Further validation of the Japanese version of the Multidimensional Assessment of Interoceptive Awareness

Interoceptive awareness in a Southeastern US college sample: validation of the multidimensional assessment of interoceptive awareness - version 2

OBJECTIVE

The Multidimensional Assessment of Interoceptive Awareness, version 2 (MAIA-2) is a commonly utilized self-report instrument to assess individuals' ability to perceive bodily sensations. The MAIA-2 has displayed variable psychometric properties across samples. Thus, we examine the psychometric properties of the MAIA-2 in a Southeastern United States college sample.

PARTICIPANTS

Our studies consisted of 710 (study 1) and 66 (study 2) college students.

METHODS

Study 1 used a cross-sectional research design where we investigated the factor structure, and measurement invariance (e.g., measured similarly across genders). Study 2 examined the test-retest reliability across a three-week period.

RESULTS

The MAIA-2 displayed adequate to good internal consistencies and factor loadings, strict invariance, and questionable temporal stability.

CONCLUSION

The MAIA-2 demonstrates adequate psychometric properties in this college sample that were similar to the original MAIA sample characteristics. Contextual and cultural factors may influence the subjective experience of interpreting bodily sensations.

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

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

Psychometric properties of an Arabic translation of the multidimensional assessment of interoceptive awareness (MAIA-2) questionnaire in a non-clinical sample of Arabic-speaking adults

BACKGROUND

Interoception refers to processes through which the nervous system identifies, analyzes, and integrates the information generated by the physiological state of the body (e.g., from internal organs such as the stomach, heart, or lungs). Despite its potential interest for clinical research and its wide use globally, no Arabic adaptation and validation of the Multidimensional Assessment of Interoceptive Awareness (MAIA-2) questionnaire exists to date. The goal of this study was to examine the psychometric properties of an Arabic translation of the MAIA-2 in a sample of Arabic-speaking community adults from Lebanon. We hypothesized that the Arabic version of the MAIA-2 would yield adequate internal consistency coefficients; the 8-factor structure model would show a good fit to our data, with measurement invariance and good convergent validity.

METHOD

The Arabic adaptation of the MAIA-2 was developed using the forward-backward translation method. A non-clinical sample of Arabic-speaking adults (n = 359, 59.9% females, mean age = 22.75 years (SD = 7.04)) took part of this validation study. To check if the model was adequate, several fit indices were calculated: the normed model chi-square (χ²/df), the Steiger-Lind root mean square error of approximation (RMSEA), the Tucker-Lewis Index (TLI) and the comparative fit index (CFI). Values ≤ 3 for χ²/df, and ≤ 0.08 for RMSEA, and 0.90 for CFI and TLI indicate good fit of the model to the data.

RESULTS

Confirmatory Factor Analyses corroborated the validity of the original 8-factor structure of the MAIA-2 [χ2/df = 1603.86/601 = 2.67, RMSEA = 0.068 (90% CI 0.064, 0.072), SRMR = 0.058, CFI = 0.903, TLI = 0.892]. Reliability estimates in our sample revealed good internal consistency, with McDonald's ω coefficients for the subscales ranging from 0.86 to 0.93. Our analyses also revealed measurement invariance of the Arabic MAIA-2 for gender. No statistically significant difference between men and women in all dimensions, except for the not worrying and attention regulation subscales where men scored significantly higher than women. Finally, the Arabic MAIA-2 dimensions showed positive correlations with the intuitive eating dimension "Reliance on Hunger and Satiety Cues", thus providing support for convergent validity.

CONCLUSION

We contribute the literature by providing the first Arabic adaptation and validation of a measure assessing the multidimensional construct of self-reported interoception. The Arabic MAIA-2 demonstrated good psychometric properties. We thus preliminarily recommend its use to measure the interoceptive awareness construct among Arabic-speaking communities worldwide.

Preliminary Rasch analysis of the multidimensional assessment of interoceptive awareness in adults with stroke

PURPOSE

The Multidimensional Assessment of Interoceptive Awareness (MAIA) measures interoceptive body awareness, which includes aspects such as attention regulation, self-regulation, and body listening. Our purpose was to perform a preliminary validation of the MAIA in adults with stroke using Rasch Measurement Theory.

METHODS

The original MAIA has 32 items that measure interoceptive sensibility, which is an aspect of body awareness. We performed a preliminary analysis with Rasch Measurement Theory to evaluate the unidimensionality and structural validity of the scale. We investigated overall fit to assess unidimensionality, person and item fit, person separation reliability, targeting, local item dependence, and principal components analysis of residuals.

RESULTS

Forty-one adults with chronic stroke (average 3.8 years post-stroke, 13 women, average age 57±13 years) participated in the study. Overall fit (χ 2 = 62.26, p = 0.26) and item fit were obtained after deleting 3 items and rescoring 26 items. One participant did not fit the model (2.44%). There were no floor (0.00%) or ceiling effects (0.00%). Local item dependence was found in 42 pairs. The person separation reliability was 0.91, and the person mean location was 0.06±1.12 logits.

