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Fani N, Fulton T, Botzanowski B. The Neurophysiology of Interoceptive Disruptions in Trauma-Exposed Populations. Curr Top Behav Neurosci 2024. [PMID: 38678141 DOI: 10.1007/7854_2024_469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
In the aftermath of psychological trauma, many individuals experience perturbations in interoception, a term that broadly references the ability to accurately detect body signals and integrate these signals with emotional states. These interoceptive disruptions can manifest in different ways, including blunting or amplification of sensitivity to internal physiological signals. In this chapter we review extant neurophysiological research on interoception in trauma-exposed populations, with a particular focus on the effects of chronic interpersonal trauma, such as childhood maltreatment and racial discrimination. We explore research that used different types of interoceptive assays, from self-report measures to electrophysiological and neuroimaging tools to characterize the disruptions in pain perception, interoceptive acuity, and physiological responses that may arise after a traumatic event. Finally, we discuss interventions that are designed to target interoceptive mechanisms, from exposure-based therapies to mindfulness-based practices, as well as future directions in trauma interoception research.
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Affiliation(s)
- Negar Fani
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| | - Travis Fulton
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Boris Botzanowski
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
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2
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Schoeller F, Horowitz AH, Jain A, Maes P, Reggente N, Christov-Moore L, Pezzulo G, Barca L, Allen M, Salomon R, Miller M, Di Lernia D, Riva G, Tsakiris M, Chalah MA, Klein A, Zhang B, Garcia T, Pollack U, Trousselard M, Verdonk C, Dumas G, Adrien V, Friston K. Interoceptive technologies for psychiatric interventions: From diagnosis to clinical applications. Neurosci Biobehav Rev 2024; 156:105478. [PMID: 38007168 DOI: 10.1016/j.neubiorev.2023.105478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 11/16/2023] [Accepted: 11/19/2023] [Indexed: 11/27/2023]
Abstract
Interoception-the perception of internal bodily signals-has emerged as an area of interest due to its implications in emotion and the prevalence of dysfunctional interoceptive processes across psychopathological conditions. Despite the importance of interoception in cognitive neuroscience and psychiatry, its experimental manipulation remains technically challenging. This is due to the invasive nature of existing methods, the limitation of self-report and unimodal measures of interoception, and the absence of standardized approaches across disparate fields. This article integrates diverse research efforts from psychology, physiology, psychiatry, and engineering to address this oversight. Following a general introduction to the neurophysiology of interoception as hierarchical predictive processing, we review the existing paradigms for manipulating interoception (e.g., interoceptive modulation), their underlying mechanisms (e.g., interoceptive conditioning), and clinical applications (e.g., interoceptive exposure). We suggest a classification for interoceptive technologies and discuss their potential for diagnosing and treating mental health disorders. Despite promising results, considerable work is still needed to develop standardized, validated measures of interoceptive function across domains and before these technologies can translate safely and effectively to clinical settings.
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Affiliation(s)
- Felix Schoeller
- Fluid Interfaces Group, Media Lab, Massachusetts Institute of Technology, USA; Institute for Advanced Consciousness Studies, Santa Monica, CA, USA; Department Cognitive Sciences, University of Haifa, Israel.
