and the water load task, respectively). With the involvement of 90 female university students (yoga group n = 57, control group n = 33) we did not find any connection between baseline heartbeat perception score and gastric fullness. Moreover, the applied 10-week-long regular yoga training did not develop any of the measured interoceptive abilities. We conclude that yoga might develop other abilities than these specific sensations. Very probably, the measured cardiac and gastric perceptual abilities do not represent bodily sensations in general. It would be worth to investigate, however, the effect of longer yoga training on interoception.

Trauma, early life stress, and mindfulness in adulthood

This article is a review that was inspired by recent studies investigating the effects of childhood trauma or early life stress (ELS) and mindfulness in adulthood. One recent study found that some forms of abuse and neglect led to higher scores in several subscales of a self-report measure of mindfulness. The authors concluded that some forms of ELS can help cultivate certain aspects of mindfulness in adulthood. However, and in contrast to this recent finding, much of the extant literature investigating ELS and trauma are linked to emotional dysregulation, alexithymia, and a host of psychopathologies in adulthood which makes the results of this study surprising. Central to the mindfulness literature is cultivating an open, non-reactive, or non-judgment awareness of inner experiences which are important for emotional regulation. In this paper, I review some of the effects of trauma or ELS on critical neural circuits linked to mindfulness, interoception, attachment, and alexithymia which I hope may clarify some of the conflicting findings from this study and throughout the literature and provide additional context and a framework that may inform research investigating these two constructs going forward.

Where is an emotion? Using an emotional spatial cueing task to test for emotional localization following targeted visceroception

The relationship between emotion and attention is vital for adaptation. Trained attention to bodily sensations can heighten emotional awareness, including during "visceroception" (sensing the viscera, principally the heart, lungs and gut), which has been linked to emotion intensity and regulation. However, it is not always clear when bodily attention is adaptive, and useful to maintain, or maladaptive and best inhibited. The current study, part of a wider exploratory project, investigates "localized emotion" in this context. Localized emotion is a novel construct, articulated within the project, and suggested to be manifested within a visceroceptive system: targeted visceroception could result in disinhibited attention to localized emotion. In particular, whilst evidence points to the importance of the gastrointestinal tract for emotion (e.g., gut biome, enteric nervous system), gut sensations are often barely detectable, consistent with an inhibition process. An emotional spatial cueing task was used to test for localized effects within several groups: one trained for 8 weeks to focus on their lower abdomen (gastroception), with another focused on their chest cavity (cardioception), plus a control group. The spatial cueing task involved rapid responding to the detection of bodily feelings following the presentation of an emotional picture. Participants then indicated on a body map where they had detected the feeling, followed by corresponding valence and arousal levels (i.e., core affect) on a self-assessment manikin. Data were analyzed using generalized estimating equations. There was some support for localization in the gastroception group relative to the chest-focused group and controls. Gastroception-related findings included: greater improvement in interoception (interoceptive sensibility), slowed reaction times, a cluster of lower abdominal detections on a body map, changes in core affect, and indications of improved emotion regulation. Attending to the gut may play a key role in improving one's ability to access emotional feeling, with associated implications for emotion regulation.

Reducing alexithymia and increasing interoceptive awareness: A randomized controlled trial comparing mindfulness with dyadic socio-emotional app-based practice

BACKGROUND

Emotion processing deficits of alexithymia are a transdiagnostic risk factor. While such deficits are malleable, the differential efficacy of brief scalable digital mental trainings remains understudied.

METHODS

This randomized controlled trial probed the efficacy of mindfulness-based (MB) and partner-based socio-emotional Affect Dyad (SE) practice, both supported by weekly coaching sessions, in reducing alexithymia in 285 adult participants. We investigated the predictive role of interoceptive awareness assessed a) before and after daily practice, b) in ecological momentary assessment (EMA) before and after the intervention, and c) weekly during the 10-week intervention.

RESULTS

Both interventions reduced emotion processing difficulties on the Toronto Alexithymia Scale (TAS-20). Similarly, both interventions improved interoceptive awareness immediately after daily practice and after the intervention period, yet SE outperformed MB training in EMA assessments. Further, only Dyad practice led to increases in body listening and self-regulatory aspects of the Multidimensional Assessment of Interoceptive Awareness (MAIA) over time, with the latter explaining a decrease in alexithymia.

LIMITATIONS

Given the subclinical study sample, findings are limited in their generalizability to clinical samples.

CONCLUSIONS

Findings suggest that app-based socio-emotional and mindfulness-based practices, supported by online coaching sessions, are effective in reducing emotion processing deficits. Dyad training showed advantages on some measures of body awareness, which predicted observed changes in alexithymia. This highlights the potential of using app-based dyadic approaches in the development of emotion awareness and regulation.

Linguistic embodiment in typical and atypical anorexia nervosa: Evidence from an image-word matching task

OBJECTIVE

The integration of sensory, motor, and cognitive systems is embodied cognition, according to which mind and body are not separate and distinct, and our body (and our brain, as part of the body) contributes to determining our mental and cognitive processes. In spite of limited data available, Anorexia nervosa (AN) appears as a condition in which embodied cognition is altered, in particular, if we consider bodily sensations and visuospatial information processing. We aimed to evaluate the ability to correctly identify body parts and actions in both full (AN) and atypical AN (AAN), looking at the role of the underweight status.

METHOD

A group of 143 females (AN = 45, AAN = 43, unaffected women = 55) was enrolled. All participants performed a linguistic embodied task to evaluate the association between a picture-showing a bodily action-and a written verb. Additionally, a subsample of 24 AN participants performed a retest after stable weight recovery.

RESULTS

Both AN and AAN demonstrated an abnormal ability to evaluate the picture-written verb associations, especially if the involved bodily effectors were the same in both stimuli (i.e., pictorial and verbal) and needed a longer response time.

CONCLUSIONS

Specific embodied cognition linked to body schema seems to be impaired in persons with AN. The longitudinal analysis showed a difference between AN and AAN only in the underweight condition, suggesting the presence of an abnormal linguistic embodiment. More attention should be devoted to embodiment during AN treatment to improve bodily cognition, which might, in turn, diminish body misperception.

