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Interoceptive Technologies for Psychiatric Interventions: From Diagnosis to Clinical Applications
... While interoceptive correlates of mental disorders were traditionally considered within specific diagnostic categories (see e.g., Harshaw, 2015 for depression), recent approaches indicate they might represent transdiagnostic mechanisms that confer common vulnerability traits across multiple disorders (Khalsa et al., 2018;Nord and Garfinkel, 2022;Nord et al., 2021). Moreover, the growing interest in interoceptive processes is driven by the potential to manipulate interoceptive channels for therapeutic purposes (Schoeller et al., 2024). ...
... Acknowledging the transdiagnostic significance of interoceptive alterations, there has been a surge of interest in exploring targeted interoceptive therapeutic interventions (Heim et al., 2023;Jenkinson et al., 2024;Khalsa et al., 2018;Schoeller et al., 2024;Weng et al., 2021). Brain-body dynamics and inferential processes can indeed be experimentally manipulated in various ways in order to induce affective, cognitive, and behavioral changes. ...
... Brain-body dynamics and inferential processes can indeed be experimentally manipulated in various ways in order to induce affective, cognitive, and behavioral changes. A recent review has extensively outlined current interoceptive techniques suited to achieve such therapeutic effects (Schoeller et al., 2024). By operating at various levels of the interoceptive hierarchy, some of these techniques aim to restore adaptive precision control. ...
... Chills typically occur during peak emotional responses to stimuli like music [6], films [7], and speeches [8], engaging brain regions linked to reward/avoidance and dopamine release [6,9]. Recent evidence suggests chills may have therapeutic potential for disorders involving dopamine dysfunction such as depression [10][11][12][13]. However, existing chills research relies heavily on self-selected musical excerpts, limiting generalizability and introducing pre-selection biases [14]. ...
... First, our investigation focused solely on audiovisual stimuli that induce aesthetic chills responses. While this allowed us to examine the specific dynamics of chills to this type of multisensory stimuli, the results may not generalize to other modalities that can elicit chills, such as purely auditory, visual, or even tactile stimuli without multisensory integration [8,13,25]. Additionally, while we did find distinct patterns across demographic groups in our sample, the participants were recruited from a geographically limited region (Southern California). This relatively homogeneous sample in terms of cultural background may limit the generalizability of our findings to more diverse populations. ...
Aesthetic chills are a peak emotional response to stimuli such as music, films, or speech characterized by shivers and goosebumps and activation of dopaminergic circuits. Despite growing scientific interest in this phenomenon, repeated exposure to chills stimuli has not been studied yet, due to the absence of a validated database. This study leverages a recent gold standard in chills stimuli to investigate the impact of repeated exposure on the frequency and intensity of aesthetic chills. Participants (n = 58) were randomly exposed to 6 chill-evoking stimuli pre-validated on the population of interest, in a counterbalanced order. Our findings revealed a significant decrease in the likelihood of experiencing chills with repeated exposure, suggesting habituation to chills itself or potential fatigue in response to aesthetic stimuli. However, we observed an increase in the intensity and duration of chills over successive exposures among those who did experience chills. The study also identified distinct demographic and psychophysiological response patterns across different participant groups, indicating variability in chill responses. These results provide insights into the dynamic nature of aesthetic experiences and their underlying neural mechanisms, with implications for understanding emotional and reward processing in psychophysiology.
... Given these limitations, considerable efforts have been made by researchers to develop alternative tasks to more accurately assess interoceptive accuracy (review in Garfinkel et al., 2022;Schoeller et al., 2024;Weng et al., 2021;Desmedt et al., 2023). For instance, the Heartbeat Discrimination Task (HDT) minimizes reliance on knowledge of heart rate and time estimation (Hickman et al., 2020;Brener and Kluvitse, 1988). ...
... A key line of evidence for the dissociability of interoceptive modalities comes from studies examining correlations in performance across tasks (Schoeller et al., 2024). If interoception reflects a unitary ability, one would expect individuals who excel in one domain to perform well in others. ...
... Most importantly, the wider perspectives of the field now invariably emphasize the role of the central and peripheral nervous systems, and with that begin to advance a truly integrative neuroscience approach to psychophysiology. This can be further extended and incpororated into new ways of thinking about sentience, as described in a recent contribution to the 50 th Anniversary Special Issue of our journal (Pezzulo et al., 2024). ...
... Originally focused on sensory signals from the viscera, and with that more oriented towards somatic illnesses, a possible role of interoception as a risk factor, cause or consequence of psychopathology is now increasing recognized (Brewer et al., 2021;Khalsa et al., 2018;Paulus & Stein, 2010;Schoeller et al., 2024). In particular, for conditions that revolve around dysfunctional symptom perception, such as somatic symptom disorder (Wolters et al., 2022), medically unexplained symptoms , irritable bowel syndrome (Hong et al., 2016), eating disorders Khalsa et al., 2022) or panic disorder (Meuret et al., 2017), interoception research can create novel insights and potentially expand treatment options. ...
... Interestingly, the SN implies the ACC and insula, which are strongly related to interoception [163]. The dysregulation of bodily signals in psychiatric illnesses may, therefore, offer an important way forward in terms of phenotyping [164,165]. ...
... Nevertheless, less invasive or expensive treatments, such as sensorimotor therapies [192][193][194], may have the potential to enhance and restore the SO and, more importantly, SA during PTSD recovery. A mounting body of evidence [165] suggests that bodily signals play an essential role in driving precision control, hinting toward the relevance of reliable body-based interventions for mental health disorders depending on the patient's life history, conditions, and symptoms. The controlled generation of artificial sensations could, therefore, lead to novel options for the diagnosis, monitoring, intervention, and treatment of disorders of emotional and interoceptive inference. ...
The concept of agency, or an individual's sense of control over their actions and external events, is important in the context of peritraumatic dissociation, and its cardinal importance in post-traumatic stress disorder (PTSD). This article provides a roadmap for the development of agency-based therapies in the future, along with offering an "enactive" perspective on trauma. We discuss the clinical implications of this perspective in terms of techniques and interventions to mitigate symptomatology. We also discuss the potential for the use of sensorimotor technologies, such as gesture sonification devices, to enhance and restore agency during PTSD recovery.
... While the role of interoceptive channels (cardioception, respiration, gastric, temperature, etc.; Craig, 2002) has long been a topic of research in mental health through, e.g., biofeedback and meditation (Schoenberg and David, 2014;Weerdmeester et al., 2020;Schoeller et al., 2024), the importance of motor processing in psychopathology has been largely understudied (Bernard and Mittal, 2015;Garvey and Cuthbert, 2017). Indeed, some of the most striking symptoms in psychopathology often include the motorium [e.g., functional neurological disorder, catatonia, hypo-kinesia, or freezing states in posttraumatic stress disorder (PTSD; Adrien et al., 2024)]. ...
Background
Body awareness (BA) and proprioception, which are essential components of the sense of agency (SA), are often altered in various mental disorders such as posttraumatic stress disorder (PTSD). However, the relationship between BA, proprioception, and SA, as well as the methods to manipulate them, remain unclear. This study explored using real-time gesture sonification (GS), i.e., wearable technology transforming body movements into sounds, to enhance proprioception, BA, and thus the SA.
Methods
In this within-subjects design, 17 healthy adults (mean age = 25.5 years) with varying dance expertise (novice, amateur, expert) improvised movements to match sounds with and without auditory feedback from motion sensors on wrists/ankles modulated by their gestures. BA, immersion, pleasure, and self-efficacy were measured.
Results
Sonification significantly increased body awareness, reward, and immersion (all p < 0.05).