| | - Adam Haar Horowitz
- Fluid Interfaces Group, Media Lab, Massachusetts Institute of Technology, USA; Center for Sleep and Cognition, Beth Israel Deaconess Medical Center, Harvard Medical School, USA
| | - Abhinandan Jain
- Fluid Interfaces Group, Media Lab, Massachusetts Institute of Technology, USA
| | - Pattie Maes
- Fluid Interfaces Group, Media Lab, Massachusetts Institute of Technology, USA
| | - Nicco Reggente
- Institute for Advanced Consciousness Studies, Santa Monica, CA, USA
| | | | - Giovanni Pezzulo
- Institute of Cognitive Sciences and Technologies, National Research Council, Rome, Italy
| | - Laura Barca
- Institute of Cognitive Sciences and Technologies, National Research Council, Rome, Italy
| | - Micah Allen
- Center of Functionally Integrative Neuroscience, Aarhus University, Denmark; Cambridge Psychiatry, University of Cambridge, UK
| | - Roy Salomon
- Department Cognitive Sciences, University of Haifa, Israel
| | - Mark Miller
- Center for Human Nature, Artificial Intelligence and Neuroscience, Hokkaido University, Japan
| | - Daniele Di Lernia
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy; Applied Technology for Neuro- Psychology Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Giuseppe Riva
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy; Applied Technology for Neuro- Psychology Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Manos Tsakiris
- The Warburg Institute, School of Advanced Study, University of London, UK; Department of Psychology, Royal Holloway, University of London, UK; Department of Behavioural and Cognitive Sciences, University of Luxembourg, Luxembourg
| | - Moussa A Chalah
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est Créteil, Créteil, France; Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Créteil, France
| | - Arno Klein
- Child Mind Institute, New York City, USA
| | - Ben Zhang
- Institute for Advanced Consciousness Studies, Santa Monica, CA, USA
| | - Teresa Garcia
- Institute for Advanced Consciousness Studies, Santa Monica, CA, USA
| | - Ursula Pollack
- Institute for Advanced Consciousness Studies, Santa Monica, CA, USA
| | - Marion Trousselard
- Institut de Recherche Biomédicale des Armées, Place Général Valérie André, 91220 Brétigny-sur-Orge, France
| | - Charles Verdonk
- Institut de Recherche Biomédicale des Armées, Place Général Valérie André, 91220 Brétigny-sur-Orge, France
| | | | - Vladimir Adrien
- Infrastructure for Clinical Research in Neurosciences (iCRIN) Psychiatry, Paris Brain Institute, Paris, France; Department of Psychiatry, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, 75012 Paris, France
| | - Karl Friston
- Queen Sq, Institute of Neurology, UCL, London WC1N 3AR, UK
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Tolin DF, McKay D, Olatunji BO, Abramowitz JS, Otto MW. On the importance of identifying mechanisms and active ingredients of psychological treatments. Behav Res Ther 2023; 170:104425. [PMID: 37913558 PMCID: PMC11034847 DOI: 10.1016/j.brat.2023.104425] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/17/2023] [Accepted: 10/23/2023] [Indexed: 11/03/2023]
Abstract
This commentary addresses the thought-provoking article by Lorenzo-Luaces (in press). We review areas of both agreement and disagreement with the author's points, noting that readers should not infer that research into active ingredients and mechanisms is pointless. We conclude with a call for more research into the mechanisms of therapeutic change and the active ingredients of therapeutic interventions, with the aim of disseminating treatments that are both effective and efficient.
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Affiliation(s)
- David F Tolin
- The Institute of Living, Yale University School of Medicine, United States.
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Ginat-Frolich R, Kara-Ivanov A, Strauss AY, Myers A, Huppert JD. Mechanisms underlying interoceptive exposure: belief disconfirmation or extinction? A preliminary study. Cogn Behav Ther 2023; 52:132-145. [PMID: 36217830 DOI: 10.1080/16506073.2022.2109511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Interoceptive exposure, or exposure to one's feared physical sensations, has been shown to be an important technique in cognitive behavioral therapies for anxiety disorders and related constructs, such as anxiety sensitivity (AS). The current study sought to further clarify the underlying cognitive-behavioral mechanisms of interoceptive exposure in a lab-based, analog study with individuals high in AS. Participants (n = 59) were randomized into three groups: a cognitive-behavioral intervention emphasizing belief disconfirmation (CbI), a behavioral intervention emphasizing exposure (BI), and a control condition. Self-report measures assessing AS, catastrophizing of bodily sensations, and subjective units of distress (SUDS) were collected before, during and after the intervention. Participants also completed online questionnaires at a one-month follow-up. Following the CbI but not BI, a decrease was observed in both AS and catastrophizing interpretations. Furthermore, only the CbI group exhibited a decrease in SUDS ratings, whereas the BI group exhibited a significant increase. Notably, these effects were not maintained at a one-month follow-up. Findings suggest that cognitive interventions without repeated behavioral exposure may be sufficient in reducing self-reported anxiety-related symptoms and catastrophic misinterpretations, though not at maintaining them. This raises questions regarding the role of pure behavioral mechanisms in exposure.
