Sarah N Garfinkel

• Ph.D.
• Professor at University College London

Emotions and affective feelings are influenced by one's internal state of bodily arousal via interoception. Autism Spectrum Conditions (ASC) are associated with difficulties in recognising others' emotions, and in regulating own emotions. We tested the hypothesis that, in people with ASC, such affective differences may arise from abnormalities in i...

Mental processes depend upon a dynamic integration of brain and body. Emotions encompass internal physiological changes which, through interoception (sensing bodily states), underpin emotional feelings, for example, cardiovascular arousal can intensify feelings of fear and anxiety. The brain is informed about how quickly and strongly the heart is b...

Emotion and cognition are dynamically coupled to bodily arousal: The induction of anger, even unconsciously, can reprioritise neural and physiological resources toward action states that bias cognitive processes. Here we examine behavioural, neural and bodily effects of covert anger processing and its influence on cognition, indexed by lexical deci...

Interoception refers to the sensing of internal bodily changes. Interoception interacts with cognition and emotion, making measurement of individual differences in interoceptive ability broadly relevant to neuropsychology. However, inconsistency in how interoception is defined and quantified led to a three-dimensional model. Here, we provide empiri...

The mind and body are intrinsically and dynamically coupled. Perceptions, thoughts and feelings change, and respond to, the state of the body. This chapter describes the integration of cognitive and affective processes with the autonomic control of bodily arousal, focusing on reciprocal effects of autonomic responses on decision making, error detec...

Dissociation is a transdiagnostic mental health symptom involving a sense of detachment from one’s own body. A coherent percept of our body relies upon the smooth integration of different senses, such as vision and touch, which are processed by the brain at different speeds. We investigated the association between multi-sensory integration and diss...

Mismatches between perceived and veridical physiological signals during false feedback (FFB) can bias emotional judgements. Paradigms using auditory FFB suggest perceived changes in heart rate (HR) increase ratings of emotional intensity irrespective of feedback type (increased or decreased HR), implicating right anterior insula as a mismatch compa...

Transcutaneous auricular vagus nerve stimulation (taVNS) has been shown to influence cognitive and emotional function and enhance interoceptive awareness. This study investigates if taVNS effects extend to the experience of body ownership, as measured via susceptibility to the rubber hand illusion (RHI) in a virtual reality setting. The experiment...

Background Anxiety symptoms are elevated among people with joint hypermobility. The underlying neural mechanisms are attributed theoretically to effects of variant connective tissue on the precision of interoceptive representations contributing to emotions. Aim To investigate the neural correlates of anxiety and hypermobility using functional neur...

Autistic people may be distinguishable from non-autistic individuals in the content and modality of their thoughts. Such differences potentially underlie both psychological vulnerability and strengths, motivating the need to better understand autistic thought patterns. In non-clinical undergraduates, a recent study found that autistic traits were a...

Background and Aims Anxiety symptoms are elevated among people with joint hypermobility. The underlying neural mechanisms are attributed theoretically to effects of variant connective tissue on the precision of interoceptive representations contributing to emotions. Methods We used functional magnetic resonance neuroimaging (fMRI) to quantify regi...

Perceptual accuracy for interoceptive signals, such as heartbeats, varies in a trait-like manner across individuals and may influence the capacity for emotion regulation and vulnerability to affective symptoms, notably anxiety. Here, we demonstrate that an interoceptive training protocol improved perceptual accuracy in two tasks of heartbeat percep...

One of the most prominent symptoms in multiple sclerosis is pathological fatigue, often described by sufferers as one of the most debilitating symptoms, affecting quality of life and employment. However, the mechanisms of both, physical and cognitive fatigue in multiple sclerosis remain elusive. Here, we use behavioural tasks and quantitative MRI t...

The heartbeat-evoked potential (HEP), a cortical response time-locked to each heartbeat, is suggested as an implicit electrophysiological marker reflecting the cortical processing of heartbeats, and more broadly interoceptive processing. An increasing number of studies suggest that HEP may be a meaningful clinical measure. However, on the scalp, HE...

Emotional feelings are putatively ascribed to central representation of bodily states in the context of expectation and uncertainty in both internal state and external world. Neurodivergent people are more likely to experience co-occurring mental health challenges, although mechanistic insights underpinning this association are scarce. We therefore...

Ordinary sensations from inside the body are important causes and consequences of our affective states and behaviour, yet the roles of neurotransmitters in interoceptive processing have been unclear. With a within-subjects design, this experiment tested the impacts of acute increases of endogenous extracellular serotonin on the neural processing of...