Increasing familiarity with the heartbeat counting task does not affect performance

BACKGROUND

Interoception is typically defined as the processing and perception of internal signals. A common evaluation of interoceptive abilities is the heartbeat counting task, during which participants count their heartbeats over a period of time. It has been argued recently, however, that performance in this task may reflect processes other than cardiac sensation.

OBJECTIVE

This study aimed to: 1) observe heartbeat counting task performance changes across multiple repetitions of the task; and 2) compare performance in the heartbeat counting task with that for a visual counting task to investigate generalised propensities for how uncertain stimuli are reported.

METHODS

Seventy-nine healthy participants performed seven blocks each of the heartbeat and visual counting tasks. Scores for each of the tasks were compared across blocks to identify any change in performance. Performance in the two tasks was then correlated. The study was preregistered at https://doi.org/10.17605/OSF.IO/GWAB7.

RESULTS

Heartbeat counting task performance did not change over blocks. In contrast, scores for the visual counting task reduced over time. A positive correlation was seen between performance in the two tasks (ρ(79) = .27).

CONCLUSION

Heartbeat counting task performance is stable across repetitions of the task, not changing with increasing familiarity. This suggests that non-interoceptive factors, such as beliefs, may be involved. The correlation between the heartbeat and visual counting tasks may point to a general propensity in counting uncertain stimuli across sensory domains. Together, these results raise questions about the interpretation of the heartbeat counting task as a measure of interoception.

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

Background

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

Methods

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

Results

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

Conclusion

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

Modulation of the heartbeat evoked cortical potential by hypnotizability and hypnosis

Hypnotizability is a psychophysiological trait measured by scales and associated with several differences, including interoceptive accuracy and the morpho-functional characteristics of interoception-related brain regions. The aim of the study was to assess whether the amplitude of the heartbeat evoked cortical potential (HEP), a correlate of interoceptive accuracy, differs in participants with low (lows) and high (highs) hypnotizability scores (assessed by the Stanford Hypnotic Susceptibility Scale, Form A) before and after the induction of hypnosis. ECG and EEG were monitored in 16 highs and 15 lows during an experimental session, including open eyes baseline (B), closed eyes relaxation (R), hypnotic induction (IND), neutral hypnosis (NH), and post session baseline (Post). No significant difference was observed between groups and conditions in autonomic variables. The HEP amplitude was lower in highs than in lows at the right parietal site, likely due to hypnotizability related differences in the functional connection between the right insula and parietal cortex. It increased in highs and decreased in lows across the session, possibly due to the highs' preeminently internally directed attention and to the lows' possible disengagement from the task. Since interoception is involved in several cognitive-emotional functions, its hypnotizability related differences may contribute to the variability of experience and behavior in daily life.

Do we need to accurately perceive our heartbeats? Cardioceptive accuracy and sensibility are independent from indicators of negative affectivity, body awareness, body image dissatisfaction, and alexithymia

Assessment of the acuity of heartbeat perception, dubbed cardioceptive accuracy, as well as its association with various psychological characteristics are hot topics of interoception research. In this study, we aimed (1) to replicate previously reported findings on the association between the mental tracking task and a novel motor tracking task that eliminates disturbing tactile sensations; and (2) to explore associations between performance in the latter task and indicators of negative affectivity (anxiety, depression, anxiety sensitivity, somatic symptom distress), alexithymia, body focus, and dissatisfaction with body image. 102 young people (age = 20.8±5.08 yrs) participated in the study. Mental tracking score was significantly higher than motor tracking scores, although they were strongly associated. Frequentist correlation analysis showed no significant associations between indicators of cardioceptive accuracy and questionnaire scores; Bayesian analysis indicated the lack of association for the majority of the cases. Similarly, detectors and non-detectors showed no differences in any of the assessed characteristics and Bayesian results typically supported the lack of associations. In conclusion, cardioceptive accuracy, as assessed with different tracking methods, is not associated with the aforementioned self-reported characteristics in young individuals.

Autonomous sensory meridian response is associated with a larger heartbeat-evoked potential amplitude without differences in interoceptive awareness

Autonomous sensory meridian response (ASMR) describes the experience of a pleasant body sensation accompanied by a feeling of well-being and relaxation in response to specific audiovisual stimuli, such as whispers and personal attention. Previous work suggests a relationship between this experience with the processing of affective and body states; however, no research has explored differences in interoception between people experiencing ASMR and those who do not. We hypothesized that the ASMR experience is based on interoception processing. To test this, we assessed group differences across different dimensions of interoception: Interoceptive sensibility (IS), measured using the multidimensional assessment of interoceptive awareness (MAIA); Interoceptive accuracy score (IAS), measured by calculating performance in a heartbeat counting task (HCT), and the electrophysiological index of interoception, the heartbeat evoked potential (HEP), which was calculated during the HCT and an ASMR tingle reporting task (ASMR-TRT). Our results showed that IS and IAS, dimensions requiring conscious awareness, showed no differences between groups. However, HEP amplitude was larger in the ASMR group in both tasks. We concluded that the ASMR experience is based on an unconscious interoceptive mechanism, reflected by HEP, where exteroceptive social-affective stimuli are integrated to represent a body state of positive affective feelings and relaxation, as has been described for affective touch. The relevance of this finding relies on that interoceptive function, body regulation, and emotional/affective experiences are fundamental for well-being, and the relationship between ASMR and interoception opens the way to future research exploring the causal relationship between them and their potential clinical applications.

Embodying Consciousness through Interoception and a Balanced Time Perspective

This review presents current research and scientific knowledge in body mind sciences through the lens of interoception, as a representative of the body; and time perspective, as the representative of the mind. This intertwining dichotomy has been a subject of discourse in many fields, all having the common denominator of consciousness. Our aim is to expand on the congruities of these seemingly deconstructed worlds-of science and philosophy, of the body and the mind, to show that the place of consciousness lies in the zone between these two. Being aware of the body in the present moment. We introduce interoception and time perspective, focusing on how interoceptive signals are depicted in autonomic nervous system (ANS) regulation, and how this relates to the concept of a balanced time perspective (BTP), a highly adaptive psychological characteristic. Time perspective and interoception are also reviewed in the case of clinical conditions. We assess findings on interoceptive pathways in the body, finding convergence with balanced time perspective through the neuroanatomical lens. We conclude with findings that both dysregulated interoceptive states and a time perspective disbalance are recognized as defining features of mental disorders, proposing prospective practical therapeutic approaches, as well as implications for further research in the field.