CONCLUSIONS

The preliminary structural validity of the MAIA demonstrated good targeting and reliability, as well as unidimensionality, and good item and person fit in adults with chronic stroke. A study with a larger sample size is needed to validate our findings.

Psychometric Properties of the Multidimensional Assessment of Interoceptive Awareness (MAIA) Questionnaire in Colombian University Students

INTRODUCTION

The university student population is influenced by multiple factors that affect body awareness. Identifying the body awareness status of students is crucial in creating self-care and emotion management programs to prevent diseases and promote health. The Multidimensional Assessment of Interoceptive Awareness (MAIA) questionnaire evaluates interoceptive body awareness in eight dimensions through 32 questions. It is one of the few tools that enable a comprehensive assessment of interoceptive body awareness by involving eight dimensions of analysis.

METHOD

The objective of this study is to present the psychometric properties of the Multidimensional Assessment of Interoceptive Awareness (MAIA) to observe to what extent the hypothesized model fits the population of university students in Colombia. A descriptive cross-sectional study was conducted with 202 students who met the inclusion criterion of being undergraduate university students. Data were collected in May 2022.

RESULTS

A descriptive analysis of the sociodemographic variables of age, gender, city, marital status, discipline, and history of chronic diseases was performed. JASP 0.16.4.0 statistical software was used to conduct confirmatory factor analysis. A confirmatory factor analysis was performed based on the proposed eight-factor model of the original MAIA, giving a significant p-value and 95% confidence interval. However, when performing loading factor analysis, a low p-value was found for item 6 of the Not Distracting factor, and for the entire Not Worrying factor.

DISCUSSION

A seven-factor model with modifications is proposed.

CONCLUSIONS

The results of this study confirmed the validity and reliability of the MAIA in the Colombian university student population.

Experimental Manipulation of Guided Attention to the Shoulder Movement Task in Clinical Dohsa-hou Induces Shifts in the Reactive Mode and Indicates Flexible Cognitive Control Performance

The empirical basis for self-control in Dohsa-hou as it relates to effects on cognitive processes has been explored in a few studies of the Japanese psychotherapy, but not under standardized conditions with a strong predictive theory of control. This study reports on a series of experiments with the Dual Mechanisms of Control framework to clarify the possible regulatory mechanism of Dohsa-hou by focusing on shoulder movement, a key body movement task used by practitioners across applied settings. Cognitive control was operationalized with the AX version of Continuous Performance Test (AX-CPT) paradigm for proactive control and a modified Stroop task paradigm for reactive control in a 3-arm parallel group trial study design. Healthy Japanese university students were assigned to a Dohsa-hou group that performed a shoulder movement task for few minutes, an active control group that performed a similar task, or a passive control group comprised of a resting condition. A total of 55 participants performed the AX-CPT and 57 participants performed the modified Stroop task before and after the group manipulation. In the AX-CPT, an increase in the error rate of AY (true cue-false probe) trial from pre- to post-test was observed in the passive control group only, and found to be marginally higher in the passive control group relative to Dohsa-hou group at post-test. This indicated that Dohsa-hou moderated the activation of proactive control by repeated AX-CPT performance. The error rate of the Proactive Behavioral Index did not differ from zero at post-test only in the Dohsa-hou group, indicating flexible cognitive control. In the modified Stroop task, there was no difference between congruent and incongruent trials at post-test for the Dohsa-hou group only, indicating the facilitation of reactive control. The evidence for a balancing effect for the Dohsa-hou-based shoulder movement task indicates that clients experience a form of continuous self-monitoring, which might reduce mind-wandering from their focus on movement execution combined with iterative verbal feedback from the therapist. Overall, the results of the present study suggest that the self-regulatory mechanism promoted in clinical Dohsa-hou emphasizes guided shifts in attention to the reactive mode toward a balance of cognitive control.

Does Long-Term Training in a Water Immersion Environment Change Interoception?

The aim of this study was to investigate individual interoception by comparing the responses of swimmers and baseball players when exposed to specific water environments, depending on training content and environment. Forty-eight healthy male university students were evaluated for their interoceptive response (accuracy, sensibility, and awareness) and heart rate following 25 min of water immersion (WI) at 35 °C. We assessed three conditions: pre-WI, during WI, and post-WI. The results indicated that interoceptive accuracy (IAcc) did not differ between groups because both swimming and baseball do not require emotional expression, as opposed to an activity such as dance. The heart rate was significantly decreased at post-WI compared to that at pre-WI. The IAcc of post-WI presented as higher than that of pre-WI. In addition, there was a significant negative correlation between the ratio of IAcc and that of HR among subjects. Moreover, the attention regulation subscale of the MAIA changed in the WI environment and the ratio of IAcc was negatively correlated with that of the not-distracting subscale of the MAIA. These results suggested that interoception did not differ among the athletes who had long-term training, which enabled them to acquire multi-modal sensorimotor integration, compared to that of non-athlete control participants. We conclude that interoception did not differ among athletes who had long-term training compared to that of non-athlete control participants.

