Sex-Specific Relationships Between Interoceptive Accuracy and Emotion Regulation

No gender difference in cardiac interoceptive accuracy: Potential psychophysiological contributors in heartbeat counting task

Gender differences in interoceptive awareness-awareness of internal bodily signals such as heartbeat perception-have been suggested, with some findings indicating behaviourally reduced but subjectively enhanced awareness in women, though these findings are still contentious. This study aimed to comprehensively examine gender differences in three aspects of interoceptive awareness: behavioural accuracy, subjective confidence, and relationship between them (i.e., metacognition). We used a modified heartbeat counting task that prohibited estimation strategies and increased the number of trials up to 20. Using data from 74 healthy young adults (39 women and 35 men), we evaluated gender differences and practice effects for each measure via Bayesian linear mixed models, controlling for individual heart rate and trial duration on a trial-by-trial basis. Contrary to previous research, the results revealed no reduced interoceptive accuracy in women; instead, higher interoceptive accuracy score was associated with shorter trial durations and lower heart rates regardless of gender. Moreover, women exhibited underconfidence about their performance, and therefore lower metacognition scores, compared to men. Trial repetitions moderated women's lowered metacognition but did not affect accuracy or confidence. These findings highlight potential physiological and psychological confounding factors in the heartbeat counting task, such as heart rate and reporting style, and emphasise several cautions for studying gender differences in interoceptive awareness.

Reframing Refractory Chronic Cough: The Role of Interoception

Refractory chronic cough (RCC) remains a persistent clinical challenge, often resistant to traditional treatments. Emerging evidence now positions RCC as a disorder rooted in hypersensitivity, driven primarily by central neural processes rather than external physiological causes. Central to this understanding is the concept of interoception-the brain's ability to perceive and interpret internal bodily signals. Neuroimaging research has identified abnormalities in brain regions associated with interoception and inhibitory control among RCC patients. Interestingly, RCC shares neurophysiological characteristics with other disorders like overactive bladder and urinary urge incontinence (OAB/UUI), which also involve dysregulated interoceptive and inhibitory mechanisms. Behavioral treatments for OAB/UUI are highly effective and are regarded as the first-line treatment in many consensus guidelines. OAB/UUI behavioral treatments have been shown to induce central neuroplastic changes, further underscoring their efficacy and potential parallel for RCC interventions. Behavioral cough suppression therapy (BCST), an efficacious treatment for RCC, may leverage similar neuroplastic adaptations, enhancing interoceptive processing and inhibitory control. Given the multi-dimensional nature of interoception, which encompasses sensory perception shaped by learning, memory, and emotional context, BCST's engagement of multiple neural pathways offers an alternative therapeutic option compared to single-mechanism pharmacological treatments. Future research should prioritize exploring the mechanistic underpinnings of BCST and other interoception-based therapies for developing more comprehensive and effective treatment options. Such research holds promise for improving patient outcomes, alleviating the significant healthcare burden associated with RCC, and advancing our understanding of central hypersensitivity disorders.

Diminished Interoceptive Accuracy in Attention-Deficit/Hyperactivity Disorder: A Systematic Review

Interoception is the perception of one's internal physiological state. Altered interoception may play a role in the pathogenesis of attention-deficit/hyperactivity disorder (ADHD). We reviewed the literature on interoception and ADHD symptoms (inattention, hyperactivity/impulsivity, executive function, emotional dysregulation) in individuals with and without the disorder. Studies included assessments of interoception and ADHD symptoms in (1) individuals with/without diagnoses of ADHD or (2) the general population. Interoception assessments included objective measures (heartbeat-tracking test) and self-report questionnaires. The literature search included the PubMed/MEDLINE, PsychINFO, CINAHL and Scopus databases. A protocol was prospectively registered in the PROSPERO database (CRD #42022351726); the PRISMA guidelines directed reporting. The Newcastle-Ottawa scale was adapted to evaluate study quality. Of 636 articles identified, 17 articles (based on 18 studies) met inclusion criteria. Five studies compared interoception in participants with/without ADHD, and three found that interoception was reduced in participants with ADHD. One study compared interoception between presentations of ADHD, finding no differences. Twelve studies assessed the association of ADHD symptoms and interoception in the general population. Overall, results suggested that interoception is reduced in individuals who reported higher symptoms of inattention, hyperactivity, impulsivity, emotional dysregulation, and executive dysfunction. Studies were of moderate quality; issues included small sample sizes and inadequate reporting. Individuals with ADHD may have decreased interoception compared to individuals without. Interoception is negatively associated with ADHD symptoms in the general population. Interventions focused on improving interoceptive abilities may provide an avenue for ADHD treatment. Future work should consider the role of culture in interoception.