Interoceptive attention facilitates emotion regulation strategy use

Background

Method

Results

Conclusions

A chatbot-based intervention with ELME to improve stress and health-related parameters in a stressed sample: Study protocol of a randomised controlled trial

Background

Stress levels in the general population had already been increasing in recent years, and have subsequently been exacerbated by the global pandemic. One approach for innovative online-based interventions are "chatbots" - computer programs that can simulate a text-based interaction with human users via a conversational interface. Research on the efficacy of chatbot-based interventions in the context of mental health is sparse. The present study is designed to investigate the effects of a three-week chatbot-based intervention with the chatbot ELME, aiming to reduce stress and to improve various health-related parameters in a stressed sample.

Methods

In this multicenter, two-armed randomised controlled trial with a parallel design, a three-week chatbot-based intervention group including two daily interactive intervention sessions via smartphone (á 10-20 min.) is compared to a treatment-as-usual control group. A total of 130 adult participants with a medium to high stress levels will be recruited in Germany. Assessments will take place pre-intervention, post-intervention (after three weeks), and follow-up (after six weeks). The primary outcome is perceived stress. Secondary outcomes include self-reported interoceptive accuracy, mindfulness, anxiety, depression, personality, emotion regulation, psychological well-being, stress mindset, intervention credibility and expectancies, affinity for technology, and attitudes towards artificial intelligence. During the intervention, participants undergo ecological momentary assessments. Furthermore, satisfaction with the intervention, the usability of the chatbot, potential negative effects of the intervention, adherence, potential dropout reasons, and open feedback questions regarding the chatbot are assessed post-intervention.

Discussion

To the best of our knowledge, this is the first chatbot-based intervention addressing interoception, as well as in the context with the target variables stress and mindfulness. The design of the present study and the usability of the chatbot were successfully tested in a previous feasibility study. To counteract a low adherence of the chatbot-based intervention, a high guidance by the chatbot, short sessions, individual and flexible time points of the intervention units and the ecological momentary assessments, reminder messages, and the opportunity to postpone single units were implemented.

Trial registration

The trial is registered at the WHO International Clinical Trials Registry Platform via the German Clinical Trials Register (DRKS00027560; date of registration: 06 January 2022). This is protocol version No. 1. In case of important protocol modifications, trial registration will be updated.

The bodily fundament of empathy: The role of action, nonaction-oriented, and interoceptive body representations

Mental representations with bodily contents or in various bodily formats have been suggested to play a pivotal role in social cognition, including empathy. However, there is a lack of systematic studies investigating, in the same sample of participants and using an individual differences approach, whether and to what extent the sensorimotor, perceptual, and interoceptive representations of the body could fulfill an explanatory role in the empathic abilities.To address this goal, we carried out two studies in which healthy adults were given measures of interoceptive sensibility (IS), action (aBR), and nonaction-oriented body representations (NaBR), and affective, cognitive, and motor empathy. A higher tendency to be self-focused on interoceptive signals predicted higher affective, cognitive, and motor empathy levels. A better performance in tasks probing aBR and NaBR predicted, respectively, higher motor and cognitive empathy levels.These findings support the view that the various facets of the empathic response are differently grounded in the body since they diversely involve representations with a different bodily format.Individual differences in the focus on one's internal body state representation can directly modulate all the components of the empathic experience. Instead, a body representation used interpersonally to represent both one's own body and others' bodies, in particular in its spatial specificity, could be necessary to accurately understand other people's minds (cognitive empathy), while a sensorimotor body representation used to represent both one's own body and others' bodies actions, could be fundamental for the self-awareness of feelings expressed in actions (motor empathy).

Anterior Insula Activation During Cardiac Interoception Relates to Depressive Symptom Severity in HIV-Positive and HIV-Negative Postmenopausal Women

OBJECTIVE

This study aimed to determine whether subclinical symptoms of depression in postmenopausal women are associated with blood oxygen level-dependent (BOLD) activity within the anterior insula during cardiac interoceptive awareness and whether this association differs for persons living with the human immunodeficiency virus (PWH).

METHOD

Twenty-three postmenopausal (mean [standard deviation] age = 56.5 [4.8] years) and 27 HIV-negative women (mean [standard deviation] age = 56.4 [8.0]) underwent functional magnetic resonance imaging while performing a heartbeat detection task. BOLD activation within the bilateral anterior insula based on the contrast of a heartbeat detection condition with and without a distracting tone was entered along with age, HIV status, and psychological stress into two multivariate regression models with self-reported depressive symptom severity as the outcome.

RESULTS

Depressive symptoms did not vary by HIV status, nor was there a main effect or interaction for PWH on insula BOLD activation. Depressive symptoms were positively associated with psychological stress for the left ( β = 0.310, t (49) = 2.352, p = .023) and right brain models ( β = 0.296, t (49) = 2.265, p = .028) as well as the magnitude of BOLD activation in the left insula ( β = 0.290, t (49) = 2.218, p = .032) and right insula ( β = 0.318, t (49) = 2.453, p = .018), respectively. Exploratory analyses revealed that greater magnitude of BOLD activation attributed to exteroceptive noise (tone) was also correlated with self-reported distrust and preoccupation with interoceptive sensations.

CONCLUSIONS

Results support an active interference model for interoceptive awareness wherein greater BOLD signal in the anterior insula in the presence of distracting exteroceptive stimuli may reflect greater prediction error, a feature of depression.