Dissociative symptoms and disorders of dissociation are characterised by disturbances in the experience of the self and the surrounding world, manifesting as a breakdown in the normal integration of consciousness, memory, identity, emotion, and perception. This paper aims to provide insights into dissociative symptoms from the perspective of intero...

Dissociation is a transdiagnostic mental health symptom involving a sense of detachment from one’s own body. A coherent percept of our body relies upon the smooth integration of different senses, such as vision and touch, which are processed by the brain at different speeds. In a N=100 non-clinical sample, we used Virtual Reality to investigate sen...

Dissociation is a transdiagnostic mental health symptom involving a sense of detachment from one’s own body. A coherent percept of our body relies upon the smooth integration of different senses, such as vision and touch, which are processed by the brain at different speeds. In a N=100 non-clinical sample, we used Virtual Reality to investigate sen...

Serotonin is known to have state-dependent modulatory influences on exteroceptive sensory processes and the processing of pain, but much less is known about its role in ordinary interoceptive processes and their relationships to affective states. This experiment compared the impact of a selective serotonin reuptake inhibitor (SSRI) (20mg CITALOPRAM...

The chronic and acute effects of stress can have divergent effects on health; long-term effects are associated with detrimental physical and mental health sequelae, while acute effects may be advantageous in the short-term. Stress-induced analgesia, the attenuation of pain perception due to stress, is a well-known phenomenon that has yet to be syst...

Background Interoception describes the predictive representation and control of the internal physiological state of the body. Disturbances in interoception have been demonstrated in people with functional seizures. Little is known about interoception in epilepsy. Aim To compare dimensions of interoception across three groups - people with function...

A growing body of work shows that autonomic signals provide a privileged evidence stream to capture various aspects of subjective and neural states. This work investigates the potential for autonomic markers to track the effects of psychedelics - potent psychoactive drugs with important scientific and clinical value. For this purpose, we introduce...

Community brief Why is this an important issue? Research shows that autistic people experience loneliness more often than nonautistic adults. It also shows that sensory differences contribute to higher loneliness, and that both sensory differences and loneliness are related to poor mental health, such as anxiety and depression. However, we do not k...

Racial-bias and stereotyping may be unconscious, yet discrimination and biased decisions can have devastating, even fatal, consequences. Such bias is influenced by interoceptive information concerning bodily physiology: Fear processing and racially-biased judgements of threat are augmented by phasic cardiac signals reflecting changes in cardiovascu...

Objective Although interoceptive abnormality in patients with functional seizure (FSs) has been demonstrated using explicit tasks, implicit measurements of interoception such as the effect of interoception on perceptual brain processes have not been investigated. It has been shown that perception is normally modulated by interoceptive signals relat...

Interoceptive mismatch is a perceptual discrepancy between ascending bodily signals and higher-order representation of anticipated physiological state. Inspired by predictive coding models, we present autonomic perceptual mismatch as a measure of this discrepancy for clinical application to brain-body interactions. Joint hypermobility is disproport...

Background Patients with functional seizures (FS) can experience dissociation (depersonalisation) before their seizures. Depersonalisation reflects disembodiment, which may be related to changes in interoceptive processing. The heartbeat-evoked potential (HEP) is an electroencephalogram (EEG) marker of interoceptive processing. Aim To assess wheth...

Background: Abnormalities in the regulation of physiological arousal and interoceptive processing are implicated in the expression and maintenance of specific psychiatric conditions and symptoms. We undertook a cross-sectional characterisation of patients accessing secondary mental health services, recording measures relating to cardiac physiology...

Objectives/Aims Patients with functional seizures (FS) can experience dissociation (depersonalisation) before their seizures. Depersonalisation encompasses a feeling of disembodiment, putatively caused by reduced afferent visceral mapping, that is, changes in interoceptive processing. The heartbeat-evoked potential (HEP) is an electroencephalograph...

Chronic stress can have long-term deleterious consequences for mental and physical health, while acute stress can promote adaptive processing to optimize short-term survival. Stress-induced analgesia (SIA) is the attenuation of pain perception with acute stress. A phenomenon that has been naturalistically reported and subsequently characterized in...

Background Patients with functional seizures (FS) can experience dissociation (depersonalisation) before their seizures. Depersonalisation encompasses a feeling of disembodiment, putatively caused by reduced afferent visceral mapping, that is, changes in interoceptive processing. The heartbeat-evoked potential (HEP) is an electroencephalographic (E...