Conclusion
GS can enhance BA and the SA, pleasure, and control during physical activity. This highlights potential mental health applications, such as agency-based therapies for PTSD. Manipulating bodily perception could improve symptoms and embodiment. Further research should replicate this in clinical populations and explore neurocognitive mechanisms.
... Antidepressants, particularly specific serotonin and noradrenaline reuptake inhibitors were found to decrease alexithymia in a one randomized trial on post-stroke depression and might present benefits if tested in MS (Cravello et al., 2009). Other experimental tools could include interoceptive technologies and treatment trials (e.g., intranasal oxytocin), but no studies have yet been conducted in MS (Samur et al., 2013;Schoeller et al., 2024). Admitting the frequency and potential impact of alexithymia in PwMS, these modalities applied alone or in combination merit to be explored aiming to pave the way for new therapeutic venues and improve patients' quality of life. ...
Alexithymia denotes the “absence” of “words” for “emotion” and has its roots in the Greek words “a,” “lexis,” and “thymos.” It is sometimes referred to as “emotional blindness,” “blunted feeling,” or “disrupted emotional awareness.” The term “alexithymia” first appeared in the 1970s in the works of Sifneos, Nemiah, and colleagues. It entails difficulties in identifying and expressing emotions and an externally oriented thinking style. It is not a psychiatric disorder but rather a multidimensional personality trait or construct, appearing to be normally distributed in the general population, with high levels of alexithymia in approximately 10% of individuals. Evidence suggests that alexithymia serves as a prognostic risk factor for health problems, a transdiagnostic risk factor for emotion-based psychopathologies, and a predictor of poor psychiatric treatment outcomes. It is frequently observed in neurological diseases. Nevertheless, its mechanisms, assessment, and management remain overlooked. In multiple sclerosis (MS), an autoimmune disease of the central nervous system, alexithymia seems to occur in up to 53% of patients. However, it remains understudied despite recent growing interest. In this mini review, we briefly reassess the prevalence, as well as the clinical, sociodemographic and neuropsychological correlates of alexithymia in MS (e.g., anxiety, depression, fatigue, socio-emotional outcomes). This is followed by an analysis of neurobiological underpinnings of alexithymia derived from neurophysiological and neuroimaging studies in this clinical population. Finally, we provide perspectives to guide future research exploring and managing alexithymia in MS.
... An accurate perception of bodily signals facilitates emotion regulation via cognitive reappraisal (i.e., a re-interpretation of the meaning of a negative situation so that it no longer feels negative), with a down-regulation of affect [27]. Rather, impaired interoceptive processing could be linked to various psychopathological conditions [28][29][30][31][32]. ...
This study examines whether the detrimental effects of the COVID-19 pandemic on the affectivity of the population extend one year after the outbreak. In an online-mobile session, participants completed surveys (i.e., demographic characteristics, positive-negative affectivity, interoceptive awareness) and a similarity judgment task of triplets of emotional concepts, from which we derived 2D maps of their affective knowledge representation. Compared with pre-pandemic data derived from a comparable population, we report three main findings. First, we observed enhanced negative affectivity during the pandemic, but no changes in positive affectivity levels. Second, increased self-reported interoceptive awareness compared to pre-pandemic data, with greater attention to bodily sensations and adaptive aspects of interoceptive sensitivity. Furthermore, female participants reported higher scores than males on the questionnaire subscales of Emotional Awareness and Attention Regulation. Third, the effect of pandemic-related conditions is also apparent in the mental organization of emotional concepts, especially for female participants (i.e., reduced coherence in the organization of the concepts along the arousal dimension and more misclassification of concepts based on arousal) and participants who did not perform physical activity (a collapse of the arousal dimension). Some of the effects of the pandemic, thus, persist about a year after the outbreak. These results advise providing programs of psychological and emotional assistance throughout the pandemic beyond the outbreak, and that age-dependent gender differences should be accounted for to define tailored interventions. Physical activity might relieve pandemic-related stressors, so it should be promoted during particularly stressful periods for the population.
... (It is worth highlighting that, while skin temperature was historically regarded as an aspect of exteroception (27), it is now widely accepted as an interoceptive function, as reflected in numerous reviews and theoretical analyses of interoception, e.g. (23,20,(28)(29)(30)(31)(32)(33)(34)). Specifically, we developed a novel experimental paradigm that required active predictions of skin temperature changes (i.e., warming or cooling from a thermoneutral baseline) in a volatile learning environment (compare (12)). ...
Contemporary theories of interoception propose that the brain constructs a model of the body for predicting the states and allostatic needs of all organs, including the skin, and updates this model using prediction error signals. However, empirical tests of this proposal are scarce in humans. This computational neuroimaging study investigated the presence and location of thermoceptive predictions and prediction errors in the brain using probabilistic manipulations of skin temperature in a novel interoceptive learning paradigm. Using functional MRI in healthy volunteers, we found that a Bayesian model provided a better account of participants' skin temperature predictions than a non-Bayesian model. Further, activity in a network including the anterior insula was associated with trial-wise predictions and precision-weighted prediction errors. Our findings provide further evidence that the anterior insula plays a key role in implementing the brain's model of the body, and raise important questions about the structure of this model.
... Other theories showed that self-related difficulties in EDs arise from the fact that these patients lack an adequate coenesthetic perception of the body [11][12][13][14]. In this case, two main phenomena are noted. ...
Introduction: Prominent eating disorders (EDs) theories identify a critical relationship between body and self. One of the ways to study this relationship is through autobiographical memories (AMs). The present review aimed to evaluate the studies that investigated AM in patients with EDs. Methods: A search of PubMed, ScienceDirect, and Scopus databases was performed to identify relevant articles. Of the 57,113 studies found, 25,016 were not duplicated. After screening, 27 articles were included. Results: The studies had some methodological flaws: none of the articles was a randomized control trial and the sample sizes were small. Nevertheless, important evidence emerged because all studies showed that patients with EDs have impaired AM function. This is because the way patients with EDs remember and define themselves is through an allocentric perspective associated with the gazes of others whose role has an impact on AM, body shape, and self. Conclusion: To our knowledge, this is the first systematic review to examine AM in patients with EDs. Future research is needed in EDs to expand knowledge about the relationship between the body and the self.
... Regarding the second (therapeutic) point, based on Danciut and colleagues' observations, it would be interesting to test the effects of some interventions targeting interoception on multiple sclerosis fatigue. The interventions could be applied as a monotherapy or in a combination fashion aiming to obtain a synergistic or a cumulative effect, and they could include but are not limited to pharmacotherapeutics, interoceptive technologies, mindfulness-based interventions, neurofeedback programs, interoceptive metacognitive training, noninvasive brain stimulation 8,9,11 . Here, considering the involvement of white matter pathologies observed in the current work, it would be of interest to consider the emergent concept of white matter plasticity in addition to the well-known mechanism of synaptic plasticity 12 . ...
This scientific commentary refers to ‘Understanding the mechanisms of fatigue in multiple sclerosis: linking interoception, metacognition and white matter dysconnectivity’, by Danciut et al. (https://doi.org/10.1093/braincomms/fcae292).
... We also have an internal mean of accessing our bodies through interoceptive signals (such as those related to our physiological state), proprioceptive signals (such as those related to our body positioning and movement), and vestibular signals (such as those related to our sense of balance). Excitingly, the emerging metaverse now allows us to modify these internal signals as well, through the development of interoceptive technologies (Schoeller et al., 2024). These technologies can generate artificial sensations that directly influence bodily signals (Di Lernia et al., 2018), create interoceptive illusions that modulate the context to influence interoception (Iodice et al, 2019), and facilitate systems of emotional augmentation (Schoeller et al., 2019). ...