Acute physical-activity related increases in interoceptive ability are not enhanced with simultaneous interoceptive attention

Interoception, the sense of the internal body, is proposed to support self-regulation, and consequently influence mental health. Researchers have therefore shown interest in improving the ability to accurately monitor internal signals (i.e., interoceptive accuracy, IAcc). Research suggests that cardiac IAcc is modifiable by both manipulations of interoceptive attention (guided attention towards the internal body), and interoceptive exposure (strategically inducing somatic signals e.g., via physical activity). Whilst successful in isolation, it is unclear whether a combined approach (i.e., directing attention towards the internal body when signals are more salient) could elicit greater benefits. In a 2 × 2 within-subject design, 48 healthy adults (M_age = 25.98 ± 4.73 years, 50% female) completed four 20-min conditions varying in both attentional focus (interoceptive vs exteroceptive) and physical activity (active vs rest), with cardiac IAcc measured immediately after. Results revealed a main effect for physical activity (p < 0.001), however, there was no effect for attentional focus (p = 0.397), and no interaction effect (p = 0.797). Differential analyses showed that a higher sporting background increased sensitivity to physical activity-related increases in cardiac IAcc (p = 0.031). Findings indicate that (irrespective of attentional focus) moderate-vigorous physical activity-based interventions have the potential to increase cardiac IAcc, with certain individuals potentially benefiting more.

Self-Reported Body Awareness: Validation of the Postural Awareness Scale and the Multidimensional Assessment of Interoceptive Awareness (Version 2) in a Non-clinical Adult French-Speaking Sample

Body awareness refers to the individual ability to process signals originating from within the body, which provide a mapping of the body's internal landscape (interoception) and its relation with space and movement (proprioception). The present study aims to evaluate psychometric properties and validate in French two self-report measures of body awareness: the Postural Awareness Scale (PAS), and the last version of the Multidimensional Assessment of Interoceptive Awareness questionnaire (version 2, MAIA-2). We collected data in a non-clinical, adult sample (N = 308; 61% women, mean age 35 ± 12 years) using online survey, and a subset of the original sample (n = 122; 62% women, mean age 44 ± 11 years) also completed the retest control. Factor analyses and reliability analyses were conducted. Construct validity of the PAS and the MAIA-2 were examined by testing their association with each other, and with self-report measures of personality (Big Five Inventory), alexithymia (Toronto Alexithymia Scale) and dispositional trait mindfulness (Freiburg Mindfulness Inventory). Factor analyses of the PAS supported the same two-factor structure as previously published versions (in other languages). For the MAIA-2, factor analyses suggested that a six-factor structure, excluding Not-Worrying and Not-Distracting factors, could successfully account for a common general factor of self-reported interoception. We found satisfactory internal consistency, construct validity, and reliability over time for both the PAS and the MAIA-2. Altogether, our findings suggest that the French version of the PAS and the MAIA-2 are reliable self-report tools to assess both components of body awareness (proprioception and interoception dimension, respectively).

Mindfulness, Interoception, and the Body

In recent years, there has been a surge of interest in the topics of interoception and mindfulness from researchers, clinicians, and the general public alike (e [...]

The Effects of a 3-Week Heartbeat Perception Training on Interoceptive Abilities

Recent studies showed promising short-term effects of heartbeat perception training on interoceptive abilities. Research on the effects of heartbeat perception training on interoceptive abilities over time is sparse. Therefore, the aim of this study was to examine the short-term effects and the effects of a 3-week heartbeat perception training over time on interoceptive abilities, namely, cardiac interoceptive accuracy (IAc) and interoceptive sensibility (IS). A total of 40 healthy participants were randomized to the intervention group (n = 20) or the control group (n = 20). The intervention group conducted three cardiac biofeedback sessions (one per week) at the laboratory, whereas the control group watched a documentary instead. Interoceptive abilities were assessed via the heartbeat perception task (IAc) and confidence ratings (IS) at baseline, after each laboratory session, and 1 week after the last session (post-measurement). IAc was significantly increased in the intervention group compared to the control group after the first training session (short-term effect). There were no significant improvements in IS due to the first session, and neither on IAc nor IS over time. Descriptive trends of improved interoceptive abilities over time were found in both groups. Single session of heartbeat perception training seems to be a promising approach to improve IAc. Future research should further investigate the long-term effects of diverse heartbeat perception training varying in frequency and intensity of the training sessions in diverse samples aiming to improve interoceptive abilities.

A heartbeat away from a valid tracking task. An empirical comparison of the mental and the motor tracking task

Individuals' ability to perceive their heartbeats, called cardioceptive accuracy, is assessed with various paradigms. Performance in the mental and a novel motor tracking task that eliminates disturbing tactile sensations was assessed at rest and during walking with the participation of 45 young people. Significantly higher scores in the mental tracking task than in the motor tracking task were found. Scores obtained at rest were consistently higher than their walking counterparts. Motor responses showed no temporal association with heartbeats for 84% of participants at rest and 95% during walking. Overall, participants' cardioceptive accuracy at rest and under slight physical activity was poor. Even if people rely on their heartbeat-related sensations during their daily activity, it is either not the ability that is assessed by the tracking tasks, or it is a relatively poor source of information about the actual state of the body.

Neurofeedback-Augmented Mindfulness Training Elicits Distinct Responses in the Subregions of the Insular Cortex in Healthy Adolescents

Mindfulness training (MT) reduces self-referential processing and promotes interoception, the perception of sensations from inside the body, by increasing one’s awareness of and regulating responses to them. The posterior cingulate cortex (PCC) and the insular cortex (INS) are considered hubs for self-referential processing and interoception, respectively. Although MT has been consistently found to decrease PCC, little is known about how MT relates to INS activity. Understanding links between mindfulness and interoception may be particularly important for informing mental health in adolescence, when neuroplasticity and emergence of psychopathology are heightened. We examined INS activity during real-time functional magnetic resonance imaging neurofeedback-augmented mindfulness training (NAMT) targeting the PCC. Healthy adolescents (N = 37; 16 female) completed the NAMT task, including Focus-on-Breath (MT), Describe (self-referential processing), and Rest conditions, across three neurofeedback runs and two non-neurofeedback runs (Observe, Transfer). Regression coefficients estimated from the generalized linear model were extracted from three INS subregions: anterior (aINS), mid (mINS), and posterior (pINS). Mixed model analyses revealed the main effect of run for Focus-on-Breath vs. Describe contrast in aINS [R2 = 0.39] and pINS [R2 = 0.33], but not mINS [R2 = 0.34]. Post hoc analyses revealed greater aINS activity and reduced pINS activity during neurofeedback runs, and such activities were related to lower self-reported life satisfaction and less pain behavior, respectively. These findings revealed the specific involvement of insula subregions in rtfMRI-nf MT.