Changes in interoceptive accuracy related to emotional interference in somatic symptom disorder

OBJECTIVE

The somatic symptom disorder (SSD) is characterized by one or more distressing or disabling somatic symptoms accompanied by an excessive amount of time, energy and emotion related to the symptoms. These manifestations of SSD have been linked to alterations in perception and appraisal of bodily signals. We hypothesized that SSD patients would exhibit changes in interoceptive accuracy (IA), particularly when emotional processing is involved.

METHODS

Twenty-three patients with SSD and 20 healthy controls were recruited. IA was assessed using the heartbeat perception task. The task was performed in the absence of stimuli as well as in the presence of emotional interference, i.e., photographs of faces with an emotional expression. IA were examined for correlation with measures related to their somatic symptoms, including resting-state heart rate variability (HRV).

RESULTS

There was no significant difference in the absolute values of IA between patients with SSD and healthy controls, regardless of the condition. However, the degree of difference in IA without emotional interference and with neutral facial interference was greater in patients with SSD than in healthy controls (p = 0.039). The IA of patients with SSD also showed a significant correlation with low-frequency HRV (p = 0.004) and high-frequency HRV (p = 0.007).

CONCLUSION

SSD patients showed more significant changes in IA when neutral facial interference was given. These results suggest that bodily awareness is more affected by emotionally ambiguous stimuli in SSD patients than in healthy controls.

Emotion regulation and emotion dysregulation in children and adolescents with Autism Spectrum Disorder: A meta-analysis of evaluation and intervention studies

Children and adolescents with Autism Spectrum Disorder (ASD) often experience challenges in emotion regulation (ER) and emotion dysregulation (ED) which can interfere with their adaptive functioning. This study aimed to systematically review and meta-analyze the evidence on ER/ED in children and/or adolescents with ASD, examining its relationship with the following variables: internalizing and externalizing symptoms, cognitive function and social skills, and the effectiveness of non-pharmacological interventions addressing ER difficulties. Both electronic and manual searches were conducted to identify potential studies. Fifty-five studies were included in the meta-analysis. A statistically significant between-group difference was found, suggesting greater ER/ED challenges in the ASD group. Also, the ASD group showed more maladaptive ER strategies and fewer adaptive ER strategies compared to the non-ASD participants. Additionally, more severe ASD and poorer social skills were associated with greater ED and poorer ER skills, respectivelly. Furthermore, there was a significant correlation between internalizing symptomatology and both adaptive and maladaptive ER strategies. Studies of non-pharmacological interventions showed significant improvement in both ER and ED. These results imply that assessing ER/ED in children and adolescents with ASD should be part of the evaluation process, and it should also be a focal point for intervention in this population.

The impact of traumatic childhood experiences on interoception: disregarding one's own body

BACKGROUND

Deficient interoception, the processing and perception of internal bodily signals, has been discussed as a mechanism underlying various mental disorders. First results indicate a mediating role of interoception in the interplay of traumatic childhood experiences and adult mental disorders. Traumatic childhood experiences may hinder the adequate processing, integration, and trust in bodily signals that are important in order to understand and regulate own needs and emotions, thereby increasing the vulnerability for mental disorders. However, an overarching study investigating alterations in different interoceptive measures and trauma-related disorders as well as their mediating role between early trauma and emotion dysregulation is still missing.