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Affiliation(s)
| | - Anna Kara-Ivanov
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Asher Y Strauss
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ayelet Myers
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jonathan D Huppert
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
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Wintermann GB, Noack R, Steudte-Schmiedgen S, Weidner K. Cortisol response under low intensity exercise during cognitive-behavioral therapy is associated with therapeutic outcome in panic disorder–an exploratory study. PLoS One 2022; 17:e0273413. [PMID: 36048809 PMCID: PMC9436097 DOI: 10.1371/journal.pone.0273413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/15/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives
Patients with Panic Disorder (PD) show an abnormal stress-induced functioning of the Hypothalamic-Pituitary-adrenal (HPA)-axis. Different protocols for stress induction are of rather low relevance for the psychotherapeutic treatment. In practice, interoceptive exposure is often realized as Low Intensity Exercise (LIE), as compared to an incremental cycle exercise test to exhaustion. Currently, it is not known, whether LIE displays an effective interoceptive stressor 1.) leading to a significant anxiety induction; 2.) a comparable HPA- and Sympathetic-Adreno-Medullar (SAM)-axis response in both patients and healthy controls; 3.) stress responses under LIE are associated with treatment outcomes.
Patients and methods
N = 20 patients with PD and n = 20 healthy controls were exposed to ten minutes of LIE on an exercise bike. LIE was applied as part of the interoceptive exposure, during an intensive Cognitive-Behavioral Therapy (CBT) in a day clinic. Heart rate was monitored and salivary cortisol samples collected. Before and after the LIE, state anxiety/ arousal were assessed. In order to evaluate psychopathology, the Panic and Agoraphobia Scale, Mobility Inventory, Agoraphobic Cognitions Questionnaire and Body Sensations Questionnaire were applied, before (T1) and after five weeks (T2) of an intensive CBT.
Results
LIE led to a significant and similar heart rate increase in both groups. Cortisol decreased over time in both groups, especially in male patients. A higher psychopathology before, and after CBT, was associated with a significantly lower cortisol response under LIE.
Conclusions
In the present study, LIE led to a divergent stress response: while there was a significant heart rate increase, cortisol decreased over time, particularly in male patients. A lower reactivity of the HPA-axis seems to be associated with a lower treatment outcome, which may affect extinction based learning. The findings suggest, that interoceptive stimuli should be designed carefully in order to be potent stressors.
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Affiliation(s)
- Gloria-Beatrice Wintermann
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Saxony, Germany
- * E-mail:
| | - René Noack
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Saxony, Germany
| | - Susann Steudte-Schmiedgen
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Saxony, Germany
| | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Saxony, Germany
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Kannis-Dymand L, Grace E, McDonald L, Chambers R. Australian and New Zealand psychologists’ perceptions and use of therapist-guided exposure for panic disorder. CLIN PSYCHOL-UK 2022. [DOI: 10.1080/13284207.2022.2035651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Lee Kannis-Dymand
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sunshine Coast, Australia
| | - Emma Grace
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sunshine Coast, Australia
| | - Lindsay McDonald
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sunshine Coast, Australia
| | - Ron Chambers
- CDHB, Anxiety Disorders Service, Christchurch, New Zealand
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Campbell RL, Cloutier R, Bynion TM, Nguyen A, Blumenthal H, Feldner MT, Leen-Feldner EW. Greater adolescent tiredness is related to more emotional arousal during a hyperventilation task: An area under the curve approach. J Adolesc 2021; 90:45-52. [PMID: 34130127 DOI: 10.1016/j.adolescence.2021.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 12/17/2020] [Accepted: 05/23/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Approximately 36% of adolescents report sleep problems (Crowley et al., 2018). Understanding the relation between sleep and emotional experience is crucial in understanding the high incidence of mental health concerns during adolescence. The current study sought to expand understanding in the area by testing the hypothesis that baseline tiredness ratings would predict greater emotional arousal and negative valence across the course of emotional response elicited by a voluntary hyperventilation procedure. METHODS A community sample of 110 youth (10-18 years; 47.8% girls) provided baseline tiredness ratings and ratings of emotional valence and arousal, 2 min before, immediately after, and 3 min after a hyperventilation task. The area under the curve (AUC) was calculated using the repeated measures of valence and arousal, and correlations between the response curves and baseline tiredness were examined. RESULTS AND CONCLUSIONS Findings indicated baseline tiredness was positively associated with AUC arousal (r = 0.23), but not valence. This suggests daytime tiredness is associated with the degree of emotional arousal elicited by a psychobiological stressor. By extension, adolescents may experience more arousing emotional reactions when tired, and thus the common sleep deprivation observed during this developmental period may increase risk for mental health problems associated with elevated emotional reactivity.
