The Role of Interoceptive Sensibility and Emotional Conceptualization for the Experience of Emotions

Reconceptualizing complex posttraumatic stress disorder: A predictive processing framework for mechanisms and intervention

In this article, we introduce a framework for interpreting Complex Posttraumatic Stress Disorder (C-PTSD) through predictive processing, a neuroscience concept explaining the brain's interpretation and prediction of sensory information. While closely related to PTSD, C-PTSD encompasses additional symptom clusters marked by disturbances in self-organization (DSO), such as negative self-concept, affect dysregulation, and relational difficulties, typically resulting from prolonged traumatic stressors. Our model leverages advances in computational psychiatry and neuroscience, offering a mechanistic explanation for these symptoms by illustrating how prolonged trauma disrupts the brain's predictive processing. Specifically, altered predictive mechanisms contribute to C-PTSD's symptomatology, focusing on DSO: (1) Negative self-concept emerges from maladaptive priors that bias perception towards self-criticism, misaligning expected and actual interoceptive states; (2) Misalignment between predicted and actual interoceptive signals leads to affect dysregulation, with sensitivity to bodily cues; and (3) Relationship challenges arise from skewed social prediction errors, fostering mistrust and withdrawal. This precision-focused approach sheds light on the dynamics underpinning C-PTSD and highlights potential intervention targets aimed at recalibrating the predictive processing system.

Higher inflammatory proteins predict future depressive symptom severity among adolescents with lower emotional clarity

BACKGROUND

A growing body of work has implicated inflammation in the pathogenesis of depression. As not all individuals with heightened levels of peripheral inflammation develop symptoms of depression, additional work is needed to identify other factors that catalyze the relationship between inflammation and depressive symptoms. Given that elevated levels of inflammatory activity can induce a variety of emotional changes, the present study examined whether emotional clarity, the trait-like ability to identify, discern, and express one's emotions, influences the strength of the association between inflammatory signaling and concurrent and prospective symptoms of depression.

METHODS

Community adolescents (N=225, Mage = 16.63 years), drawn from a larger longitudinal project investigating sex and racial differences in depression onset, provided blood samples to determine peripheral levels of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and C-reactive protein (CRP) at a baseline visit, along with self-report measures of emotional clarity and depressive symptom severity. Depressive symptom severity was assessed again at a follow-up visit approximately 5-months after baseline.

RESULTS

Hierarchical multiple regressions detected a significant interaction between inflammatory markers and emotional clarity on future depression severity, controlling for baseline depressive symptoms. Specifically, among adolescents with low levels of emotional clarity, higher IL-6, CRP levels, and inflammatory composite scores were significantly associated with greater future depression severity.

CONCLUSIONS

These results indicate that low emotional clarity and high inflammatory signaling may jointly confer risk for prospective depressive symptom severity among adolescents. Therapeutic interventions that improve emotional clarity may reduce risk of depressive symptoms among adolescents with low-grade peripheral inflammation.

The association between negative emotion differentiation and emotion regulation flexibility in daily life

Emotion differentiation emphasises labelling emotional experiences in a precise and context-sensitive way. Negative emotion differentiation (NED) has been found to be associated with mental health, where emotion regulation (ER) may act as a pathway. The current study aims to explore the association between NED and flexible ER implementation in daily life. Specifically, we examined how NED was associated with two aspects of ER flexibility: contextual synchrony and temporal ER variability. 101 college students (54% female; Mage = 20.24 years) reported their momentary emotions via a 7-day experience sampling protocol, and the intraclass correlation coefficients were calculated to reflect NED. In 10-day daily diaries, they also reported information about the most negative event during the day (i.e. event type, event intensity and ER goal) and how they regulated their emotions. The results revealed that individuals with high NED showed higher levels of synchrony between change in ER use and change in event type and ER goal. In addition, NED was positively associated with both within- and between-strategy variability in ER use. The results demonstrated that the ability to differentiate between negative emotions was related to higher ER flexibility, which shed new light on understanding the role of emotion differentiation in well-being.