... Finally, a multidisciplinary approach integrating different modalities might contribute to enhancing the management of patients with neuropsychiatric conditions. These could include but are not limited to pharmacotherapeutics, neuromodulation, psychotherapies, cognitive training, physical exercise, psychosocial interventions, and interoceptive technologies (England et al., 2015;Kim et al., 2018;Swenson et al., 2020;Hertenstein et al., 2021;Schoeller et al., 2024). This would open a venue for developing an optimized patient-tailored approach. ...
... This underscores the importance of integrating embodiment illusions into clinical environments as an adjunctive strategy alongside established treatments such as Cognitive Behavioral Therapy (CBT). Future research should combine illusions with technology targeting interoception to see if this improves effectiveness [61]. ...
Purpose of Review
We review the first pilot studies applying metaverse-related technologies in psychiatric patients and discuss the rationale for using this complex federation of technologies to treat mental diseases. Concerning previous virtual-reality applications in medical care, metaverse technologies provide the unique opportunity to define, control, and shape virtual scenarios shared by multi-users to exploit the “synchronized brains” potential exacerbated by social interactions.
Recent Findings
The application of an avatar-based sexual therapy program conducted on a metaverse platform has been demonstrated to be more effective concerning traditional sexual coaching for treating female orgasm disorders. Again, a metaverse-based social skills training program has been tested on children with autism spectrum disorders, demonstrating a significant impact on social interaction abilities.
Summary
Metaverse-related technologies could enable us to develop new reliable approaches for treating diseases where behavioral symptoms can be addressed using socio-attentive tasks and social-interaction strategies.
... In addition, combining neuromodulation with other interventions might engender cumulative or synergistic effects. The choice of interventions would depend on the symptom in question and could include cognitive training (Benedict et al., 2020), neurofeedback (Ayache et al., 2021), psychotherapies (Sesel et al., 2018), physical exercise (Muñoz-Paredes et al., 2022), neurobiological methods (Hertenstein et al., 2021), interoceptive technologies (Schoeller et al., 2024), among others. Finally, coupling neuroimaging and neuromodulation would help unveil the underlying neuromodulation mechanisms. ...
Gamma‐aminobutyric acid (GABA) B receptors (GABABRs) that acts slowly and maintains the inhibitory tone are versatile regulators in the complex nervous behaviors and their involvement in various neuropsychiatric disorders, such as anxiety, epilepsy, pain, drug addiction, and Alzheimer's disease. Additional study advances have implied the crucial roles of GABABRs in regulating feeding‐related behaviors, yet their therapeutic potential in addressing the neuropsychiatric disorders, binge eating, and feeding‐related disorders remains underutilized. This general review summarized the physiological structure and functions of GABABR, explored the regulation in various psychiatric disorders, feeding behaviors, binge eating, and metabolism disorders, and fully discussed the potential of targeting GABABRs and its regulator‐binding sites for the treatment of different psychiatric disorders, binge eating and even obesity. While agonists that directly bind to GABABR1 have some negative side effects, positive allosteric modulators (PAMs) that bind to GABABR2 demonstrate excellent therapeutic efficacy and tolerability and have better safety and therapeutic indexes. Moreover, phosphorylation sites of downstream GABABRs regulators may be novel therapeutic targets for psychiatric disorders, binge eating, and obesity. Further studies, clinical trials in particular, will be essential for confirming the therapeutic value of PAMs and other agents targeting the GABABR pathways in a clinical setting.
Chronic pain is a prevalent yet often under-recognized symptom among individuals with multiple sclerosis (MS), affecting 29–86% of the population. This condition can significantly impact the individuals' functionality, including their capacity to engage in professional activities. The pathophysiology underlying this condition remains intricate and not fully elucidated, and inadequate responses to pharmacological interventions or adverse effects can hinder its management. In light of these observations, there is an urgent need to identify new therapeutic interventions. Non-invasive brain stimulation (NIBS) techniques hold promise for addressing MS-related pain. This mini-review aims to analyze the findings from studies using NIBS techniques, such as transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), to assess their analgesic potential in people with MS. Seven relevant reports are available. Five of these studies used tDCS, one utilized a transcranial random noise stimulation (tDCS variant), and one compared rTMS with transcranial theta burst stimulation (rTMS variant). The results indicate the potential benefits of NIBS for pain management in MS. However, the study's limitations, including the scarcity of data, small sample size, the limited number of sessions, sham design, and brief follow-up, are also noted and discussed. Finally, directions for future research are suggested.
The dominant paradigm in biomedicine focuses on genetically‐specified components of cells and their biochemical dynamics, emphasizing bottom‐up emergence of complexity. Here, I explore the biomedical implications of a complementary emerging field: diverse intelligence. Using tools from behavioral science and multiscale neuroscience, we can study development, regenerative repair, and cancer suppression as behaviors of a collective intelligence of cells navigating the spaces of possible morphologies and transcriptional and physiological states. A focus on the competencies of living material—from molecular to organismal scales—reveals a new landscape for interventions. Such top‐down approaches take advantage of the memories and homeodynamic goal‐seeking behavior of cells and tissues, offering the same massive advantages in biomedicine and bioengineering that reprogrammable hardware has provided information technologies. The bioelectric networks that bind individual cells toward large‐scale anatomical goals are an especially tractable interface to organ‐level plasticity, and tools to modulate them already exist. This suggests a research program to understand and tame the software of life for therapeutic gain by understanding the many examples of basal cognition that operate throughout living bodies.
Objectives: Recent survey data suggest that a high proportion of patients with Tourette syndrome (TS) experience pain, yet pain features in TS have not been previously investigated in a systematic manner. This article reviews the current understanding and impact of pain in TS as well as identifies possible areas for emphasis for future research on pain in TS. Methods: Using a comprehensive search strategy in two relevant research databases (PubMed and Scopus), we searched for relevant peer-reviewed, primary research articles, and review articles. Search terms used were Tourette syndrome, tic disorder, pain, pain management, sensory, and sensory gating. Results: A total of 116 pertinent articles were identified. Pain is reported by 47%-60% of individuals with TS and may relate to different aspects of tic phenomenology or other causes. Pain is more prevalent among TS patients than in the general population and negatively impacts quality of life. To standardize future research efforts, we propose the following classification: tic-related immediate pain, tic-related delayed injury/pain, suppression-related pain, premonitory urge-related pain, and associated primary pain syndromes. Altered sensory gating and interoceptive processing abnormalities are possible mechanisms contributing to pain in TS but warrant further study. Despite pain prevalence, most TS clinical rating scales and outcome measures used in therapeutic studies do not incorporate sufficient information regarding pain. Therapies known to improve pain in non-TS conditions that are also reported to improve tics have not been investigated for their effects on pain among TS patients. Conclusion: TS can be associated with a chronic pain syndrome that negatively affects quality of life. Future research using a systematic framework is needed to better understand pain cause(s) and prevalence, develop appropriate assessment methods, establish outcome measures, and understand mechanisms of pain in TS. Such investigations are likely to lead to therapeutic options for this troublesome symptom.
Interoception is crucial for human health as it constitutes the afferent component of the brain-body feedback loop that is essential for maintaining physiological equilibrium. Disruption in interoceptive processes is increasingly recognized as a common thread across numerous psychiatric disorders, suggesting that enhanced understanding and targeting of interoceptive dysfunction may aid in improving the diagnosis, prognosis, or treatment of those conditions. This chapter systematically explores the continuum of interoception in health and disease, from the manifestation of psychiatric disorders to states of optimal health and well-being. We identify and discuss prevailing gaps in current research and introduce key methodologies capable of bridging these gaps via mechanistic studies. Finally, with an eye toward current global challenges, we examine the potential mental health consequences of climate change and other environmental stressors, highlighting the need for further inquiry into how these factors intersect with interoceptive processes. This comprehensive synthesis aims not only to provide a foundational framework for understanding the role of interoception in mental health but also to catalyze the development of mechanism-driven clinical research in the emerging domain of interoceptive neuroscience.