Psychometric validation and refinement of the Interoception Sensory Questionnaire (ISQ) in adolescents and adults on the autism spectrum

BACKGROUND

Individuals on the autism spectrum are reported to display alterations in interoception, the sense of the internal state of the body. The Interoception Sensory Questionnaire (ISQ) is a 20-item self-report measure of interoception specifically intended to measure this construct in autistic people. The psychometrics of the ISQ, however, have not previously been evaluated in a large sample of autistic individuals.

METHODS

Using confirmatory factor analysis, we evaluated the latent structure of the ISQ in a large online sample of adults on the autism spectrum and found that the unidimensional model fit the data poorly. Using misspecification analysis to identify areas of local misfit and item response theory to investigate the appropriateness of the seven-point response scale, we removed redundant items and collapsed the response options to put forth a novel eight-item, five-response choice ISQ.

RESULTS

The revised, five-response choice ISQ (ISQ-8) showed much improved fit while maintaining high internal reliability. Differential item functioning (DIF) analyses indicated that the items of the ISQ-8 were answered in comparable ways by autistic adolescents and adults and across multiple other sociodemographic groups.

LIMITATIONS

Our results were limited by the fact that we did not collect data for typically developing controls, preventing the analysis of DIF by diagnostic status. Additionally, while this study proposes a new 5-response scale for the ISQ-8, our data were not collected using this method; thus, the psychometric properties for the revised version of this instrument require further investigation.

CONCLUSION

The ISQ-8 shows promise as a reliable and valid measure of interoception in adolescents and adults on the autism spectrum, but additional work is needed to examine its psychometrics in this population. A free online score calculator has been created to facilitate the use of ISQ-8 latent trait scores for further studies of autistic adolescents and adults (available at https://asdmeasures.shinyapps.io/ISQ_score/ ).

Similarities and Differences in Interoceptive Bodily Awareness Between US-American and Japanese Cultures: A Focus-Group Study in Bicultural Japanese-Americans

Interoceptive awareness is the conscious perception of sensations that create a sense of the physiological condition of the body. A validation study for the Japanese translation of the Multidimensional Assessment of Interoceptive Awareness (MAIA) surprised with a factor structure different from the original English-language version by eliminating two of eight scales. This prompted an exploration of the similarities and differences in interoceptive bodily awareness between Japanese and European Americans. Bicultural Japanese-Americans discussed concepts and experiences in the two cultures. We conducted focus groups and qualitative thematic analyses of transcribed recordings. 16 participants illustrated cross-cultural differences in interoceptive bodily awareness: switching between languages changes embodied experience; external versus internal attention focus; social expectations and body sensations; emphasis on form versus self-awareness; personal space; and mind-body relationship; context dependency of bodily awareness and self-construal. The participants explained key concepts that present challenges for a Japanese cultural adaptation of the MAIA, specifically the concept of self-regulation lost in the factor analysis. In Japanese culture, self-regulation serves the purpose of conforming to social expectations, rather than achieving an individual self-comforting sense of homeostasis. Our findings will inform the next phase of improving the MAIA's cross-cultural adaptation.

Translation and validation of a Bahasa Malaysia (Malay) version of the Multidimensional Assessment of Interoceptive Awareness (MAIA)

OBJECTIVES

The 32-item Multidimensional Assessment of Interoceptive Awareness (MAIA) is a widely-used measure of multidimensional interoception. In the present study, we examined the psychometric properties of a Bahasa Malaysia (Malay) translation of the MAIA.

METHODS

An online sample of 815 Malaysian Malays (women n = 403) completed a novel translation of the MAIA. Validated measures of trait mindfulness and self-esteem were also completed to facilitate a preliminary assessment of convergent validity.

RESULTS

Exploratory factor analysis indicated that the MAIA items reduced to a 19-item, 3-factor model. The 3-factor model was further tested using confirmatory factor analysis (CFA) alongside the parent 8-factor model. Both models had good fit on some indices, but less-than-ideal fit on other indices. The 3-factor model evidenced comparatively better fit, with fit indices being adequate following modification. Multi-group CFA indicated both the 3-factor model and the 8-factor model had full strict invariance across sex. However, evidence for construct and convergent validity was mixed.

CONCLUSIONS

Overall the 3-dimensional Malay MAIA was demonstrated to be both internally consistent and invariant across sex, but further evidence of construct and convergent validity is required. Issues that affect the dimensionality of MAIA scores in the present and extant work are discussed in conclusion.