Transcutaneous auricular vagus nerve stimulation modulates the processing of interoceptive prediction error signals and their role in allostatic regulation

It has recently been suggested that predictive processing principles may apply to interoception, defined as the processing of hormonal, autonomic, visceral, and immunological signals. In the current study, we aimed at providing empirical evidence for the role of cardiac interoceptive prediction errors signals on allostatic adjustments, using transcutaneous auricular vagus nerve stimulation (taVNS) as a tool to modulate the processing of interoceptive afferents. In a within-subject design, participants performed a cardiac-related interoceptive task (heartbeat counting task) under taVNS and sham stimulation, spaced 1-week apart. We observed that taVNS, in contrast to sham stimulation, facilitated the maintenance of interoceptive accuracy levels over time (from the initial, stimulation-free, baseline block to subsequent stimulation blocks), suggesting that vagus nerve stimulation may have helped to maintain engagement to cardiac afferent signals. During the interoceptive task, taVNS compared to sham, produced higher heart-evoked potentials (HEP) amplitudes, a potential readout measure of cardiac-related prediction error processing. Further analyses revealed that the positive relation between interoceptive accuracy and allostatic adjustments-as measured by heart rate variability (HRV)-was mediated by HEP amplitudes. Providing initial support for predictive processing accounts of interoception, our results suggest that the stimulation of the vagus nerve may increase the precision with which interoceptive signals are processed, favoring their influence on allostatic adjustments.

Transcutaneous Auricular Vagus Nerve Stimulation to Improve Emotional State

Emotional experiences are a part of our lives. The maladaptive functioning of an individual's emotional field can lead to emotional disturbances of various kinds, such as anxiety and depression. Currently, there is an increasing prevalence of emotional disorders that cause great human suffering and high socioeconomic costs. Emotional processing has a biological basis. The major neuroscientific theories of emotion are based on biological functioning, and all of them take into account the anatomy and function of the tenth cranial nerve: the vagus nerve. The vagus nerve connects the subdiaphragmatic and supradiaphragmatic areas and modulates emotional processing as the basis of interoceptive functioning. Auricular vagus nerve stimulation is a new and innovative neuromodulation technique based on the function of the vagus nerve. Several interventions have shown that this new neurostimulation technique is a very promising resource for treating emotional disorders. In this paper, we summarise three neuroscientific theories of emotion, explain what transcutaneous auricular nerve stimulation is, and present arguments for its use and continued research.

Elements of cultural scripts of trauma sequelae among trauma victims in East Africa

Background

As a new, unifying approach to mapping the cultural expressions of trauma sequelae, cultural scripts of trauma sequelae are empirically investigated here for the first time in a primarily qualitative study. Elements of Cultural Scripts of Trauma (CST) include the typical symptoms and appraisals of changes of those who have experienced traumatic events. These elements refer to the value orientations in the given culture.

Aims

To identify post-traumatic cultural scripts' elements and their groupings, as expressed by trauma survivors from the East African population, and to explore the cultural values that serve as a reference to such scripts' elements.

Methods

Semi-structured, in-depth interviews were conducted in nine focus groups of trauma survivors and trauma experts. Grounded theory was the basis for the content analysis, and MAXQDA was used for coding and grouping. Semi-quantitative analyses of the frequency of groupings followed.

Results

The study extracted 270 elements of the cultural scripts of trauma. Three stages of cultural scripts' elements were identified including unspeakable, heart wounds and painful scars and growth. The reported elements are only those in the three last stages and they are grouped into six categories, such as cognitive appraisals, worldview, interpersonal relationships, body-related, positive changes and changes in family interest and management, while the elements of the first stages are not codable as the survivors do not yet get the words of their expressions. The cultural values that served as a reference consisted of holding the sadness, Christianity, community reputation, solidarity, social connectedness, social cynicism, and reproductiveness, among others.

Discussion

This comprehensive study with participants from several countries in East Africa collected a large number of elements of cultural scripts of trauma for this regional area. Notably, these elements were based mostly on man-made traumas, such as the genocide against the Tutsis in Rwanda. Further steps in the CST investigation are subject to future studies, such as a more systematic investigation of the relationship with cultural values and the temporal relationships within the scripts.

Assessment of the mind-body connection: preliminary psychometric evidence for a new self-report questionnaire

OBJECTIVES

While interoceptive self-report scales provide a foundation for measuring the mind-body connection, they variably consider other important factors that could influence interpretations of internal bodily sensations and perceptions related to mind-body integration. The proposed Body-Mind Connection Questionnaire (BMCQ) aimed to operationalise the notion that this construct involves three major components: (a) Interoceptive Attention, (b) Sensation-Emotion Articulation, and (c) Body-Mind Values.

