Theory of Motivated Cue-Integration and COVID-19: Between Interoception, Somatization, and Radicalization

A longitudinal study of interoception changes in the times of COVID-19: Effects on psychophysiological health and well-being

Background

Interoception - the processing of the internal state of the body - has been consistently tied to well-being and mental health, which in turn have been severely challenged by the COVID-19 pandemic. Moreover, the fact that symptoms of COVID-19 (high temperature, shortness of breath, fatigue, and even gastro-intestinal problems) directly alter interoceptive signals has fueled people's tendency to constantly check their internal bodily state.

Objectives

In this longitudinal study we tested for changes in interoception and psychophysiological health and well-being during different stages of the pandemic in 2020 and assessed their potential association. To highlight this association, we combined both subjective (i.e., self-reported questionnaires) and objective (i.e., measures of heart rate variability, HRV and of interoceptive accuracy) measures.

Methods

245 Italian participants who had completed the Multidimensional Assessment of Interoceptive Awareness (MAIA-2) prior to the onset of the pandemic, repeated the questionnaire during the first national lockdown in Italy, and four months after restrictions. Participants also completed survey measures of depression (PHQ-9), anxiety (STAI), and sleep disturbance (PSQI). A sub-sample of 28 participants, who had completed the heartbeat counting task (HCT) and a measure of heart rate variability (HRV), was tested again remotely, in the same time windows, using phone applications and photoplethysmography.

Results

While performance in the HCT remained unvaried, MAIA-2 scores consistently increased from before the pandemic to the national lockdown, and remained largely unvaried after four months. The national lockdown was associated with the lowest psychophysiological health and well-being, as evidenced by a decrease in HRV compared to before the pandemic and by higher scores in self-reported depression, anxiety, and sleep disturbance compared to four months after the lockdown. Interestingly, psychophysiological health and well-being were predicted by specific regulatory components of interoception (e.g., the ability to regulate distress by focusing on body sensations and experiencing one's body as safe and trustworthy).

Conclusions

Our results suggest an increased attention towards visceral signals during the COVID-19 pandemic, and highlight the positive role of specific components of interoception in contributing to well-being, suggesting that novel interventions aimed at increasing interoception may be developed to protect against stressful life events such as COVID-19.

Management of Somatization in COVID-19: A Narrative Review

Somatization refers to the condition in which psychological distress is shown in the form of somatic symptoms such as persistent headache, nausea, gastrointestinal discomfort, etc. Various predisposing factors, including familial such as high expressed emotion, poor parental care, genetic, biological, and demographic which includes age and gender, cognitive such as learning disabilities, psychiatric such as depression, anxiety, post-traumatic stress disorder, social, etc., play an essential role in saturation of the disease. During the time of the COVID-19 pandemic, psychological distress increased in the patients infected with the coronavirus due to some the factors such as social distancing from loved ones, lack of physical exercise, loss of income, loneliness due to quarantine, etc. Therefore, management and treatment of the disorder became essential, especially in coronavirus-infected patients, as it may lead to an increase in complications of the disease. Many studies have been conducted to identify the proper way to manage the condition. Treatments include pharmacological therapy and psychosocial interventions. Pharmacological therapy includes using various antidepressants, hypnotics, and sedatives such as benzodiazepines. For the treatment, mirtazapine is a secure and reliable antidepressant. Another drug, trizolobenzodiazepine adinazolam, was also very useful in treating patients. In some randomized experiments, alprazolam significantly outperformed amitryptiline in reducing the symptoms. Psychosocial interventions include sessions such as cognitive behavioral therapy (CBT), mindfulness-based cognitive therapy, relaxation training, meditation, and psychological interventions such as enhancing multidimensional social help, modifying cognitive assessment, directing positive coping, and inspiring positive emotions.