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Decreased defensive reactivity to interoceptive threat after successful exposure-based psychotherapy in patients with panic disorder. Transl Psychiatry 2021; 11:177. [PMID: 33731674 PMCID: PMC7969920 DOI: 10.1038/s41398-021-01298-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/18/2021] [Accepted: 02/26/2021] [Indexed: 01/10/2023] Open
Abstract
Panic disorder (PD) is characterized by a dysfunctional defensive responding to panic-related body symptoms that is assumed to contribute to the persistence of panic symptomatology. The present study aimed at examining whether this dysfunctional defensive reactivity to panic-related body symptoms would no longer be present following successful cognitive behavior therapy (CBT) but would persist when patients show insufficient symptom improvement. Therefore, in the present study, effects of CBT on reported symptoms and defensive response mobilization during interoceptive challenge were investigated using hyperventilation as a respiratory symptom provocation procedure. Changes in defensive mobilization to body symptoms in the course of CBT were investigated in patients with a primary diagnosis of PD with or without agoraphobia by applying a highly standardized hyperventilation task prior to and after a manual-based CBT (n = 38) or a waiting period (wait-list controls: n = 20). Defensive activation was indexed by the potentiation of the amygdala-dependent startle eyeblink response. All patients showed a pronounced defensive response mobilization to body symptoms at baseline. After treatment, no startle reflex potentiation was found in those patients who showed a clinically significant improvement. However, wait-list controls and treatment non-responders continued to show increased defensive responses to actually innocuous body symptoms after the treatment/waiting period. The present results indicate that the elimination of defensive reactivity to actually innocuous body symptoms might be a neurobiological correlate and indicator of successful CBT in patients with PD, which may help to monitor and optimize CBT outcomes.
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9
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Garey L, Smit T, Neighbors C, Gallagher MW, Zvolensky MJ. Personalized Feedback for Smoking and Anxiety Sensitivity: A Randomized Controlled Trial. Subst Use Misuse 2021; 56:929-940. [PMID: 33761839 PMCID: PMC10032029 DOI: 10.1080/10826084.2021.1900255] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Cigarette smoking is the leading preventable cause of death and disability globally. Most smokers want to quit, and most make a serious quit attempt each year. Nevertheless, more than 95% of cessation attempters relapse within six months. Thus, alternative interventions are needed to combat this major public health concern. Objective: The current study was conducted to develop and test a smoking treatment among 95 (63.2% male; Mage = 46.20 years, SD = 10.90) adult daily cigarette smokers that targets a known risk factor for smoking maintenance and relapse: anxiety sensitivity (AS). Methods: The current study employed a randomized controlled trial design to test an integrated, brief, computer-delivered smoking and AS intervention among current, daily smokers. Participants completed four appointments: (a) phone-screener; (b) baseline (pre-intervention assessment, intervention [personalized feedback intervention (PFI) versus smoking information control], and post-intervention assessment); (c) 2-week follow-up; and (d) 4-week follow-up. Results: Participants indicated highly positive evaluations of both the PFI and control intervention. Between the baseline and 2-week follow-up, 44.2% [PFI: 46.9% (n = 23); control: 41.3% (n = 19)] of participants reported a quit attempt. At the 4-week follow-up, 49.5% [PFI: 57.1% (n = 28); control: 41.3% (n = 19)] of participants reported a quit attempt since their previous laboratory session. Conclusion: Within the context of an intervention development approach, the present investigation provides descriptive data on the feasibility, acceptability, and initial efficacy of a single-session, computer-delivered, AS/smoking PFI.