Interoceptive awareness and beliefs about health and the body as predictors of the intensity of emotions experienced at the beginning of the pandemic

Background

The COVID-19 pandemic is a type of stressful event which might have an impact on psychological state. A prolonged threat of getting a serious, contagious illness is expected to be associated with an increase of negative emotions and, conversely, with a decrease of positive emotions. As the stressor is strongly linked to health and the body, we decided to investigate what types of factors related to body perception and appraisal are associated with different types of reported emotions. The purpose of the study was to verify the associations between three types of variables: interoceptive awareness as described by Mehling and colleagues (2012a, 2018), negative beliefs about health and body, and different types of emotions.

Methodology

A Multidimensional Assessment of Interoceptive Awareness questionnaire was applied to evaluate interoceptive awareness. The declared emotional state was diagnosed with a list of 20 emotions-divided by valence and origin. Additionally, a list of 10 negative beliefs about health and body was used. The study was held in a correlational schema with 299 subjects recruited via the social media platform Facebook who took part in an online survey.

Results

The study revealed that the scales of Self-Regulation and Trusting are primarily associated with negative automatic and reflective emotions and positive automatic emotions. Furthermore, the Self-Regulation, Trusting dimensions of interoceptive awareness predict an intensity of emotions categorised on the basis of valence and origin. In addition, negative beliefs about health and the body provided an adequate explanation of the variance of most of the types of emotions experienced during the pandemic.

Conclusions

Factors related to body perception, such as interoceptive awareness and negative beliefs about health and body provide a significant contribution to explaining emotional state at the beginning of the pandemic.

Interoceptive accuracy does not predict emotion perception in daily life

Peripheral emotion theories suggest a crucial role of interoception for emotion perception, which in turn facilitates emotion regulation. Laboratory studies found positive relations between interoceptive accuracy and perceived emotion intensity and arousal. Studies in natural settings are largely missing, but seem important by virtue of emotional experience and regulation diversity.

On hundred seven participants underwent a cardiovascular interoceptive accuracy task. Afterwards, participants provided detailed information on perceived emotions and emotion regulation strategies in an ecological momentary assessment (EMA). Multilevel models were calculated. In consideration of valence, emotion intensity, arousal, intensity of body sensations and, emotion regulation success were modeled as a function of centered interoceptive accuracy.

Interoceptive accuracy did not predict any emotion perception criterion. Lower accuracy was related to a slightly stronger decrease of perceived arousal after regulation.

Differences in emotion categories, intensity, and sample collection might explain divergences to laboratory studies.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSION

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

Alcohol use and interoception - A narrative review

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

Effects of a Single Yoga Session on Cardiac Interoceptive Accuracy and Emotional Experience

BACKGROUND

There is an increasing body of research supporting the idea that cardiac interoceptive accuracy (IAc) can be improved by training. Findings concerning the effects of a single yoga session on IAc and the related construct emotional experience are sparse. The aim of this study was to examine if a single yoga session increases IAc and improves emotional experience.

METHODS

137 students were randomly assigned to a 20-min yoga session (n = 47), an endurance session (n = 46), or an inactive control condition (n = 44). IAc and emotional experience were assessed before and after the sessions.

RESULTS

There were no significant changes in IAc, or positive and negative affect. IAc at baseline and the change in positive effect were found as predictors for IAc after the yoga session.

CONCLUSION

A 20-min yoga session seems to be not applicable to improve IAc and emotional experience. Future studies should investigate long-term interventions and diverse healthy and clinical populations.

Sex differences in interoceptive accuracy: A meta-analysis

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

The Relationship between Mindful Attention Awareness, Perceived Stress and Subjective Wellbeing

It has been suggested that mindfulness is a predictive factor in self-reported perceived stress. The present study aimed to investigate the link between mindful attention awareness, perceived stress and subjective wellbeing without the presence of a complementary intervention to promote mindfulness-based strategies.

METHODS

The online survey participants (N = 257) were university students enrolled in initial teacher training. Self-report measures included the Mindful Attention Awareness Scale (MAAS), Perceived Stress Scale (PSS) and Personal Wellbeing Index (PWI).

RESULTS

PWI was negatively correlated with PSS (r = -0.550, p = .001), MAAS was negatively correlated with PSS (r = -0.567, p = .001) and positively correlated with PWI (r = 0.336, p = .001). The mean score for PSS (M = 20.61, SD = 6.62) was above the reported norm (14.2).

CONCLUSIONS

The findings suggest that higher levels of mindful attention awareness may be associated with lower levels of perceived stress and higher subjective wellbeing levels and lower levels of perceived stress may be associated with higher subjective wellbeing. The findings confirm that pre-service teachers are a demographic that experiences elevated levels of perceived stress regardless of the stage in initial teacher training programs.

Interoception abnormalities in schizophrenia: A review of preliminary evidence and an integration with Bayesian accounts of psychosis

Schizophrenia research has traditionally focused almost exclusively on how the brain interprets the outside world. However, our internal bodily milieu is also central to how we interpret the world and construct our reality: signals from within the body are critical for not only basic survival, but also a wide range of brain functions from basic perception, emotion, and motivation, to sense of self. In this article, we propose that interoception-the processing of bodily signals-may have implications for a wide range of clinical symptoms in schizophrenia and may thus provide key insights into illness mechanisms. We start with an overview of interoception pathways. Then we provide a review of direct and indirect findings in various interoceptive systems in schizophrenia and interpret these findings in the context of computational frameworks that model interoception as hierarchical Bayesian inference. Finally, we propose a conceptual model of how altered interoceptive inference may contribute to specific schizophrenia symptoms-negative symptoms in particular-and suggest directions for future research, including potential new avenues of treatment.