METHODS

Following panel review and piloting with the target population, the developed BMCQ was evaluated in 316 participants (189 identifying as female) aged 18-50 (MAge=30.78), alongside established self-report measures of interoceptive sensibility, body awareness, sensory processing sensitivity, and alexithymia. We examined the BMCQ factor structure through exploratory factor analysis and analysed convergent and discriminant validity.

RESULTS

Exploratory factor analysis supported three scales of the BMCQ, which explained 54.03% of variance. Factor loadings (>0.44) and reliability indices (0.74 to 0.85) were acceptable. Inter-scale correlations suggested that the scales are distinct but related (rs=0.38 to 0.59). BMCQ scales were supported by convergent (r=0.33 to 0.67) and discriminant evidence (rs=0.01 to 0.39, p range n.s. to <.05).

CONCLUSIONS

Preliminary psychometric properties indicate that the BMCQ is multidimensional and consists of three constructs that differentially relate to theoretically associated measures. Interoceptive Attention, Sensation-Emotion Articulation, and Body-Mind Values may serve as a basis for efficiently assessing the mind-body connection more holistically, which could be useful for developing interventions aimed at enhancing mind-body integration.

Self-reported interoceptive accuracy and interoceptive attention differentially correspond to measures of visual attention and self-regard

Background

Interoception, the perception of bodily functions and sensations, is a crucial contributor to cognition, emotion, and well-being. However, the relationship between these three processes is not well understood. Further, it is increasingly clear that dimensions of interoception differentially corresponds to these processes, yet this is only recently being explored. The present study addresses two important questions: Are subjective interoceptive accuracy and interoceptive attention related to self-regard and well-being? And are they related to exteroceptive (visual) attention?

Methods

Participants (N = 98; 29% women; aged 23-64 years) completed: a battery of questionnaires to assess subjective accuracy (how well one predicts bodily sensations), interoceptive attention (a tendency to notice bodily signals), self-regard (self-esteem, self-image, life satisfaction), state negative affect (depression, anxiety, and stress), a self-esteem Implicit Association Task (a measure of implicit self-esteem), and a flanker task to assess visual selective attention. Subjective interoceptive accuracy and attention served as dependent variables. Correlations and principal component analysis was used to establish correlations among variables and determine how, or whether, these measures are associated with subjective interoceptive accuracy or attention.

Results

Greater scores on measures of self-regard, implicit self-esteem, cognition and lower negative affect were broadly associated with greater subjective interoceptive accuracy. Conversely, only explicit self-esteem, satisfaction with life, and self-image corresponded to subjective interoceptive attention. An exploratory analysis with a more inclusive scale of interoceptive attention was conducted. Results of this exploratory analysis showed that the broader measure was a stronger correlate to self-regard than subjective interoceptive accuracy, though it, too, did not correlate with visual attention. In short, both subjective interoceptive accuracy and attention corresponded to well-being and mental health, but only accuracy was associated with exteroceptive attention.

Conclusion

These results add to a growing literature suggesting different dimensions of (subjective) interoception differentially correspond to indices of well-being. The links between exteroceptive and interoceptive attention, and their association with merit further study.

Antisocial and impulsive personality traits are linked to individual differences in somatosensory maps of emotion

Somatosensory experience is an important component of emotion, playing a prominent role in many traditional emotion theories. Nonetheless, and despite the extensive literature on the influence of individual differences in emotional processing, the relation between personality traits and emotion-related somatosensation has received little attention. Here, we addressed this question in a large sample of healthy individuals through the "bodily maps of emotion" behavioural paradigm, in which participants indicated the location and extent of their body sensations for the 6 basic and 4 additional social emotions (contempt, envy, pride, shame). We found that emotional somatosensation in specific body areas, including the heart, the stomach, and the head, was related to specific personality factors, particularly antisocial attitudes and impulsivity. Moreover, the similarity of individual participants' maps to the group-average was likewise negatively correlated with antisocial tendencies. Overall, our results suggest that differences in individuals' sensitivity to somatosensation from different body areas, as well as the typicality of their topographical patterns, may partly underlie variation in higher-order social and affective traits.

Moral Emotions and Their Brain Structural Correlates Across Neurodegenerative Disorders

BACKGROUND

Although social cognition is compromised in patients with neurodegenerative disorders such as behavioral variant frontotemporal dementia (bvFTD) and Alzheimer's disease (AD), research on moral emotions and their neural correlates in these populations is scarce. No previous study has explored the utility of moral emotions, compared to and in combination with classical general cognitive state tools, to discriminate bvFTD from AD patients.