A complex interaction among sensory, social and epigenetic determinants in psychiatric conditions was described across all age strata. The high prevalence of mental disorders in individuals with sensory deficits might be attributed to the interaction among social isolation, cognitive functioning and sensory processing. The epigenetic implications of such interactions were examined: environmental and social factors can affect gene expression and impact the pathogenesis of psychiatric disorders also through sensory processing. This article discussed the role of social determinants, in other words, social isolation, loneliness and chronic stress, in promoting psychiatric disorders and, in a vicious circle, sensory deficits (vision, hearing, olfaction and somatosensation). We emphasized the importance of integrating social, sensory and epigenetic factors to target different treatments for psychiatric conditions.
Posttraumatic stress disorder (PTSD) is a significant public health concern, with only a third of patients recovering within a year of treatment. While PTSD often disrupts the sense of body ownership and sense of agency (SA), attention to the SA in trauma has been lacking. This perspective paper explores the loss of the SA in PTSD and its relevance in the development of symptoms. Trauma is viewed as a breakdown of the SA, related to a freeze response, with peritraumatic dissociation increasing the risk of PTSD. Drawing from embodied cognition, we propose an enactive perspective of PTSD, suggesting therapies that restore the SA through direct engagement with the body and environment. We discuss the potential of agency-based therapies and innovative technologies such as gesture sonification, which translates body movements into sounds to enhance the SA. Gesture sonification offers a screen-free, noninvasive approach that could complement existing trauma-focused therapies. We emphasize the need for interdisciplinary collaboration and clinical research to further explore these approaches in preventing and treating PTSD.
While rodent models are vital for studying mental disorders, the underestimation of construct validity of fear indicators has led to limitations in translating to effective clinical treatments. Addressing this gap, we systematically reviewed 5054 articles from the 1960 s, understanding underlying theoretical advancement, and selected 68 articles with at least two fear indicators for a three-level meta-analysis. We hypothesized correlations between different indicators would elucidate similar functions, while magnitude differences could reveal distinct neural or behavioral mechanisms. Our findings reveal a shift towards using freezing behavior as the primary fear indicator in rodent models, and strong, moderate, and weak correlations between freezing and conditioned suppression ratios, 22-kHz ultrasonic vocalizations, and autonomic nervous system responses, respectively. Using freezing as a reference, moderator analysis shows treatment types and fear stages significantly influenced differences in magnitudes between two indicators. Our analysis supports a two-system model of fear in rodents, where objective and subjective fears could operate on a threshold-based mechanism.
The idea that different states of energy need give rise to distinct interoceptive sensations has been basic to many accounts of the physiological and the learned controls of feeding. Yet, a number of difficulties have complicated attempts to provide direct evidence for this view. The present article describes a research strategy that confirms that food deprivation states produce salient interoceptive stimuli in rats. The implications of this research for the physiological origins of energy state signals, the brain structures involved with processing energy state information, and the manner in which signals of energy need influence feeding were considered. The possibility that food deprivation cues influence feeding by modulating the activation of associations involving external events and their postingestive aftereffects was discussed with reference to earlier associative accounts of the function of hunger signals.
We investigated cardiac perception in panic disorder with both self-report and objective measures. In Study 1, 120 patients with panic disorder, 86 infrequent panickers, and 38 patients with other anxiety disorders reported greater cardiac and gastrointestinal awareness than 62 normal control subjects. Subjects with panic attacks reported greater cardiac awareness, but not gastrointestinal awareness, than those with other anxiety disorders. Studies 2 and 3 included a test of heart rate perception in which subjects silently counted their heartbeats without taking their pulse. In Study 2, 65 panic disorder patients showed better performance than 50 infrequent panickers, 27 patients with simple phobias, and 46 normal control subjects. No group differences were found in ability to estimate time intervals. In Study 3, 13 patients with panic disorder and 15 with generalized anxiety disorder showed better heart rate perception than 16 depressed patients.
Embodied cognition—the idea that mental states and processes should be understood in relation to one’s bodily constitution and interactions with the world—remains a controversial topic within cognitive science. Recently, however, increasing interest in predictive processing theories among proponents and critics of embodiment alike has raised hopes of a reconciliation. This article sets out to appraise the unificatory potential of predictive processing, focusing in particular on embodied formulations of active inference. Our analysis suggests that most active-inference accounts invoke weak, potentially trivial conceptions of embodiment; those making stronger claims do so independently of the theoretical commitments of the active-inference framework. We argue that a more compelling version of embodied active inference can be motivated by adopting a diachronic perspective on the way rhythmic physiological activity shapes neural development in utero. According to this visceral afferent training hypothesis, early-emerging physiological processes are essential not only for supporting the biophysical development of neural structures but also for configuring the cognitive architecture those structures entail. Focusing in particular on the cardiovascular system, we propose three candidate mechanisms through which visceral afferent training might operate: (a) activity-dependent neuronal development, (b) periodic signal modeling, and (c) oscillatory network coordination.
Interoception is the perception of signals from inside the body. It plays a significant role in the nervous, cardiovascular, respiratory, gastrointestinal, genitourinary, and endocrine systems. It is also closely related to the autonomic nervous system and inflammatory pathways and plays a significant role in our optimal functioning. Recently, interoception has gained more attention in neuropsychiatric research. Anatomical and physiological aspects of interoception like relevant brain areas, the role of the vagus nerve, and the autonomic nervous system are gradually being understood. Different facets of interoception like interoceptive attention, detection, magnitude, discrimination, accuracy, awareness, and appraisal have been proposed and their assessments and importance are being evaluated. Further, interoception is often dysregulated or abnormal in psychiatric disorders. It has been implicated in the psychopathology, etiopathogenesis, clinical features and treatment of mood, anxiety, psychotic, personality and addiction-related disorders. This narrative review attempts to provide a nuanced understanding of the pathway(s), components, functions, assessments, and problems of interoception and will help us to detect its disturbances and evaluate its impact on psychiatric disorders, leading to a better perspective and management. This will also advance interoception-related research.
Aesthetic chills are an embodied peak emotional experience induced by stimuli such as music, films, and speeches and characterized by dopaminergic release. The emotional consequences of chills in terms of valence and arousal are still debated and the existing empirical data is conflicting. In this study, we tested the effects of ChillsDB, an open-source repository of chills-inducing stimuli, on the emotional ratings of 600+ participants. We found that participants experiencing chills reported significantly more positive valence and greater arousal during the experience, compared to participants who did not experience chills. This suggests that the embodied experience of chills may influence one’s perception and affective evaluation of the context, in favor of theoretical models emphasizing the role of interoceptive signals such as chills in the process of perception and decision-making. We also found an interesting pattern in the valence ratings of participants, which tended to harmonize toward a similar mean after the experiment, though initially disparately distributed. We discuss the significance of these results for the diagnosis and treatment of dopaminergic disorders such as Parkinson’s, schizophrenia, and depression.
