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

Validation of the Multidimensional Assessment of Interoceptive Awareness Scale in a Sample of Transgender and Gender-Diverse Adults

The Multidimensional Assessment of Interoceptive Awareness (MAIA-2) is a leading assessment of interoception. We examined the factor structure and psychometric characteristics of the MAIA-2 and its associations with psychopathology in a sample of transgender and gender-diverse (TGD) adults. Participants (N = 301) were recruited via Prolific Academic. Regression analyses were conducted to examine the association between the MAIA-2 subscales, disordered eating, and self-injurious thoughts and behaviors. The eight-factor MAIA-2 demonstrated good model fit after removing Item 2. The MAIA-2 subscales were significantly positively associated with body appreciation and body satisfaction and negatively associated with depression, anxiety, and stress. The MAIA-2 subscales also demonstrated several significant associations with disordered eating. Only Body Trust was significantly negatively associated with participants' perceived likelihood of making a future suicide attempt. This study provided preliminary evidence that the MAIA-2 is an adequate measure of interception in TGD samples.

Eating Pathology and Interoceptive Sensibility Using the Brief Multidimensional Assessment of Interoceptive Awareness-2: Can There be Too Much of a Good Thing?

This study evaluated the factorial structure and invariance of the Multidimensional Assessment of Interoceptive Awareness-v2 (MAIA-2). We also investigated incremental validity of the MAIA-2 factors for predicting eating pathology beyond appetite-based interoception. US-based online respondents (N = 1294; Mage=48.7 ± 18.4; 63% cis women; 78% White) were sampled. We conducted hierarchical stepwise regressions, dominance analysis, and multiple-group confirmatory factor analyses across age, gender, and eating disorder symptoms. An 8-factor, 24-item Brief MAIA-2 (BMAIA-2) model showed optimal fit. Using strict criteria (Δ CFI > 0.002), configural, metric, and scalar invariance were supported. After controlling for appetite-based interoception, higher scores on body listening, noticing, and emotional awareness unexpectedly predicted worse eating pathology, while higher scores on not worrying, not distracting, and trusting predicted less eating pathology, as hypothesized. Dominance analysis showed no subscales contributed >2% unique variance to global disordered eating beyond appetite-based interoception. For loss of control eating, however, not worrying was the dominant BMAIA-2 predictor, explaining 5% unique variance beyond appetite-based interoception. Research supported the relevance of multiple interoceptive sensibility dimensions captured by the BMAIA-2 to understanding eating-based pathology. Future studies should consider assessing its incremental validity using behavioral tasks and autonomic biomarkers of interoception to better understand the complex interplay among interoceptive skills and eating behavior.

Exploring Individual Differences in Interoception Among Athletes Based on a Three-Dimensional Construct of Interoception

Previous studies demonstrated that sensorimotor training enhances interoceptive abilities. Athletes are highly engaged in performance-driven physical training and often incorporate-to varying degrees-sensorimotor training into their routines. In this study, we investigated the role of individual differences in interoception by comparing professional athletes of different performance levels and both sexes with recreational athletes and controls, applying a three-dimensional model of interoception. Twenty-six elite athletes, 52 recreational athletes, and 50 college students were recruited from national sports teams, local sports training centers, and local universities. We used the Multidimensional Assessment of Interoperative Awareness (MAIA), the Heartbeat Detecting Task (HDT), and a numeric rating scale based on HDT to measure interoceptive sensibility, accuracy, and awareness. At average, athletes showed significantly higher interoceptive sensibility, interoceptive accuracy, and interoceptive awareness than controls. Elite athletes reported significantly higher scores in all measures of interception compared to recreational athletes. Intriguingly, Non-Distracting for interoceptive sensibility was positively correlated with the level of experience in elite athletes. Male athletes had better interoceptive sensibility and interoceptive awareness compared to female athletes in the elite group, while no significant sex differences were detected in the other two groups. These results indicated that level of sport experience and sex are associated with differences in interoceptive accuracy, interoceptive sensibility, and interoceptive awareness. It also suggests that interoceptive ability is possibly an experience-dependent trait for athletic performance, which provides insight for improving sports performance through an approach of enhancing interoceptive ability.

The association between interoception and olfactory affective responses

Odors are known to affect an individual's emotions and physiological states. Recent research has revealed that olfaction is linked to the mental representation of internal sensations, known as interoception. However, little research has examined how interoception relates to emotional responses to odors. This research aimed to fill this gap in the literature. We conducted two studies with a total of 548 Japanese women (n = 500 and n = 48 in Studies 1 and 2, respectively). Study 1 used an online survey to assess the relationship between self-reported interoceptive traits and the intensity of positive emotions in response to daily odors. Study 2 examined how self-reported interoceptive traits modulated the arousal ratings of odors presented in the laboratory and the concordance between these perceived arousal ratings and odor-evoked physiological responses. Study 1 confirmed that self-reported interoceptive traits were significant predictors of positive emotional intensity of odors. In Study 2, individuals with high interoceptive measure scores showed concordance between their perceived emotional arousal and the physiological responses associated with that emotion, whereas individuals with low scores did not. These findings suggest that how people perceive their internal sensations contributes to shaping their olfactory affective experiences, thereby broadening the scope of interoception research and aromachology. The practical implications of these findings for the development of commercial fragrances are discussed.