OBJECTIVE

To examine self-conscious (guilt and embarrassment) and other-oriented (pity and indignation) moral emotions, their subjective experience, and their structural brain underpinnings in bvFTD (n = 31) and AD (n = 30) patients, compared to healthy controls (n = 37). We also explored the potential utility of moral emotions measures to discriminate bvFTD from AD.

METHODS

We used a modified version of the Moral Sentiment Task measuring the participants' accuracy scores and their emotional subjective experiences.

RESULTS

bvFTD patients exhibited greater impairments in self-conscious and other-oriented moral emotions as compared with AD patients and healthy controls. Moral emotions combined with general cognitive state tools emerged as useful measures to discriminate bvFTD from AD patients. In bvFTD patients, lower moral emotions scores were associated with lower gray matter volumes in caudate nucleus and inferior and middle temporal gyri. In AD, these scores were associated with lower gray matter volumes in superior and middle frontal gyri, middle temporal gyrus, inferior parietal lobule and supramarginal gyrus.

CONCLUSION

These findings contribute to a better understanding of moral emotion deficits across neurodegenerative disorders, highlighting the potential benefits of integrating this domain into the clinical assessment.

Interoceptive pathways to understand and treat mental health conditions

An increasing recognition that brain and body are dynamically coupled has enriched our scientific understanding of mental health conditions. Peripheral signals interact centrally to influence how we think and feel, generating our sense of the internal condition of the body, a process known as interoception. Disruptions to this interoceptive system may contribute to clinical conditions, including anxiety, depression, and psychosis. After reviewing the nature of interoceptive disturbances in mental health conditions, this review focuses on interoceptive pathways of existing and putative mental health treatments. Emerging clinical interventions may target novel peripheral treatment mechanisms. Future treatment development requires forward- and back-translation to uncover and target specific interoceptive processes in mental health to elucidate their efficacy relative to interventions targeting other factors.

Altered Interoceptive Sensibility in Adults With Chronic Tic Disorder

BACKGROUND

Interoception refers to the sensing, interpretation, integration, and regulation of signals about the body's internal physiological state. Interoceptive sensibility is the subjective evaluation of interoceptive experience, as assessed by self-report measures, and is abnormal in numerous neuropsychiatric disorders. Research examining interoceptive sensibility in individuals with chronic tic disorders (CTDs), however, has yielded conflicting results, likely due to methodologic differences between studies and small sample sizes.

OBJECTIVE

We sought to compare interoceptive sensibility between adults with CTD and healthy controls, adjusting for co-occurring psychiatric symptoms, and to examine the relationship of interoceptive sensibility with other CTD clinical features, in particular, premonitory urge.

METHODS

We recruited adults with CTDs and sex- and age-matched healthy controls to complete the Multidimensional Assessment of Interoceptive Awareness, Version 2 (MAIA-2), as well as a battery of measures assessing psychiatric symptoms prevalent in CTD populations. CTD participants additionally completed scales quantifying tic severity, premonitory urge severity, and health-related quality of life. We conducted between-group contrasts (Wilcoxon rank-sum test) for each MAIA-2 subscale, analyzed the effect of psychiatric symptoms on identified between-group differences (multivariable linear regression), and examined within-group relationships between MAIA-2 subscales and other clinical measures (Spearman rank correlations, multivariable linear regression).

RESULTS

Between adults with CTD (n = 48) and healthy controls (n = 48), MAIA-2 Noticing and Not-Worrying subscale scores significantly differed. After adjusting for covariates, lower MAIA-2 Not-Worrying subscale scores were significantly associated with female sex (β = 0.42, p < 0.05) and greater severity of obsessive-compulsive symptoms (β = -0.028, p < 0.01), but not with CTD diagnosis. After adjusting for severity of tics and obsessive-compulsive symptoms, a composite of MAIA-2 Noticing, Attention Regulation, Emotional Awareness, Self-Regulation, Body Listening, and Trusting subscales (β = 2.52, p < 0.01) was significantly associated with premonitory urge.

CONCLUSION

Study results revealed three novel findings: adults with CTD experience increased anxiety-associated somatization and increased general body awareness relative to healthy controls; anxiety-associated somatization is more closely associated with sex and obsessive-compulsive symptoms than with CTD diagnosis; and increased general body awareness is associated with greater severity of premonitory urges.