From Self-Esteem to Selflessness: An Evidence (Gap) Map of Self-Related Processes as Mechanisms of Mindfulness-Based Interventions

Self-related processes (SRPs) have been theorized as key mechanisms of mindfulness-based interventions (MBIs), but the evidence supporting these theories is currently unclear. This evidence map introduces a comprehensive framework for different types of SRPs, and how they are theorized to function as mechanisms of MBIs (target identification). The evidence map then assesses SRP target engagement by mindfulness training and the relationship between target engagement and outcomes (target validation). Discussion of the measurement of SRPs is also included. The most common SRPs measured and engaged by standard MBIs represented valenced evaluations of self-concept, including rumination, self-compassion, self-efficacy, and self-esteem. Rumination showed the strongest evidence as a mechanism for depression, with other physical and mental health outcomes also supported. Self-compassion showed consistent target engagement but was inconsistently related to improved outcomes. Decentering and interoception are emerging potential mechanisms, but their construct validity and different subcomponents are still in development. While some embodied self-specifying processes are being measured in cross-sectional and meditation induction studies, very few have been assessed in MBIs. The SRPs with the strongest mechanistic support represent positive and negative evaluations of self-concept. In sum, few SRPs have been measured in MBIs, and additional research using well-validated measures is needed to clarify their role as mechanisms.

Investigating differential effects of socio-emotional and mindfulness-based online interventions on mental health, resilience and social capacities during the COVID-19 pandemic: The study protocol

BACKGROUND

The SARS-CoV-2 pandemic has led to a mental health crisis on a global scale. Epidemiological studies have reported a drastic increase in mental health problems, such as depression and anxiety, increased loneliness and feelings of disconnectedness from others, while resilience levels have been negatively affected, indicating an urgent need for intervention. The current study is embedded within the larger CovSocial project which sought to evaluate longitudinal changes in vulnerability, resilience and social cohesion during the pandemic. The current second phase will investigate the efficacy of brief online mental training interventions in reducing mental health problems, and enhancing psychological resilience and social capacities. It further provides a unique opportunity for the prediction of intervention effects by individual biopsychosocial characteristics and preceding longitudinal change patterns during the pandemic in 2020/21.

METHODS

We will examine the differential effects of a socio-emotional (including 'Affect Dyad') and a mindfulness-based (including 'Breathing Meditation') intervention, delivered through a web- and cellphone application. Participants will undergo 10 weeks of intervention, and will be compared to a retest control group. The effectiveness of the interventions will be evaluated in a community sample (N = 300), which is recruited from the original longitudinal CovSocial sample. The pre- to post-intervention changes, potential underlying mechanisms, and prediction thereof, will be assessed on a wide range of outcomes: levels of stress, loneliness, depression and anxiety, resilience, prosocial behavior, empathy, compassion, and the impact on neuroendocrine, immunological and epigenetic markers. The multi-method nature of the study will incorporate self-report questionnaires, behavioral tasks, ecological momentary assessment (EMA) approaches, and biological, hormonal and epigenetic markers assessed in saliva.

DISCUSSION

Results will reveal the differential effectiveness of two brief online interventions in improving mental health outcomes, as well as enhancing social capacities and resilience. The present study will serve as a first step for future application of scalable, low-cost interventions at a broader level to reduce stress and loneliness, improve mental health and build resilience and social capacities in the face of global stressors.

TRIAL REGISTRATION

This trial has been registered on May 17, 2020 with the ClinicalTrials.gov NCT04889508 registration number (clinicaltrials.gov/ct2/show/NCT04889508).

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

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

The Effects of a Standardized Cognitive-Behavioural Therapy and an Additional Mindfulness-Based Training on Interoceptive Abilities in a Depressed Cohort

BACKGROUND

Interoceptive accuracy and sensibility are decreased in depressive samples. However, different studies showed that cognitive-behavioural therapy (CBT) and mindfulness interventions are promising approaches to improve interoceptive abilities. Based on these findings, the study aims to investigate the pre-post effect of CBT in a depressive sample. Additionally, we examined the effect of mindfulness-based stress reduction (MBSR) training in the context of CBT.

METHODS

Sixty depressive patients were investigated over four weeks, with two conditions-CBT vs. CBT + MBSR. Further, the changes in interoceptive abilities (interoceptive accuracy and sensibility) of the depressive patients were compared to baseline data of healthy controls.

RESULTS

The depressive patients showed significantly higher levels of depression and lower mindfulness and interoceptive abilities than healthy controls. The depressive sample showed a significant decrease in depressive symptoms and increased mindfulness and interoceptive abilities after CBT. Lastly, depressive patients of the CBT + MBSR condition did not differ from those who only received CBT in the levels of depression, mindfulness or interoceptive abilities over the time course.

DISCUSSION

This study demonstrates a positive effect of CBT on interoceptive abilities in a depressive sample. It is shown that the depressive sample did not profit from additional mindfulness training. It can be concluded that CBT is an efficient treatment, resulting in increased interoceptive abilities. Unexpectedly, the combination of CBT and MBSR has no additional effect on these changes. Future studies should investigate the effect of MBSR as a stand-alone therapy.

Interoceptive Accuracy as a Function of Hypnotizability

This study aimed to measure the interoceptive accuracy (IA) of individuals with high (highs), medium (mediums), and low hypnotizability (lows) through the heartbeat-counting task during 3 relaxation trials. Participants completed the Multidimensional Assessment of Interoceptive Awareness (MAIA), ECG and skin conductance (SC) were monitored, and the experienced difficulty in counting was reported. Results showed similar counting difficulty and number of actual heartbeats in highs, mediums, and lows. SC decreased in highs during all trials, in mediums and lows only in the third trial. IA measured as [1 - (ǀrecorded heartbeats-counted heartbeatsǀ)/recorded heartbeats] was negatively correlated with hypnotizability and not correlated with interoceptive sensitivity (IS) measured by MAIA scales. Among mediums, IA was higher in males than in females.