It has been proposed that accuracy in time perception is related to interoceptive accuracy and vagal activity. However, studies investigating time perception in the supra-second range have provided mixed results, and few studies have investigated the sub-second range. Moreover, there is a lack of studies investigating the relationship between precision in time perception and interoceptive accuracy. A recent meta-analytic review of neuroimaging studies proposed a dynamic interaction between two types of timing processing—an endogenous time keeping mechanism and the use of exogenous temporal cues. Interoceptive accuracy may affect both accuracy and precision of primary temporal representations, as they are generated based on the endogenous time keeping mechanism. Temporal accuracy may vary when adapted to the environmental context. In contrast, temporal precision contains some constant noise, which may maintain the relationship with interoceptive accuracy. Based on these assumptions, we hypothesized that interoceptive accuracy would be associated with temporal precision in the sub-second range, while vagal activity would be associated with temporal accuracy. We used the temporal generalization task, which allowed us to calculate the indices of temporal accuracy and temporal precision in line with the existing research, and also compute the index of participants’ sensitivity according to the signal detection theory. Specifically, we investigated whether (1) interoceptive accuracy would correlate with temporal accuracy, temporal precision, or sensitivity and (2) resting-state vagal activity would correlate with temporal accuracy, temporal precision, or sensitivity. The results indicated that interoceptive accuracy was positively correlated with temporal precision as well as sensitivity, but not with temporal accuracy, in the sub-second range time perception. Vagal activity was negatively correlated only with sensitivity. Furthermore, we found a moderation effect of sensitivity on the relationship between vagal activity and perceived duration, which affected the association between vagal activity and temporal accuracy. These findings suggest the importance of precision as an aspect of time perception, which future studies should further explore in relation to interoception and vagal activity, and of the moderation effects of factors such as participants’ sensitivity in this context.
Respiratory rhythms sustain biological life, governing the homeostatic exchange of oxygen and carbon dioxide. Until recently, however, the influence of breathing on the brain has largely been overlooked. Yet new evidence demonstrates that the act of breathing exerts a substantive, rhythmic influence on perception, emotion, and cognition, largely through the direct modulation of neural oscillations. Here, we synthesize these findings to motivate a new predictive coding model of respiratory brain coupling, in which breathing rhythmically modulates both local and global neural gain, to optimize cognitive and affective processing. Our model further explains how respiratory rhythms interact with the topology of the functional connectome, and we highlight key implications for the computational psychiatry of disordered respiratory and interoceptive inference. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
In the past 2 decades, interoception has received increasing attention in the fields of psychology and cognitive science, as well as neuroscience and physiology. A plethora of studies adopted the perception of cardiac signals as a proxy for interoception. However, recent findings have cast doubt on the methodological and intrinsic validity of the tasks used thus far. Therefore, there is an ongoing effort to improve the existing cardiac interoceptive tasks and to identify novel channels to target the perception of the physiological state of the body. Amid such scientific abundancy, one could question whether the field has been partially neglecting one of our widest organs in terms of dimensions and functions: the skin. According to some views grounded on anatomical and physiological evidence, skin-mediated signals such as affective touch, pain, and temperature have been redefined as interoceptive. However, there is no agreement in this regard. Here, we discuss some of the anatomical, physiological, and experimental arguments supporting the scientific study of interoception by means of skin-mediated signals. We argue that more attention should be paid to the skin as a sensory organ that monitors the bodily physiological state and further propose thermosensation as a particularly attractive model of skin-mediated interoception.
Objective : Automatic detection of auditory stimuli, represented by the mismatch negativity (MMN), facilitates rapid processing of salient stimuli in the environment. The amplitude of MMN declines with ageing. However, whether automatic detection of auditory stimuli is affected by visually perceived negative emotions with normal ageing remains unclear. We aimed to evaluate how fearful facial expressions affect the MMN amplitude under ageing.
Methods : We used a modified oddball paradigm to analyze the amplitude of N100 (N1) and MMN in 22 young adults and 21 middle-aged adults.
Results : We found that the amplitude of N1 elicited by standard tones was smaller under fearful facial expressions than neutral facial expressions and was more negative for young adults than middle-aged adults. The MMN amplitude under fearful facial expressions was greater than neutral facial expressions, but the amplitude in middle-aged adults was smaller than in young adults.
Conclusion : Visually perceived negative emotion promotes the extraction of auditory features. Additionally, it enhances the effect of auditory change detection in middle-aged adults but fails to compensate for this decline with normal ageing.
Significance : The study may help to understand how visually perceived emotion affects the early stage of auditory information processing from an event process perspective.
The field of motor control has long focused on the achievement of external goals through action (e.g., reaching and grasping objects). However, recent studies in conditions of multisensory conflict, such as when a subject experiences the rubber hand illusion or embodies an avatar in virtual reality, reveal the presence of unconscious movements that are not goal-directed, but rather aim at resolving multisensory conflicts; for example, by aligning the position of a person’s arm with that of an embodied avatar. This second, conflict-resolution imperative of movement control did not emerge in classical studies of motor adaptation and online corrections, which did not allow movements to reduce the conflicts; and has been largely ignored so far in formal theories. Here, we propose a model of movement control grounded in the theory of active inference that integrates intentional and conflict-resolution imperatives. We present three simulations showing that the active inference model is able to characterize movements guided by the intention to achieve an external goal, by the necessity to resolve multisensory conflict, or both. Furthermore, our simulations reveal a fundamental difference between the (active) inference underlying intentional and conflict-resolution imperatives by showing that it is driven by two different (model and sensory) kinds of prediction errors. Finally, our simulations show that when movement is only guided by conflict resolution, the model incorrectly infers that is velocity is zero, as if it was not moving. This result suggests a novel speculative explanation for the fact that people are unaware of their subtle compensatory movements to avoid multisensory conflict. Furthermore, it can potentially help shed light on deficits of motor awareness that arise in psychopathological 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.
The ability to sense, monitor, and control respiration - e.g., respiratory interoception (henceforth, respiroception) is a core homeostatic ability. Beyond the regulation of gas exchange, enhanced awareness of respiratory sensations is directly related to psychiatric symptoms such as panic and anxiety. Indeed, chronic breathlessness (dyspnea) is associated with a fourfold increase in the risk of developing depression and anxiety, and the regulation of the breath is a key aspect of many mindfulness-based approaches to the treatment of mental illness. Physiologically speaking, the ability to accurately monitor respiratory sensations is important for optimizing cardiorespiratory function during athletic exertion, and can be a key indicator of illness. Given the important role of respiroception in mental and physical health, it is unsurprising that there is increased interest in the quantification of respiratory psychophysiology across different perceptual and metacognitive levels of the psychological hierarchy. Compared to other more popular modalities of interoception, such as in the cardiac domain, there are relatively few methods available for measuring aspects of respiroception. Existing inspiratory loading tasks are difficult to administer and frequently require expensive medical equipment, or offer poor granularity in their quantification of respiratory-related perceptual ability. To facilitate the study of respiroception, we here present a new, fully automated and computer-controlled apparatus and psychophysiological method, which can flexibly and easily measure respiratory-related interoceptive sensitivity, bias and metacognition, in as little as 30 minutes of testing, using easy to make 3D printable parts.
Susceptibility to the rubber hand illusion (RHI) varies. To date, however, there is no consensus explanation of this variability. Previous studies, focused on the role of multisensory integration, have searched for neural correlates of the illusion. But those studies have failed to identify a sufficient set of functionally specific neural correlates. Because some evidence suggests that frontal α power is one means of tracking neural instantiations of self, we hypothesized that the higher the frontal α power during eyes-closed resting state, the more stable the self. As a corollary, we infer that the more stable the self, the less susceptible are participants to a blurring of boundaries—to feeling that the rubber hand belongs to them. Indeed, we found that frontal α amplitude oscillations negatively correlate with susceptibility. Moreover, since lower frequencies often modulate higher frequencies, we explored the possibility that this might be the case for the RHI. Indeed, some evidence suggests that high frontal α power observed in low-RHI participants is modulated by δ frequency oscillations. We conclude that while neural correlates of multisensory integration might be necessary for the RHI, sufficient explanation involves variable intrinsic neural activity that modulates how the brain responds to incompatible sensory stimuli.