METHODS

One hundred thirty-six individuals with varying levels of traumatic childhood experiences who either had a current diagnosis of major depression, posttraumatic stress disorder, or somatic symptom disorder, or no mental disorder, took part in a multidimensional assessment of interoceptive processes, including interoceptive accuracy, sensibility, and awareness. Kruskal-Wallis tests were used to compare groups regarding interoceptive processes and associations with traumatic childhood experiences and emotion dysregulation were analyzed with Spearman correlations. Furthermore, mediation analyses were computed to examine and compare interoceptive processes as potential mediators between traumatic childhood experiences and emotion dysregulation.

RESULTS

Only body dissociation, a measure for interoceptive sensibility, was significantly reduced in individuals with a current mental disorder. Body dissociation was also the only interoceptive measure significantly associated with traumatic childhood experiences and emotion dysregulation and the only significant mediator in the relationship between traumatic childhood experiences and emotion dysregulation across groups.

CONCLUSION

Results suggest body dissociation, but not other interoceptive measures, as an important feature linking traumatic childhood experiences to current emotion dysregulation, an important transdiagnostic feature. As body dissociation refers to a habitual non-attendance or disregard of interoceptive signals, integrative therapeutic interventions could help affected individuals to overcome difficulties in emotion perception and regulation.

TRIAL REGISTRATION

The general study design was preregistered; see the German Clinical Trials Register (DRKS-ID: DRKS00015182). This study's analysis plan was not preregistered.

Gender differences in interoceptive accuracy and emotional ability: An explanation for incompatible findings

Most theories of emotion describe a crucial role for interoceptive accuracy, the perception of the body's internal physiological signals, in emotional experience. Despite support for interoceptive accuracy's role in emotion, findings of gender differences in emotional and interoceptive processing are incompatible with theory; women typically show poorer interoceptive accuracy, but women often outperform men on measures of emotional processing and recognition. This suggests a need to re-evaluate the relationship between interoceptive accuracy and emotion considering sex and gender. Here we extend Pennebaker and Roberts' (1992) theory of gender differences in the use of interoceptive signals for emotional experience, proposing that language socialisation may result in gender differences in the propensity to label internal state changes as physiological or emotional, respectively. Despite outstanding questions concerning the fractionation of interoceptive and emotional domains, this theory provides a plausible explanation for seemingly incompatible findings of gender differences in interoceptive and emotional abilities.

The Impact of Emotional States on Construction Workers’ Recognition Ability of Safety Hazards Based on Social Cognitive Neuroscience

The construction industry is one of the most dangerous industries with grave situation owing to high accident rate and mortality rate, which accompanied with a series of security management issues that need to be tackled urgently. The unsafe behavior of construction workers is a critical reason for the high incidence of safety accidents. Affective Events Theory suggests that individual emotional states interfere with individual decisions and behaviors, which means the individual emotional states can significantly influence construction workers’ unsafe behaviors. As the complexity of the construction site environment and the lack of attention to construction workers’ emotions by managers, serious potential emotional problems were planted, resulting in the inability of construction workers to effectively recognize safety hazards, thus leading to safety accidents. Consequently, the study designs a behavioral experiment with E-prime software based on social cognitive neuroscience theories. Forty construction workers’ galvanic skin response signals were collected by a wearable device (HKR-11C+), and the galvanic skin response data were classified into different emotional states with support vector machine (SVM) algorithm. Variance analysis, correlation analysis and regression analysis were used to analyze the influence of emotional states on construction workers’ recognition ability of safety hazards. The research findings indicate that the SVM algorithm could effectively classify galvanic skin response data. The construct ion workers’ the reaction time to safety hazards and emotional valence were negatively correlated, while the accuracy of safety hazards recognition and the perception level of safety hazard separately had an inverted “U” type relationship with emotional valence. For construction workers with more than 20 years of working experience, work experience could effectively reduce the influence of emotional fluctuations on the accuracy of safety hazards identification. This study contributes to the application of physiological measurement techniques in construction safety management and shed a light on improving the theoretical system of safety management.