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.

Investigating the relationship between self-reported interoceptive experience and risk propensity

Risky behaviour may be associated with visceral experiences, such as increased heart rate. Previous studies examining the relationship between perception of such signals (interoception) and risk-taking typically used behavioural tasks with potential for monetary reward. This approach may be less informative for understanding general risk propensity. In addition, such research does not usually consider the varied ways individuals engage with interoceptive signals. However, examining these different forms of engagement may help us understand how subjective experience of interoception influences risk-taking. As such, we performed two surveys (n = 471, primarily young adults) to examine the relationship between self-reported engagement with interoceptive signals (measured using the Multidimensional Assessment of Interoceptive Awareness) and a generalised measure of risk propensity (the General Risk Propensity Scale). Results indicated that different ways of interpreting or engaging with interoceptive signals were differentially associated with risk propensity. In particular, they provide preliminary evidence that those with the ability to ignore or not worry about visceral signals when they are uncomfortable display greater risk propensity (and these effects may possibly be gender-specific).

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.

Cultural Adaptation and Validation of the Barriers to HIV Testing Scale-Karolinska Version for Brazilian Men Who Have Sex With Men

ABSTRACT

The aim of this study was to perform the cultural adaptation and validation of the Barriers to HIV testing scale-Karolinska version for Brazilian men who have sex with men. A methodological study was conducted for cultural adaptation and validation of the scale. Reliability analyses, exploratory factor analysis, confirmatory factor analysis, and convergent and discriminant validity tests were performed. Four factors were extracted: F1, personal consequences; F2, structural barriers; F3, confidentiality; F4, economic consequences and individual concerns. Good fit indexes were obtained: (χ 2 )/GL (2.71); goodness of fit index (0.94); root-mean-square error of approximation (0.052; 90% CI [0.045-0.059]); Tucker-Lewis index (0.94); normed fit index (0.93); IFI (0.95); comparative fit index (0.95). Convergent validity results were greater than 0.7 for the four factors. The adapted version of the scale showed satisfactory reliability and validity for assessing barriers to HIV testing among men who have sex with men.

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.

Interoceptive awareness in a Norwegian population: psychometric properties of the Multidimensional Assessment of Interoceptive Awareness (MAIA) 2

BACKGROUND

Interoception plays a vital role in human cognition and emotion and is an increasingly important part of clinical studies of mind-body approaches and mental health. Interoceptive awareness (IA) encompasses numerous mind-body components and can be assessed by employing a self-report measure such as the Multidimensional Assessment of Interoceptive Awareness (MAIA), which has been adapted and validated across several countries and is used in experimental and clinical settings. In this study, the MAIA-2, which was developed due to the psychometric shortages of MAIA, was thoroughly translated, and its psychometric features were examined in a sample of 306 Norwegian-speaking participants (81% females, ages 16 through 66 plus).

METHODS

The participants completed the MAIA-2 Norwegian version (MAIA-2-N) and the COOP/WONCA Functional Assessment Charts measuring psychological, physical, and overall health. The following psychometric qualities of the MAIA-2 were investigated: factor structure, internal consistency, and the moderating role of gender.

RESULTS

Confirmatory Factor Analysis (CFA) revealed that an 8-factor model of MAIA-2-N provided the best fit. Also, a bifactor model revealed a proper fit. Good internal consistency and a moderating role of gender, age, and education on the relationships between certain MAIA-2-N factors and health were observed.

CONCLUSIONS

The MAIA-2-N is an adequate measure of IA in Norwegian-speaking individuals. The factor-structure corresponds with the original MAIA-2 and it shows good internal consistency. Some moderating effects of gender were observed, particularly related to the relationship between IA and physical and psychological state, with the physical state/fitness more closely linked to IA in males and psychological state in females.

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.

Inward VR: Toward a Qualitative Method for Investigating Interoceptive Awareness in VR

Immersive virtual reality (VR) technologies can produce powerful illusions of being in another place or inhabiting another body, and theories of presence and embodiment provide valuable guidance to designers of VR applications that use these illusions to "take us elsewhere." However, an increasingly common design goal for VR experiences is to develop a deeper awareness of the internal landscape of one's own body (i.e., interoceptive awareness); here, design guidelines and evaluative techniques are less clear. To address this, we present a methodology, including a reusable codebook, for adapting the five dimensions of the Multidimensional Assessment of Interoceptive Awareness (MAIA) conceptual framework to explore interoceptive awareness in VR experiences via qualitative interviews. We report results from a first exploratory study (n=21) applying this method to understand the interoceptive experiences of users in a VR environment. The environment includes a guided body scan exercise with a motion-tracked avatar visible in a virtual mirror and an interactive visualization of a biometric signal detected via a heartbeat sensor. The results provide new insights on how this example VR experience might be refined to better support interoceptive awareness and how the methodology might continue to be refined for understanding other "inward-facing" VR experiences.