Contemplative Mental Training Reduces Hair Glucocorticoid Levels in a Randomized Clinical Trial

OBJECTIVE

This study aimed to investigate the effect of regular contemplative mental training on endocrine and psychological indices of long-term stress.

METHODS

An open-label efficacy trial that comprised three distinct 3-month long modules targeting attention and interoception, socioaffective, or sociocognitive abilities through dyadic exercises and secularized meditation practices was conducted with healthy adults. Participants underwent the training for 3 or 9 months, or were assigned to a retest control cohort. Chronic stress indices were assayed at four time points: pretraining and after 3, 6, and 9 months. The main outcome measures were cortisol (HC) and cortisone (HE) concentration in hair and self-reported long-term stress.

RESULTS

Of 362 initially randomized individuals, 30 dropped out before study initiation (n = 332; mean [SD] age = 40.7 [9.2] years; 197 women). Hair-based glucocorticoid assays were available from n = 227, and questionnaire data from n = 326. Results from three separate training cohorts (TC1-3) revealed consistent decreases in HC and HE levels over the first three (TC3) to 6 months (TC1 and TC2) of training, with no further reduction at the final 9-month mark (baseline to end of training differences, HC, TC1: t(355) = 2.59, p = .010, contrast estimate (est.) [SE] = 0.35 [0.14]; HC, TC2: t(363) = 4.06, p < .001, est. = 0.48 [0.12]; HC, TC3: t(368) = 3.18, p = .002, est. = 0.41 [0.13]; HE, TC1: t(435) = 3.23, p = .001, est. = 0.45 [0.14]; HE, TC2: t(442) = 2.60, p = .010, est. = 0.33 [0.13]; HE, TC3: t(446) = 4.18, p < .001, est. = 0.57 [0.14]). Training effects on HC increased with individual compliance (practice frequency), and effects on both HC and HE were independent of training content and unrelated to change in self-reported chronic stress. Self-reported stress, and cortisol-to-dehydroepiandrosterone ratios as an exploratory endpoint, were also reduced, albeit less consistently.

CONCLUSIONS

Our results point to the reduction of long-term cortisol exposure as a mechanism through which meditation-based mental training may exert positive effects on practitioners' health.Trial Registration: ClinicalTrials.gov identifier: NCT01833104.

The Effects of Mindfulness-Based Stress Reduction on the Association Between Autonomic Interoceptive Signals and Emotion Regulation Selection

OBJECTIVE

The ability to select the most adaptive regulatory strategy as a function of the emotional context plays a pivotal role in psychological health. Recently, we showed that mindfulness-based interventions (MBIs) can improve the sensitivity of regulatory strategy selection to emotional intensity. However, the mechanisms underlying this improvement are unclear. In this study, we tested the hypothesis that MBIs support adaptive regulatory selection by increasing sensitivity to interoceptive signals associated with the emotional stimuli.

METHODS

Participants (n = 84, mean [standard deviation {SD}] age = 30.9 [8.3] years; 54% women) were randomized to either a mindfulness-based stress reduction (MBSR) program or a wait-list control condition. Before and after the MBSR program, physiological measures for autonomic nervous system activity were obtained, and participants performed a task examining emotion regulation selections (reappraisal versus distraction) when confronted with low or high negative intensity images. They also completed a battery of mindfulness, interoception, and well-being self-report measures. A cross-classified model was used for the main analyses.

RESULTS

The participants assigned to the MBSR were overall more likely to choose reappraisal than distraction (b = 0.26, posterior SD = 0.13, 95confidence interval = 0.02-0.52) after the program. Interoceptive signals in response to negative images were associated with subsequent regulatory selections (b = 0.02, posterior SD = 0.01, 95% confidence interval = 0.01-0.03) in the MBSR group. Specifically, lower cardiac reactivity was associated with the choice to reappraise, whereas higher cardiac reactivity was related to the choice to distract. Greater differences in cardiac reactivity between states that prompt reappraisal and states that prompt distraction were associated with higher well-being (Satisfaction With Life Scale, Pearson r (29) = 0.527, p = .003).

CONCLUSIONS

Mindfulness seems to increase the sensitivity of regulatory selections to interoceptive signals, and this is associated with subjective well-being. This may be a central pathway through which MBIs exert their positive effects on mental health and resilience.

The effect of aerobic exercise on interoception and cognitive function in healthy university students: a non-randomized controlled trial

BACKGROUND

Interoception refers to the body's physiological responses that occur in response to emotions. This phenomenon influences decision-making, an important cognitive ability that affects the maintenance of an exercise routine. However, it is controversial whether interoception is a reliable measure of an individual's traits or their response to emotion. Given this evidence, we hypothesized that performing an exercise with positive feelings could improve interoception and that the rational decision-making capabilities acquired by improved interoception would, in turn, help in maintaining an exercise routine. Persistent aerobic exercise is essential for improving cognitive and musculoskeletal function in the long term. Therefore, we aimed to investigate changes in interoception during moderate-intensity aerobic exercise at a level that might potentially improve cognitive function.

METHODS

We devided 48 healthy university students into an exercise group (n = 37) and a control group (n = 11). The control group did not perform any exercises, while the exercise group performed bench step exercises at an intensity of 50% of heart rate reserve for 30 min a day, three times a week, for three months. We assessed their cognitive function by measuring their auditory information/working memory processing speed using a paced auditory serial addition task (PASAT) and evaluated their interoceptive accuracy (IA) using a heartbeat tracking task at baseline and 1, 2, and 3 months after the start of the exercise intervention.

RESULTS

There was a significant positive correlation between IA and PASAT scores at baseline. However, exercise did not lead to a significant increase in PASAT scores of the exercise group as compared with the control group. IA scores increased at 2 and 3 months after the start of exercise only in the exercise group.

CONCLUSIONS

This preliminary study showed an improvement in interoception after persistent moderate-intensity aerobic exercise. We believe that exercise-induced improvement of interoception may facilitate exercise maintenance through improved cognitive function. Statistical analysis did not explain the non-uniformity of sample sizes, therefore, future studies should have larger sample sizes with equal subjects in each group to allow for better comparability and generalizability.