Interoception, the sense of the internal physiological state of the body, theoretically underpins aspects of self-representation. Experimental studies link feelings of body ownership to interoceptive perception, yet few studies have tested for association between the sense of agency and interoceptive processing. Here, we combined an intentional bin...

Rationale Interoception is the signalling, perception, and interpretation of internal physiological states. Many mental disorders associated with changes of interoception, including depressive and anxiety disorders, are treated with selective serotonin reuptake inhibitors (SSRIs). However, the causative link between SSRIs and interoception is not y...

Background Functional seizures (FS), otherwise known as psychogenic nonepileptic seizures (PNES), are a common symptom presenting to neurology and epilepsy clinics. There is a pressing need for further research to understand the neurobiology of FS to develop mechanistically targeted treatments. Joint hypermobility is an expression of variation in c...

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...

Heart rate and heart rate variability have enabled insight into a myriad of psychophysiological phenomena. There is now an influx of research attempting using these metrics within both laboratory settings (typically derived through electrocardiography or pulse oximetry) and ecologically-rich contexts (via wearable photoplethysmography, i.e., smartw...

Previous studies indicate that neurophysiological signatures of feedback processing might be enhanced when participants are assigned a low-status position. Error commission and negative feedback can evoke responses in the peripheral (autonomic) nervous system including heart rate deceleration. We conducted an exploratory study to investigate whethe...

Internal bodily signals are dynamically coupled to brain dynamics; interoception, the ‘sensing’ of internal signals, can influence cognition, emotion and perception. An appreciation of the wide-ranging implications of interoceptive processing has surpassed the range and breadth of available interoceptive methods. New techniques are required to supp...

There is a long history of, and renewed interest in, cardiac timing effects on behaviour and cognition. Cardiac timing effects may be identified by expressing events as a function of their location in the cardiac cycle, and applying circular (i.e. directional) statistics to test cardiac time-behaviour associations. Typically this approach ‘stretche...

Interoception has historically been assessed using behavioural tests of accuracy, self-report measures or through the characterisation of neural signals underlying interoceptive processing. More recent conceptualisations of interoception incorporate interoceptive attention and higher-order measures related to the interpretation of interoceptive sig...

Background: Auditory verbal hallucinations (AVH) commonly occur in the context of borderline personality disorder (BPD) yet remain poorly understood. AVH are often perceived by patients with BPD as originating from inside the head and hence viewed clinically as 'pseudohallucinations', but they nevertheless have a detrimental impact on wellbeing....

Despite the persistent stereotype that autistic individuals are not motivated to seek meaningful social relationships, rates of loneliness among the autistic population are higher than in the non-autistic population. In this two-part, mixed methods study, we sought to 1) quantify the level of distress associated with loneliness in autistic and non-...

Objective Emotional states are expressed in body and mind through subjective experience of physiological changes. In previous work, subliminal priming of anger prior to lexical decisions increased systolic blood pressure (SBP). This increase predicted the slowing of response times (RT), suggesting that baroreflex-related autonomic changes and their...

Individuals vary in their ability to perceive, as conscious sensations, signals like the beating of the heart. Tests of such interoceptive ability are, however, constrained in nature and reliability. Performance of the heartbeat tracking task, a widely used test of cardiac interoception, often corresponds well with individual differences in emotion...

Threat learning elicits robust changes across multiple affective domains, including changes in autonomic indices and subjective reports of fear and anxiety. It has been argued that the underlying causes of such changes may be dissociable at a neural level, but there is currently limited evidence to support this notion. To address this, we examined...

Background This trial tested if a novel therapy, Aligning Dimensions of Interoceptive Experience (ADIE), reduces anxiety in autistic adults. ADIE targets the association of anxiety with mismatch between subjective and behavioral measures of an individual's interoceptive sensitivity to bodily signals, including heartbeats. Methods In this superiori...

The study of the brain’s processing of sensory inputs from within the body (‘interoception’) has been gaining rapid popularity in neuroscience, where interoceptive disturbances are thought to exist across a wide range of chronic physiological and psychological conditions. Here we present a task and analysis procedure to quantify specific dimensions...

Objective: The current article discusses recent literature on perceptual processing in autism and aims to provide a critical review of existing theories of autistic perception and suggestions for future work. Method: We review findings detailing exteroceptive and interoceptive processing in autism and discuss their neurobiological basis as well as...

Introduction The aetiology and pathophysiology of fibromyalgia and ME/CFS are poorly characterised but altered inflammatory, autonomic and interoceptive processes have been implicated. Interoception has been conceptualised as a predictive coding process; where top-down prediction signals compare to bottom-up afferents, resulting in prediction error...