A growing number of studies have focused on identifying cognitive processes that are modulated by interoceptive signals, particularly in relation to the respiratory or cardiac cycle. Considering the fundamental role of interoception in bodily self-consciousness, we here investigated whether interoceptive signals also impact self-voice perception. We applied an interactive, robotic paradigm associated with somatic passivity (a bodily state characterized by illusory misattribution of self-generated touches to someone else) to investigate whether somatic passivity impacts self-voice perception as a function of concurrent interoceptive signals. Participants' breathing and heartbeat signals were recorded while they performed two self-voice tasks (self-other voice discrimination and loudness perception) and while simultaneously experiencing two robotic conditions (somatic passivity condition; control condition). Our data reveal that respiration, but not cardiac activity, affects self-voice perception: participants were better at discriminating self-voice from another person's voice during the inspiration phase of the respiration cycle. Moreover, breathing effects were prominent in participants experiencing somatic passivity and a different task with the same stimuli (i.e., judging the loudness and not identity of the voices) was unaffected by breathing. Combining interoception and voice perception with self-monitoring framework, these data extend findings on breathing-dependent changes in perception and cognition to self-related processing.
Background
Substance use disorder (SUD) causes conditions such as cognitive and behavioral disorders, anxiety, depression, and social isolation it also causes acute airway inflammation by affecting airway bronchial dynamics. The current study aimed to investigate the lung function, respiratory muscle strength, and exercise capacity in patients with SUD.
Methods
One hundred-eighty three patients with SUD, a total of 119 healthy controls, 54 of whom were cigarette smokers and 65 of whom were non-smokers were included in the study. Spirometric tests, respiratory muscle strength (MIP and MEP), and the 6-Minute Walk Test (6-MWT) were assessed. The III National Health and Nutrition Examination Survey were used to evaluate respiratory symptoms in patients with SUD and cigarette smokers.
Results
86.3% of the SUD patients included in the study were using heroin, 9.2% were cannabis, and 5.5% were spice. The most common symptom in both SUD patients and cigarette smokers was shortness of breath, wheezing, and sputum production. After post-hoc tests, the FVC (p = 0.002), FVC (%predicted) (p < 0.0001), FEV1 (p = 0.002), FEV1 (%predicted) (p < 0.0001), FEV1/FVC (%) (p < 0.0001), PEF (p < 0.0001) and FEF%25-75 (p < 0.0001) lung function parameters were significantly lower in SUD patients than non-smokers. In addition, it was found that MIP (p < 0.0001), MIP (%predicted) (p < 0.0001), MEP (p < 0.0001), and MEP (%predicted) (p < 0.0001) values of SUD patients were significantly lower than non-smokers.
Conclusion
The study findings indicate that substance use has an effect on lung functions and the most commonly reported symptoms are shortness of breath, wheezing, and sputum production. In addition, respiratory muscle strength and exercise capacity were decreased in SUD patients compared to non-smokers.
Interoception - the physiological sense of our inner bodies - has risen to the forefront of psychological and psychiatric research. Much of this research utilizes tasks that attempt to measure the ability to accurately detect cardiac signals. Unfortunately, these approaches are confounded by well-known issues limiting their validity and interpretation. At the core of this controversy is the role of subjective beliefs about the heart rate in confounding measures of interoceptive accuracy. Here, we recast these beliefs as an important part of the causal machinery of interoception, and offer a novel psychophysical “heart rate discrimination“ method to estimate their accuracy and precision. By applying this task in 223 healthy participants, we demonstrate that cardiac interoceptive beliefs are more biased, less precise, and are associated with poorer metacognitive insight relative to an exteroceptive control condition. Our task, provided as an open-source python package, offers a robust approach to quantifying cardiac beliefs.
Objectives: Sweating, hot flushes, and blushing are symptoms frequently reported by individuals with anxiety disorders. They represent important reinforcers of anxiogenic cognitions and behaviours. One system that may be involved in the manifestation of these symptoms is the thermosensory/thermoregulatory system. The aim of the present study was to investigate to what extent individuals with anxiety disorders are characterised by alterations in this system.
Methods: PubMed and PsycINFO were systematically searched. Studies were eligible if they (i) assessed individuals with anxiety disorders, (ii) thermosensation or thermoregulatory effectors/outcomes, and (iii) used a case-control design.
Results: N = 86 studies were identified. There was no evidence of altered thermosensation in individuals with anxiety disorders. Regarding thermoregulatory effectors, individuals with social anxiety disorder exhibited altered cutaneous vasodilation upon pharmacological challenge; individuals with specific phobia showed increased sweating upon confrontation with phobic stimuli; individuals with panic disorder showed increased daily sweating as well as increased sweating in response to non-phobic and phobic stimuli. Regarding thermoregulatory outcomes, there was evidence for altered skin temperature in all subtypes of anxiety.
Conclusion: Whereas there was no evidence of altered thermoregulation in specific phobia, a subgroup of individuals with social anxiety and panic disorder appears to exhibit altered vasodilation and sweating, respectively. Longitudinal research is warranted to investigate whether this represents a vulnerability to anxiety/panic.
The term “regenerative medicine” (RM) indicates an emerging trend in biomedical sciences that aims at replacing, engineering, or regenerating human cells, tissues, or organs to restore or establish normal function. So far, the focus of RM has been the physical body. Neuroscience, however, is now suggesting that mental disorders can be broadly characterized by a dysfunction in the way the brain computes and integrates the representations of the inner and outer body across time [bodily self-consciousness (BSC)]. In this perspective, we proposed a new kind of clinical intervention, i.e., “Regenerative Virtual Therapy” (RVT), which integrates knowledge from different disciplines, from neuroscience to computational psychiatry, to regenerate a distorted or faulty BSC. The main goal of RVT was to use technology-based somatic modification techniques to restructure the maladaptive bodily representations behind a pathological condition. Specifically, starting from a Bayesian model of our BSC (i.e., body matrix), we suggested the use of mindful attention, cognitive reappraisal, and brain stimulation techniques merged with high-rewarding and novel synthetic multisensory bodily experience (i.e., a virtual reality full-body illusion in sync with a low predictabIlity interoceptive modulation) to rewrite a faulty experience of the body and to regenerate the wellbeing of an individual. The use of RVT will also offer an unprecedented experimental overview of the dynamics of our bodily representations, allowing the reverse-engineering of their functioning for hacking them using advanced technologies.
Pain, whether acute or persistent, is a serious medical problem worldwide. However, its management remains unsatisfactory, and new analgesic molecules are required. We show here that TAFA4 reverses inflammatory, postoperative, and spared nerve injury (SNI)-induced mechanical hypersensitivity in male and female mice. TAFA4 requires functional low-density lipoprotein receptor-related proteins (LRPs) because their inhibition by RAP (receptor-associated protein) dose-dependently abolishes its antihypersensitive actions. SNI selectively decreases A-type K⁺ current (IA) in spinal lamina II outer excitatory interneurons (L-IIo ExINs) and induces a concomitant increase in IA and decrease in hyperpolarization-activated current (Ih) in lamina II inner inhibitory interneurons (L-IIi InhINs). Remarkably, SNI-induced ion current alterations in both IN subtypes were rescued by TAFA4 in an LRP-dependent manner. We provide insights into the mechanism by which TAFA4 reverses injury-induced mechanical hypersensitivity by restoring normal spinal neuron activity and highlight the considerable potential of TAFA4 as a treatment for injury-induced mechanical pain.