Are some interoceptive sensibility components more central than others? Using item pool visualisation to understand the psychometric representation of interoception

Interoception refers to the processing of stimuli originating within the body and is widely considered a multidimensional construct. However, there remains a lack of consensus regarding the definition and measurement of the subjective, self-reported component, referred to here as interoceptive sensibility. As a contribution to knowledge on the topic, we sought to examine the construct commonality and distinguishability of seven self-report measures of interoceptive sensibility using Item Pool Visualisation (IPV), an illustrative method that locates item pools from within the same dataset and illustrates these in the form of nested radar charts. Adults from the United Kingdom (N = 802) completed seven measures of interoceptive sensibility, and the data were subjected to IPV. Results demonstrated that, of the included measures, the Multidimensional Assessment of Interoceptive Awareness-2 provided the closest and most precise measurement of the core interoceptive sensibility construct (i.e., core of the entire investigated item pool). The Body Awareness Questionnaire and the Private Body Consciousness Scale were also centrally located measures, while the Body Perception Questionnaire and the Body Responsiveness Scale appear to tap more distal aspects of the core construct. We discuss implications for interpreting complicated data patterns using measures of interoceptive sensibility and, more generally, for measuring the construct of interoceptive sensibility.

Subjective judgments on direct and generative retrieval of autobiographical memory: The role of interoceptive sensibility and emotion

Autobiographical remembering is a subjective experience, and whether retrieval is perceived to occur through involuntary or voluntary, direct or generative cognitive processes is also based on subjective intuition. The present study examined factors that may contribute to the subjective judgment that occurs when we perceive memories as being retrieved directly (i.e., a memory comes to mind directly and immediately) or through generative processes (i.e., recalling a memory with effort or by using additional information). We examined the hypothesis that internal awareness (interoceptive sensibility and mindfulness traits) contributes to the physical reaction and emotional impact of memories at retrieval, which then influence the subjective judgment that memories are retrieved directly. In two online experiments, participants were asked to recall specific memories following verbal cues and to judge the retrieval process (i.e., direct or generative). We demonstrated that emotional awareness, an interoceptive sensibility scale factor, consistently predicted a high probability of direct retrieval judgments independent of other predictors of direct retrieval, such as retrieval latency and cue concreteness. This effect was especially common for concrete cues. In Experiment 2 we demonstrated that emotional awareness predicted direct retrieval judgments through the mediation of retrieval impact (physical reaction and emotional impact). These results indicate the involvement of interoceptive processing in the direct retrieval of autobiographical memories. We discuss the role of interoception in memory retrieval and present interoceptive prediction error as a novel and potentially integrative account of our findings.

Validation of the Multidimensional Assessment of Interoceptive Awareness (MAIA-2) questionnaire in hospitalized patients with major depressive disorder

OBJECTIVES

Interoception refers to the sensation, interpretation, and integration of internal somatic signals. Abnormalities in self-reported interoception are prevalent features of major depressive disorder (MDD) and may affect treatment outcomes. In the present study, we investigated the psychometric properties of the revised eight-dimensional and 37-item Multidimensional Assessment of Interoceptive Awareness questionnaire (the MAIA-2) in a severely depressed sample, after translating two updated scales (Not-Distracting, Not-Worrying) into German. Specifically, we examined the measure's internal consistency reliability, sensitivity to change, and minimal important differences (MID) with a focus on patient's antidepressive responses to treatment.

METHODS

The study enrolled 110 participants (age: M = 46.85, SD = 11.23; female: 55.45%) undergoing hospital treatment, of whom 87 were included in the pre-post analysis. Participants completed a German translation of MAIA-2 and the Beck Depression Inventory-II (pre-/post-treatment). Internal consistency reliability was determined by Cronbach's α/McDonalds's ω, sensitivity to change was determined by effect sizes, and MIDs were determined by distribution- (0.5*SD) and anchor-based approaches (mean change method; ROC curve cut-points).

RESULTS

Depression severity reduced over the course of treatment (Median = -65.22%), and 34.48% of patients achieved remission. Reliability was appropriate for post-treatment (range of ω: .70-.90), but questionable for two pre-treatment scales (Noticing: ω = .64; Not-Distracting: ω = .66). The eight dimensions of MAIA-2 were sensitive to change (standardized response mean: .32-.81; Cohen's effect size: .30-.92). Distribution-based MIDs (.38-.61) and anchor-based mean change MIDs (remission vs. partial response: .00-.85; partial response vs. nonresponse: .08-.88) were established on the group level. For six scales, ROC cut-points (remission: .00-1.33; response: -.20-1.00) demonstrated accurate classification to treatment response groups on the individual level.

CONCLUSIONS

This study demonstrated the applicability of the MAIA-2 questionnaire in MDD. The updated version may have led to reliability improvements regarding the revised scales, but subthreshold reliability was evident prior to treatment. The measure's dimensions were sensitive to change. MIDs were established that corresponded with antidepressive treatment outcomes. Our findings are consistent with a growing area of research which considers somatic feelings as key contributors to mental health.