Background The presence of auditory verbal hallucinations (AVH) does not currently feature in the main diagnostic criteria for Borderline Personality Disorder (BPD). However, there is accumulating evidence that a high proportion of BPD patients report longstanding and frequent AVH which constitute a significant risk factor for suicide plans and att...

Many interoceptive tasks (i.e. measuring the sensitivity to bodily signals) are based upon heartbeats perception. However, the temporal perception of heartbeats— when heartbeats are felt—varies among individuals. Moreover, the spatial perception of heartbeats— where on the body heartbeats are felt—has not been characterized in relation to temporal....

There are well known phenotypic differences in sweet-liking across individuals, but it remains unknown whether these are related to broader underlying differences in interoceptive abilities (abilities to sense the internal state of the body). Here, healthy women (N = 64) classified as sweet likers (SLs) or sweet dislikers (SDs) completed a bimodal...

Heart rate and its variability have enabled insight into a myriad of psychophysiological phenomena. There is now an influx of research attempting using these metrics within both laboratory settings (typically derived through electrocardiography or pulse oximetry) and ecologically-rich contexts (via wearable photoplethysmography, i.e. smartwatches)....

Introduction Pain, fatigue and anxiety are common features of fibromyalgia and ME/CFS and significantly impact quality of life. Aetiology is poorly defined but dysfunctional inflammatory, autonomic and interoceptive (sensing of internal bodily signals) processes are implicated. Objectives To investigate how altered interoception relates to baselin...

Novel research suggests the rhythms in our stomachs can influence our response to disgusting stimuli. Monetary reward will only encourage people to engage with disgusting stimuli after a peripherally acting drug alters gastric signals.

Mental processes are recognized to be embodied, hence dependent upon functions of the body. Interoception (i.e., the sense of the internal bodily physiology) underpinning motivational states and emotional feelings, however, are mostly ignored within present sensory-motor accounts of embodiment. The inclusion of interoception within models of embodi...

To survive, organisms must effectively respond to the challenge of maintaining their physiological integrity in the face of an ever-changing environment. Preserving this homeostasis critically relies on adaptive behavior. In this review, we consider recent frameworks that extend classical homeostatic control via reflex arcs to include more flexible...

Tourette syndrome is characterised by ‘unvoluntary’ tics, which are compulsive, yet often temporarily suppressible. The inferior frontal gyrus (IFG) is implicated in motor control, including inhibition of pre-potent actions through influences on downstream subcortical and motor regions. While tic suppression in Tourette Syndrome also engages the IF...

Fear is coupled to states of physiological arousal. We tested how learning and memory of threat, specifically conditioned fear, is influenced by interoceptive signals. Forty healthy individuals were exposed to two threat (conditioned stimuli [CS+], paired with electrocutaneous shocks) and two safety (CS-) stimuli, time-locked to either cardiac vent...

Interoception is the sensing of internal bodily signals. Individuals vary in their ability to perceive, as conscious sensations, signals like the beating of the heart. Tests of such interoceptive ability are, however, constrained in nature and reliability. Performance of the heartbeat tracking task, a widely used test of cardiac interoception, ofte...

There are well known phenotypic differences in sweet-liking across individuals, but it remains unknown whether these are related to broader underlying differences in interoceptive abilities (abilities to sense the internal state of the body). Here, healthy women (N = 64) classified as sweet likers (SLs) or sweet dislikers (SDs) completed a bimodal...

Interoception is the signaling, perception, and interpretation of internal physiological states. A causal link between serotonin and interoception was tested by a within-participant, crossover, placebo-controlled study. Forty-seven healthy human volunteers were tested on and off a 20mg oral dose of the selective serotonin reuptake inhibitor (SSRI)...

The majority of interoceptive tasks (i.e. measuring the sensitivity to bodily signals) are based upon the heartbeat sensations perception. However, temporal perception of heartbeats varies among individuals and confidence and spatial perception of heartbeats in relation to temporal judgements have not yet been systematically investigated. This stud...

The study of the brain's processing of sensory inputs from within the body ('interoception') has been gaining rapid popularity in neuroscience, where interoceptive disturbances have been postulated to exist across a wide range of chronic physiological and psychological conditions. Here we present a task and analysis procedure to quantify specific d...

Loneliness can be operationalized as the actual or perceived absence of those social relationships that serve to meet basic emotional needs. In contrast to solitude, a chosen state of being without company, loneliness is associated with negative affect and emotional distress. Loneliness can have detrimental effects on mental and physical wellbeing,...