Short-term fasting induced changes in HRV are associated with interoceptive accuracy: Evidence from two independent within-subjects studies

Previous research suggested increased cardiac interoceptive accuracy after 24-h food-deprivation by means of the heartbeat tracking task. The present study investigated if 16-h of voluntary fasting shows similar effects and whether changes in interoceptive accuracy are accompanied by changes in autonomic function. In two independent within-subjects studies two measures of interoceptive accuracy, the heartbeat tracking task and the heartbeat discrimination task were applied. In study 1 (n = 24) and study 2 (n = 72) vagally-mediated HRV increases and heart rate decreases were observed. Stronger effects of fasting on vagally-mediated HRV went along with a higher interoceptive accuracy increase in the heartbeat tracking task. Furthermore, the fasting associated changes in interoceptive accuracy in both tasks were significantly associated, suggesting that these tasks are suitable to track changes in cardiac interoception. Taken together, fasting of 16-h might be suitable to increase participants' parasympathetic efference, thereby facilitating interoception.

A mysterious sensation about sleep and health: the role of interoception

Background

Interoception is mental awareness, recognition and acknowledgement of physiological body signals. Understanding the role of sleep and interoception may provide a better understanding surrounding the sleep-health connection. Our primary objective was to examine the potential relationships between subjective sleep quality and multiple dimensions of interoceptive abilities in a large sample of young adults, a group who are vulnerable to sleep impairment and its widespread health consequences.

Methods

We conducted an online cross-sectional survey targeting young adults, aged 18–25 years. The Pittsburgh Sleep Quality Index (PSQI) was used to identify subjective sleep quality and the Multidimensional Assessment of Interoceptive Awareness Version 2 was used to assess eight domains of interoception. We conducted a series of Spearman’s bivariate correlations to assess the relationships between global sleep quality as well as the seven PSQI sub-components in relation to the eight interoception outcomes. We then conducted quantile regression to assess if global PSQI score was an independent predictor of interoception. Participants (n = 609) consented and provided data.

Results

After adjustment, the global PSQI was a significant predictor of ‘Non-Distracting’, ‘Emotional Awareness’ and ‘Trusting’, where β = − 0.10 (95% CI: − 0.14, − 0.07), β = 0.05 (0.01, 0.09), and β = − 0.10 (− 0.14, − 0.05), respectively.

Conclusions

Our findings reveal a small, significant relationship between sleep quality and interoceptive abilities amongst young adults. Sleep impairment may inhibit interoceptive skills, thus adding value to the mechanistic explanation of the sleep-health relationship. Experimental and prospective studies are needed to determine temporal associations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11603-0.

Heart Rate Variability Modulates Interoceptive Accuracy

Our emotional experiences depend on our interoceptive ability to perceive and interpret changes in our autonomous nervous system. An inaccurate perception and interpretation of autonomic changes impairs our ability to understand and regulate our emotional reactions. Impairments in emotion understanding and emotion regulation increase our risk for mental disorders, indicating that interoceptive deficits play an important role in the etiology and pathogenesis of mental disorders. We, thus, need measures to identify those of us whose interoceptive deficits impair their emotion understanding and emotion regulation. Here, we used cardiac measures to investigate how our ability to engage prefrontal and (para-)limbic brain region regions affects our ability to perceive and interpret cardiac changes. We administered a heartbeat detection task to a sample of healthy individuals (n = 113) whose prefrontal-(para-) limbic engagement had been determined on basis of a heart rate variability recording. We found a positive association between heartbeat detection and heart rate variability, implying that individuals with higher heart rate variability were more accurate in heartbeat detection than individuals with lower heart rate variability. These findings suggest that our interoceptive accuracy depends on our prefrontal-(para-)limbic engagement during the perception and interpretation of cardiac changes. Our findings also show that cardiac measures may be useful to investigate the association between interoceptive accuracy and prefrontal-(para-)limbic engagement in a time- and cost-efficient manner.