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Affiliation(s)
- Lorra Garey
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Tanya Smit
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Clayton Neighbors
- Department of Psychology, University of Houston, Houston, Texas, USA
| | | | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, Texas, USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- HEALTH Institute, University of Houston, Houston, Texas, USA
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10
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Tunnell N, Ritz T, Wilhelm FH, Roth WT, Meuret AE. Habituation or Normalization? Experiential and Respiratory Recovery From Voluntary Hyperventilation in Treated Versus Untreated Patients With Panic Disorder. Behav Ther 2021; 52:124-135. [PMID: 33483110 PMCID: PMC9020269 DOI: 10.1016/j.beth.2020.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 10/24/2022]
Abstract
Psychophysiological theories postulate respiratory dysregulation as a mechanism contributing to panic disorder (PD). Additionally, symptomatic and respiratory recovery from voluntary hyperventilation (HVT-recovery) have been shown to lag in PD and it is unclear if HVT-recovery normalizes with treatment. Thirty-seven panic disorder patients were randomized to hypoventilation therapy (TX, n = 20) or waitlist control (WL, n = 17) (Meuret et al., 2008). In a secondary analysis, their HVT-recovery was analyzed at pre- and post-TX/WL, compared to 29 healthy controls (HC). HVT included three phases: 5-min baseline, 3-min hyperventilation, and 8-min recovery. HVT-elicited symptom severity and anxiety were rated following each phase, and end-tidal PCO2 and respiratory rate (RR) were recorded throughout. Treatment, compared to WL, was highly effective in reducing PD pathology (d=2.21, Meuret et al., 2008). At pre-TX/WL, PD demonstrated delayed HVT-recovery PCO2 and higher RR. Treated patients demonstrated normalization of HVT-recovery for PCO2 and RR; however, improvements of HVT-recovery for symptom severity and anxiety did not differ between TX and WL. Results replicate pretreatment HVT respiratory recovery abnormalities in PD and further demonstrate normalization, comparable to HC, following successful treatment. The results provide support for respiratory dysregulation as a feature of PD and demonstrate the utility of HVT respiratory recovery as treatment outcome measure for respiration-based PD therapy.
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Affiliation(s)
| | - Thomas Ritz
- Southern Methodist University, Department of Psychology
| | - Frank H. Wilhelm
- University of Salzburg, Department of Psychology, Division of Clinical Psychology, Psychotherapy, and Health Psychology
| | - Walton T. Roth
- Stanford University, Department of Psychiatry, and the VA Palo Alto Health Care System
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11
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Mai-Lippold SA, Dettlinger CM, Khalsa SS, Pollatos O. A Pilot Study on the Effect of an Energy Drink on Interoception in High vs. Low Anxiety Sensitivity Individuals. EUROPEAN JOURNAL OF HEALTH PSYCHOLOGY 2020. [DOI: 10.1027/2512-8442/a000061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Abstract. Background: The market for energy drinks has grown quickly over the past 20 years. While the physiological and psychological effects of different ingredients have been studied, the influence of energy drinks on interoceptive processes is unclear. Anxiety has been associated with amplified interoceptive functioning, suggesting potentially exaggerated reactions to energy drinks. Aims: Investigate the effect of energy drink consumption and anxiety sensitivity (AS) as well as their possible interactions on cardiorespiratory dimensions of interoception. Method: Thirty-nine healthy students consumed an energy drink via a placebo-controlled, counterbalanced, crossover design. Cardiac and respiratory interoceptive accuracy (IAcc), interoceptive sensibility (IS), and interoceptive evaluation (IE) were assessed. Heartbeat-evoked potentials (HEPs) were analyzed to evaluate neural processing of the heartbeat. Results: Consumption of one energy drink did not influence IAcc, IS, or IE. However, high AS subjects reported reduced interoceptive confidence after energy drink intake. While HEP amplitudes did not differ depending on the type of drink, high AS subjects showed reduced HEPs overall compared to low AS subjects. Heart rate was significantly lower following energy drink consumption as compared to the placebo condition. Limitations: The sample size was small, energy dosages low, and physiological parameters should be assessed in more detail. Conclusion: Energy drink consumption was associated with an interoceptive bias in high AS individuals suggesting possible interaction effects between changes in physical state, interoception, and anxiety.