Interoceptive signals concerning the internal physiological state of the body influence motivational feelings and action decisions. Cardiovascular arousal may facilitate inhibition to mitigate risks of impulsive actions. Baroreceptor discharge at ventricular systole underpins afferent signalling of cardiovascular arousal. In a modified Go/NoGo task...

Autism symptomology has a profound impact on cognitive and affective functioning, yet we know relatively little about how it shapes patterns of ongoing thought. In an exploratory study in a large population of neurotypical individuals, we used experience sampling to characterise the relationship between ongoing cognition and self-reported autistic...

Fear is coupled to states of physiological arousal. We tested how learning and memory of threat, i.e. conditioned fear, is influenced by interoceptive signals. Forty healthy individuals were exposed to two threat (CS+, paired with electrocutaneous shocks) and two safety (CS-) stimuli, specifically time-locked to either cardiac ventricular systole (...

Background: Interoception, the sensing of information about the internal physiological state of the body, is proposed to be fundamental to normal and abnormal affective feelings. We undertook a cross-sectional characterisation of cardiac interoception in patients accessing secondary mental health services to understand how interoceptive abnormaliti...

The dynamic embodiment of psychological processes is evident in the association of health outcomes, behavioural traits and psychological functioning with Heart Rate Variability (HRV). The dominant high-frequency component of HRV is an index of the central neural control of heart rhythm, mediated via the parasympathetic vagus nerve. HRV provides a p...

Interoceptive signals concerning the internal physiological state of the body influence motivational feelings and action decisions. Cardiovascular arousal may facilitate inhibition to mitigate risks of impulsive actions. Baroreceptor discharge at ventricular systole underpins afferent signalling of cardiovascular arousal. We used a modified Go/NoGo...

The sensing of internal bodily signals, a process known as interoception, contributes to subjective emotional feeling states that can guide empathic understanding of the emotions of others. Individuals with Autism Spectrum Conditions (ASC) typically show an attenuated intuitive capacity to recognise and interpret other peoples' emotional signals. H...

Interoception, the sensing of bodily signals, is related to emotional reactivity and may contribute to the pathophysiology of addiction. Evidence is accumulating that individuals with alcohol use disorders and other substance-dependences show altered interoceptive processing, however little is known about the acute effects of alcohol on interocepti...

Interoceptive processes in Tourette syndrome may foster the premonitory urges that commonly precede tics. Twenty-one adults with TS and 22 controls completed heartbeat tracking and discrimination tasks. Three dimensions of interoception were examined: objective accuracy, metacognitive awareness, and subjective (self-report) sensibility. Trait inter...

Tourette syndrome is a neurodevelopmental disorder, characterized by motor and phonic tics. Tics are typically experienced as avolitional, compulsive, and associated with premonitory urges. They are exacerbated by stress and can be triggered by external stimuli, including social cues like the actions and facial expressions of others. Importantly, e...

Objective: Spider phobia is a common form of anxiety disorder for which exposure therapy is an effective first-line treatment. Motivated by the observed modulation of threat processing by afferent cardiac signals; we tested the hypothesis that interoceptive information concerning cardiovascular arousal can influence the outcomes of computerised ex...

Interoception is the body-to-brain axis of sensation concerning the state of the internal body. Interoceptive signals from the heart can modulate emotional processing. Moreover, the degree to which people accurately detect their own heart beating at rest can predict their emotional responsivity. Here we determine how interoceptive signals can modul...

Interoception is the sensing of internal bodily sensations. Interoception is an umbrella term that encompasses (1) the afferent (body-to-brain) signaling through distinct neural and humoral (including immune and endocrine) channels; (2) the neural encoding, representation, and integration of this information concerning internal bodily state; (3) th...

Altered interoceptive processes in Tourette Syndrome may foster the premonitory urges that commonly precede tics. Twenty-one adults with TS and 22 controls completed a heartbeat tracking task, and a heartbeat discrimination task. Three dimensions of interoception were examined: objective accuracy, metacognitive awareness, and subjective (self-repor...

Motor actions can be facilitated or hindered by psychophysiological states of readiness, to guide rapid adaptive action. Cardiovascular arousal is communicated by cardiac signals conveying the timing and strength of individual heartbeats. Here, we tested how these interoceptive signals facilitate control of motor impulsivity. Participants performed...

Interoception refers to the process by which the nervous system senses, interprets, and integrates signals originating from within the body, providing a moment-by-moment mapping of the body’s internal landscape across conscious and unconscious levels. Interoceptive signaling has been considered a component process of reflexes, urges, feelings, driv...