In order to interact seamlessly with robots, users must infer the causes of a robot’s behavior–and be confident about that inference (and its predictions). Hence, trust is a necessary condition for human-robot collaboration (HRC). However, and despite its crucial role, it is still largely unknown how trust emerges, develops, and supports human relationship to technological systems. In the following paper we review the literature on trust, human-robot interaction, HRC, and human interaction at large. Early models of trust suggest that it is a trade-off between benevolence and competence; while studies of human to human interaction emphasize the role of shared behavior and mutual knowledge in the gradual building of trust. We go on to introduce a model of trust as an agent’ best explanation for reliable sensory exchange with an extended motor plant or partner. This model is based on the cognitive neuroscience of active inference and suggests that, in the context of HRC, trust can be casted in terms of virtual control over an artificial agent. Interactive feedback is a necessary condition to the extension of the trustor’s perception-action cycle. This model has important implications for understanding human-robot interaction and collaboration–as it allows the traditional determinants of human trust, such as the benevolence and competence attributed to the trustee, to be defined in terms of hierarchical active inference, while vulnerability can be described in terms of information exchange and empowerment. Furthermore, this model emphasizes the role of user feedback during HRC and suggests that boredom and surprise may be used in personalized interactions as markers for under and over-reliance on the system. The description of trust as a sense of virtual control offers a crucial step toward grounding human factors in cognitive neuroscience and improving the design of human-centered technology. Furthermore, we examine the role of shared behavior in the genesis of trust, especially in the context of dyadic collaboration, suggesting important consequences for the acceptability and design of human-robot collaborative systems.
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 of breathing-related interoception, including interoceptive sensitivity (accuracy), decision bias, metacognitive bias, and metacognitive performance. Two major developments address some of the challenges presented by low trial numbers in interoceptive experiments: (i) a novel adaptive algorithm to maintain task performance at 70-75% accuracy; (ii) an extended hierarchical metacognitive model to estimate regression parameters linking metacognitive performance to relevant (e.g. clinical) variables. We demonstrate the utility of the task and analysis developments, using both simulated data and three empirical datasets. This methodology represents an important step towards accurately quantifying interoceptive dimensions from a simple experimental procedure that is compatible with clinical settings.
Interoception has increasingly been the focus of psychiatric research, due to its hypothesized role in mental health. Existing interoceptive tasks either suffer from important methodological limitations, impacting their validity, or are burdensome and require specialized equipment, which limits their usage in vulnerable populations. We report on the development of the CARdiac Elevation Detection (CARED) task. Participants’ heart rate is recorded by a wearable device connected to a mobile application. Notifications are sent to participants’ mobile throughout the day over a period of 4 weeks. Participants are asked to state whether their heart rate is higher than usual, rate their confidence and describe the activity they were involved in when the notification occurred. Data (N = 30) revealed that 1/3 of the sample was classified as interoceptive and that participants presented overall good insight into their interoceptive abilities. Given its ease of administration and accessibility, the CARED task has the potential to be a significant asset for psychiatric and developmental research.
The mainstream science of consciousness offers a few predominate views of how the brain gives rise to awareness. Chief among these are the Higher-Order Thought Theory, Global Neuronal Workspace Theory, Integrated Information Theory, and hybrids thereof. In parallel, rapid development in predictive processing approaches have begun to outline concrete mechanisms by which interoceptive inference shapes selfhood, affect, and exteroceptive perception. Here, we consider these new approaches in terms of what they might offer our empirical, phenomenological, and philosophical understanding of consciousness and its neurobiological roots.
Interoception, perception of one's bodily state, has been associated with mental health and socio-emotional processes. However, several interoception tasks are of questionable validity, meaning associations between interoception and other variables require confirmation with new measures. Here we describe the novel, smartphone-based Phase Adjustment Task (PAT). Tones are presented at the participant's heart rate, but out of phase with heartbeats. Participants adjust the phase relationship between tones and heartbeats until they are synchronous. Data from 124 participants indicates variance in performance across participants which is not affected by physiological or strategic confounds. Associations between interoception and anxiety, depression and stress were not significant. Weak associations between interoception and mental health variables may be a consequence of testing a non-clinical sample. A second study revealed PAT performance to be moderately stable over one week, consistent with state effects on interoception.
Interoception—the ability to perceive and respond to internal bodily sensations—is fundamental for the continuous regulation of physiological processes. Recently, it has been suggested that because infants depend completely on their caregivers for survival, the development of interoceptive processing emerges as a result of early dyadic interactions, and relies on caregivers’ ability to respond to and meet infants’ physiological needs. In this article, I examine how both caregivers’ and infants’ own characteristics contribute to the emergence and development of infants’ interoceptive processing. In particular, by focusing on feeding interactions, I suggest that infants build expectations about the cause of their internal sensations via a dynamic process of interoceptive distinction between self and other. This developmental account provides a framework that considers the complexity of early dyadic exchanges, and offers novel hypotheses for research investigating the mechanisms involved in the ontogeny of interoceptive processing and eating behaviors.
People witness or experience episodes they explain as due to an emotion. Like ordinary folk, many academic theorists try to understand these obviously important episodes in the same way using the terms emotion, fear, anger, joy, grief, and so on. Yet, each term refers to a heterogeneous cluster of events with unclear boundaries and no single cause-rather than to a prepackaged pancultural bundle of common components (subjective experience, behavior, expression, thought, physiological change). Psychological construction is an alternative approach that treats the concepts of emotion, fear, and so on as the folk concepts they are. It invites emotion researchers in the sciences and humanities to work together to characterize different folk theories of emotion and their influence, but also, in a separate project, to hone more precise scientific concepts embedded in separate accounts of each component of emotional episodes, cognizant of both human diversity and what humans have in common. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
We advance a novel computational model that characterizes formally the ways we perceive or misperceive bodily symptoms, in the context of panic attacks. The computational model is grounded within the formal framework of Active Inference, which considers top-down prediction and attention dynamics as key to perceptual inference and action selection. In a series of simulations, we use the computational model to reproduce key facets of adaptive and maladaptive symptom perception: the ways we infer our bodily state by integrating prior information and somatic afferents; the ways we decide whether or not to attend to somatic channels; the ways we use the symptom inference to make decisions about taking or not taking a medicine; and the ways all the above processes can go awry, determining symptom misperception and ensuing maladaptive behaviors, such as hypervigilance or excessive medicine use. While recent existing theoretical treatments of psychopathological conditions focus on prediction-based perception (predictive coding), our computational model goes beyond them, in at least two ways. First, it includes action and attention selection dynamics that are disregarded in previous conceptualizations but are crucial to fully understand the phenomenology of bodily symptom perception and misperception. Second, it is a fully implemented model that generates specific (and personalized) quantitative predictions, thus going beyond previous qualitative frameworks. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Recent accounts of social cognition focus on how we do things together, suggesting that becoming aligned relies on a reciprocal exchange of information. The next step is to develop richer computational methods that quantify the degree of coupling and describe the nature of the information exchange. We put forward a definition of coupling, comparing it to related terminology and detail, available computational methods and the level of organization to which they pertain, presenting them as a hierarchy from weakest to richest forms of coupling. The rationale is that a temporally coherent link between two dynamical systems at the lowest level of organization sustains mutual adaptation and alignment at the highest level. Postulating that when we do things together, we do so dynamically over time and we argue that to determine and measure instances of true reciprocity in social exchanges is key. Along with this computationally rich definition of coupling, we present challenges for the field to be tackled by a diverse community working towards a dynamic account of social cognition.