TRIAL REGISTRATION

UMIN, UMIN000042891. 04/01/2021, retrospectively registered.

Disrupted Dorsal Mid-Insula Activation During Interoception Across Psychiatric Disorders

OBJECTIVE

Maintenance of bodily homeostasis relies on interoceptive mechanisms in the brain to predict and regulate bodily state. While altered neural activation during interoception in specific psychiatric disorders has been reported in many studies, it is unclear whether a common neural locus underpins transdiagnostic interoceptive differences.

METHODS

The authors conducted a meta-analysis of neuroimaging studies comparing patients with psychiatric disorders with healthy control subjects to identify brain regions exhibiting convergent disrupted activation during interoception. Bibliographic, neuroimaging, and preprint databases through May 2020 were searched. A total of 306 foci from 33 studies were extracted, which included 610 control subjects and 626 patients with schizophrenia, bipolar or unipolar depression, posttraumatic stress disorder, anxiety, eating disorders, or substance use disorders. Data were pooled using a random-effects model implemented by the activation likelihood estimation algorithm. The preregistered primary outcome was the neuroanatomical location of the convergence of peak voxel coordinates.

RESULTS

Convergent disrupted activation specific to the left dorsal mid-insula was found (Z=4.47, peak coordinates: -36, -2, 14; volume: 928 mm3). Studies directly contributing to the cluster included patients with bipolar disorder, anxiety, major depression, anorexia, and schizophrenia, assessed with task probes including pain, hunger, and interoceptive attention. A series of conjunction analyses against extant meta-analytic data sets revealed that this mid-insula cluster was anatomically distinct from brain regions involved in affective processing and from regions altered by psychological or pharmacological interventions for affective disorders.

CONCLUSIONS

These results reveal transdiagnostic, domain-general differences in interoceptive processing in the left dorsal mid-insula. Disrupted mid-insular activation may represent a neural marker of psychopathology and a putative target for novel interventions.

The heartbeat evoked potential does not support strong interoceptive sensibility in trait mindfulness

The enhancement of body awareness is proposed as one of the cognitive mechanisms that characterize mindfulness. To date, this hypothesis is supported by self-report and behavioral measures but still lacks physiological evidence. The current study investigated relation between trait mindfulness (i.e., individual differences in the ability to be mindful in daily life) and body awareness in combining a self-report measure (Multidimensional Assessment of Interoceptive Awareness [MAIA] questionnaire) with analysis of the heartbeat evoked potential (HEP), which is an event-related potential reflecting the cortical processing of the heartbeat. The HEP data were collected from 17 healthy participants under five minutes of resting-state condition. In addition, each participant completed the Freiburg Mindfulness Inventory and the MAIA questionnaire. Taking account of the important variability of HEP effects, analyses were replicated with the same participants three times (in three distinct sessions). First, group-level analyses showed that HEP amplitude and trait mindfulness do not correlate. Secondly, we observed that HEP amplitude could positively correlate with self-reported body awareness; however, this association was unreliable over time. Interestingly, we found that HEP measure shows very poor reliability over time at the individual level, potentially explaining the lack of reliable association between HEP and psychological traits. Lastly, a reliable positive correlation was found between self-reported trait mindfulness and body awareness. Taken together, these findings provide preliminary evidence that the HEP might not support the increased subjective body awareness in trait mindfulness, thus suggesting that perhaps objective and subjective measures of body awareness could be independent.

Disentangling interoceptive abilities in alexithymia

In recent years, research on interoceptive abilities (i.e., sensibility, accuracy, and awareness) and their associations with emotional experience has flourished. Yet interoceptive abilities in alexithymia—a personality trait characterized by a difficulty in the cognitive interpretation of emotional arousal, which impacts emotional experience—remain under-investigated, thereby limiting a full understanding of subjective emotional experience processing. Research has proposed two contrasting explanations thus far: in one model, the dimensions of interoceptive sensibility and accuracy in alexithymia would increase; in the other model, they would decrease. Surprisingly, the contribution of interoceptive awareness has been minimally researched. In this study (N = 182), the relationship between participants’ level of alexithymia and the three interoceptive dimensions was tested. Our results show that the higher the level of alexithymia is, the higher interoceptive accuracy and sensibility (R² = 0.29 and R² = 0.14); conversely, the higher the level of alexithymia is, the lower interoceptive awareness (R² = 0.36). Moreover, an ROC analysis reveals that interoceptive awareness is the most accurate predictor of alexithymia, yielding over 92% accuracy. Collectively, these results support a coherent understanding of interoceptive abilities in alexithymia, whereby the dissociation of interoceptive accuracy and awareness may explain the underlying psycho-physiological mechanisms of alexithymia. A possible neurocognitive mechanism is discussed which suggests insurgence of psychosomatic disorders in alexithymia and related psychotherapeutic approaches.

Evidence toward the potential absence of relationship between temporal and spatial heartbeats perception

Many interoceptive tasks (i.e. measuring the sensitivity to bodily signals) are based upon heartbeats perception. However, the temporal perception of heartbeats-when heartbeats are felt-varies among individuals. Moreover, the spatial perception of heartbeats-where on the body heartbeats are felt-has not been characterized in relation to temporal. This study used a multi-interval heartbeat discrimination task in which participants judged the timing of their own heartbeats in relation to external tones. The perception of heartbeats in both time and spatial domains, and relationship between these domains was investigated. Heartbeat perception occurred on average ~ 250 ms after the ECG R-wave, most frequently sampled from the left part of the chest. Participants' confidence in discriminating the timing of heartbeats from external tones was maximal at 0 ms (tone played at R-wave). Higher confidence was related to reduced dispersion of sampling locations, but Bayesian statistics indicated the absence of relationship between temporal and spatial heartbeats perception. Finally, the spatial precision of heartbeat perception was related to state-anxiety scores, yet largely independent of cardiovascular parameters. This investigation of heartbeat perception provides fresh insights concerning interoceptive signals that contribute to emotion, cognition and behaviour.