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Affiliation(s)
| | | | - Sahib S. Khalsa
- Laureate Institute for Brain Research, University of Tulsa, OK, USA
- Oxley College of Health Sciences, University of Tulsa, OK, USA
| | - Olga Pollatos
- Department of Clinical and Health Psychology, Ulm University, Germany
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12
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Lapidus RC, Puhl M, Kuplicki R, Stewart JL, Paulus MP, Rhudy JL, Feinstein JS, Khalsa SS. Heightened affective response to perturbation of respiratory but not pain signals in eating, mood, and anxiety disorders. PLoS One 2020; 15:e0235346. [PMID: 32667951 PMCID: PMC7363095 DOI: 10.1371/journal.pone.0235346] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 06/14/2020] [Indexed: 12/14/2022] Open
Abstract
Several studies have recently suggested that an abnormal processing of respiratory interoceptive and nociceptive (painful) stimuli may contribute to eating disorder (ED) pathophysiology. Mood and anxiety disorders (MA) are also characterized by abnormal respiratory symptoms, and show substantial comorbidity with ED. However, no studies have examined both respiratory and pain processing simultaneously within ED and MA. The present study systematically evaluated responses to perturbations of respiratory and nociceptive signals across the levels of physiology, behavior, and symptom report in a transdiagnostic ED sample (n = 51) that was individually matched to MA individuals (n = 51) and healthy comparisons (HC; n = 51). Participants underwent an inspiratory breath-holding challenge as a probe of respiratory interoception and a cold pressor challenge as a probe of pain processing. We expected both clinical groups to report greater stress and fear in response to respiratory and nociceptive perturbation than HCs, in the absence of differential physiological and behavioral responses. During breath-holding, both the ED and MA groups reported significantly more stress, feelings of suffocation, and suffocation fear than HC, with the ED group reporting the most severe symptoms. Moreover, anxiety sensitivity was related to suffocation fear only in the ED group. The heightened affective responses in the current study occurred in the absence of group differences in behavioral (breath hold duration, cold pressor duration) and physiological (end-tidal carbon dioxide, end-tidal oxygen, heart rate, skin conductance) responses. Against our expectations, there were no group differences in the response to cold pain stimulation. A matched-subgroup analysis focusing on individuals with anorexia nervosa (n = 30) produced similar results. These findings underscore the presence of abnormal respiratory interoception in MA and suggest that hyperreactivity to respiratory signals may be a potentially overlooked clinical feature of ED.
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Affiliation(s)
- Rachel C Lapidus
- Laureate Institute for Brain Research, Tulsa, OK, United States of America.,Department of Psychology, University of Tulsa, Tulsa, OK, United States of America
| | - Maria Puhl
- Laureate Institute for Brain Research, Tulsa, OK, United States of America
| | - Rayus Kuplicki
- Laureate Institute for Brain Research, Tulsa, OK, United States of America
| | - Jennifer L Stewart
- Laureate Institute for Brain Research, Tulsa, OK, United States of America.,Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, United States of America
| | - Martin P Paulus
- Laureate Institute for Brain Research, Tulsa, OK, United States of America.,Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, United States of America
| | - Jamie L Rhudy
- Department of Psychology, University of Tulsa, Tulsa, OK, United States of America
| | - Justin S Feinstein
- Laureate Institute for Brain Research, Tulsa, OK, United States of America.,Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, United States of America
| | - Sahib S Khalsa
- Laureate Institute for Brain Research, Tulsa, OK, United States of America.,Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, United States of America
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13
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Brehl AK, Kohn N, Schene AH, Fernández G. A mechanistic model for individualised treatment of anxiety disorders based on predictive neural biomarkers. Psychol Med 2020; 50:727-736. [PMID: 32204741 PMCID: PMC7168651 DOI: 10.1017/s0033291720000410] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 10/09/2019] [Accepted: 02/09/2020] [Indexed: 12/29/2022]
Abstract
Increased amygdala responsiveness is the hallmark of fear and a characteristic across patients with anxiety disorders. The amygdala is embedded in a complex regulatory circuit. Multiple different mechanisms may elevate amygdala responsiveness and lead to the occurrence of an anxiety disorder. While top-down control by the prefrontal cortex (PFC) downregulates amygdala responses, the locus coeruleus (LC) drives up amygdala activation via noradrenergic projections. This indicates that the same fearful phenotype may result from different neural mechanisms. We propose a mechanistic model that defines three different neural biomarkers causing amygdala hyper-responsiveness in patients with anxiety disorders: (a) inherent amygdala hypersensitivity, (b) low prefrontal control and (c) high LC drive. First-line treatment for anxiety disorders is exposure-based cognitive behavioural therapy, which strengthens PFC recruitment during emotion regulation and thus targets low-prefrontal control. A treatment response rate around 50% (Loerinc et al., 2015, Clinical Psychological Reviews, 42, 72-82) might indicate heterogeneity of underlying neurobiological mechanisms among patients, presumably leading to high variation in treatment benefit. Transforming insights from cognitive neuroscience into applicable clinical heuristics to categorise patients based on their underlying biomarker may support individualised treatment selection in psychiatry. We review literature on the three anxiety-related mechanisms and present a mechanistic model that may serve as a rational for pathology-based diagnostic and biomarker-guided treatment selection in psychiatry.
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Affiliation(s)
- Anne-Kathrin Brehl
- Radboud University, Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands
| | - Nils Kohn
- Radboud University, Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands
| | | | - Guillen Fernández
- Radboud University, Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands
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