Background: The auricular branch of the vagus nerve runs superficially, which makes it a favorable target for non-invasive stimulation techniques to modulate vagal activity. For this reason, there have been many early-stage clinical trials on a diverse range of conditions. These trials often report conflicting results for the same indication.
Methods: Using the Cochrane Risk of Bias tool we conducted a systematic review of auricular vagus nerve stimulation (aVNS) randomized controlled trials (RCTs) to identify the factors that led to these conflicting results. The majority of aVNS studies were assessed as having “some” or “high” risk of bias, which makes it difficult to interpret their results in a broader context.
Results: There is evidence of a modest decrease in heart rate during higher stimulation dosages, sometimes at above the level of sensory discomfort. Findings on heart rate variability conflict between studies and are hindered by trial design, including inappropriate washout periods, and multiple methods used to quantify heart rate variability. There is early-stage evidence to suggest aVNS may reduce circulating levels and endotoxin-induced levels of inflammatory markers. Studies on epilepsy reached primary endpoints similar to previous RCTs testing implantable vagus nerve stimulation therapy. Preliminary evidence shows that aVNS ameliorated pathological pain but not evoked pain.
Discussion: Based on results of the Cochrane analysis we list common improvements for the reporting of results, which can be implemented immediately to improve the quality of evidence. In the long term, existing data from aVNS studies and salient lessons from drug development highlight the need for direct measures of local neural target engagement. Direct measures of neural activity around the electrode will provide data for the optimization of electrode design, placement, and stimulation waveform parameters to improve on-target engagement and minimize off-target activation. Furthermore, direct measures of target engagement, along with consistent evaluation of blinding success, must be used to improve the design of controls—a major source of concern identified in the Cochrane analysis. The need for direct measures of neural target engagement and consistent evaluation of blinding success is applicable to the development of other paresthesia-inducing neuromodulation therapies and their control designs.
Recently, interest in the unique pathways linking discrete positive emotions to specific health outcomes has gained increasing attention, but the role of awe is yet to be elucidated. Awe is a complex and transformative emotion that can restructure individuals' mental frames so deeply that it could be considered a therapeutic asset for major mental health major issues, including depression. Despite sparse evidence showing a potential connection between depression and awe, this link has not been combined into a proposal resulting in specific intervention guidelines. The aim of this perspective was three-fold: (i) to provide a new unifying model of awe's functioning—the Matryoshka model; (ii) to show systematic and explicit connections between this emotion and depression; and (iii) to suggest specific guidelines of intervention utilizing the potential therapeutic role of awe for mental health, specifically for depression. This theoretical endeavor in its entirety has been framed within the health domain.
This study employed a series of heartbeat perception tasks to assess the hypothesis that cardiac interoceptive processing in individuals with depression/anxiety (N = 221), and substance use disorders (N = 136) is less flexible than that of healthy individuals (N = 53) in the context of physiological perturbation. Cardiac interoception was assessed via heartbeat tapping when: (1) guessing was allowed; (2) guessing was not allowed; and (3) experiencing an interoceptive perturbation (inspiratory breath hold) expected to amplify cardiac sensation. Healthy participants showed performance improvements across the three conditions, whereas those with depression/anxiety and/or substance use disorder showed minimal improvement. Machine learning analyses suggested that individual differences in these improvements were negatively related to anxiety sensitivity, but explained relatively little variance in performance. These results reveal a perceptual insensitivity to the modulation of interoceptive signals that was evident across several common psychiatric disorders, suggesting that interoceptive deficits in the realm of psychopathology manifest most prominently during states of homeostatic perturbation.
Interoceptive pathways may be manipulated at various levels to develop interventions to improve symptoms in a range of disorders. Primarily through the lens of the respiratory system, we outline various pathways that can be manipulated at neural, behavioral, and psychological levels to change the representation of and attention to interoceptive signals, which can alter interconnected physiological systems and improve functioning and adaptive behavior. Interventions can alter interoception via neuromodulation of the vagus nerve, slow breathing to change respiratory rate and depth, or awareness processes such as mindfulness-based interventions. Aspects of this framework may be applied to other physiological systems and future research may integrate interventions across multiple levels of manipulation or bodily systems.
Interoception refers to the representation of the internal states of an organism, and includes the processes by which it senses, interprets, integrates, and regulates signals from within itself. This review presents a unified research framework and attempts to offer definitions for key terms to describe the processes involved in interoception. We elaborate on these definitions through illustrative research findings, and provide brief overviews of central aspects of interoception, including the anatomy and function of neural and non-neural pathways, diseases and disorders, manipulations and interventions, and predictive modeling. We conclude with discussions about major research gaps and challenges.
Aesthetic chills involve pleasurable bodily sensations co-occurring with self-transcendent emotions. In this study, 94 participants were exposed to pre-validated musical stimuli with chills-inducing potential. Participants experiencing chills reported significantly greater psychological insight and emotional awareness compared to non-chills controls. Chills intensity positively correlated with insight and emotional awareness. These results suggest that interoceptive signals may precipitate cognitive-emotional shifts. Further research should explore the role of bodily manipulations across altered states.
Background
Heart rate variability (HRV) is an indicator of autonomic abnormalities. However, little is known about the role of HRV related to substance use behavior and the association between the changes in HRV and signs of relapse in substance use.
Aim
The purpose of this study was to review the existing literature on autonomic response to substance use (i.e., opioids, cocaine, and methamphetamine) measured by HRV and its outcomes related to the risk factors of relapse.
Methods
A systematic search of the literature was conducted using PubMed, PsychINFO, and Ovid Medline databases. The study includes full-text articles published in English from 2010 to 2020, using measures of HRV in human subjects who use substances.
Results
A total of 14 studies were reviewed. Studies included outpatients with a prescription or nonprescription opioid misuse behavior with a primary diagnosis being chronic pain or substance use disorder (SUD). Significantly decreased resting HRV was found in substance users compared to healthy controls. Lower resting HRV has been significantly associated with stress, craving, and greater symptom severities in individuals with SUD and other substance dependence. HRV indices can be potential measures of homeostatic imbalance and self-regulation flexibility.
Conclusion
HRV may be a useful tool for monitoring early indication of relapse so that relapse prevention measures can be implemented in a timely manner. Future studies in substance use may benefit from examining HRV in relations to substance use and relapse signs and symptoms in a larger population to guide future relapse prevention strategies.
Aesthetic chills, a strong emotional reaction characterized by a specific bodily response of thermoregulatory mechanisms such as shivers and goosebumps, may hold scientific and clinical potential for reward-related or dopaminergic illnesses. In this first exploratory study, we examined the effects of chills stimulation on subjects clinically diagnosed with depression. Our results suggest that chill-inducing stimuli may have the potential to affect the core schema of depressed patients, specifically in terms of shame and self-acceptance. These results suggest that the mechanism of action during the chills response may resemble the form of problem resolution induced by the psychedelic and psychotherapeutic experience, leading to similar positive outcomes for the subject. Further research is needed to fully understand the effects of chills on mental health and to determine the feasibility and safety of using aesthetic chills as a therapeutic intervention.
Cancer Symptom Science is the first interdisciplinary compilation of research on the mechanisms underlying the expression of cancer-related symptoms. It presents innovations in clinical, animal and in vitro research, research methods in brain imaging, and statistical-descriptive approaches to understanding the mechanistic basis of symptom expression. This volume also provides perspectives from patients, government and industry. By collecting and synthesizing the developing threads of new approaches to understanding cancer-related symptoms, the book promotes a pioneering framework for merging behavioral and biological disciplines to clarify mechanisms of symptom evolution, incorporating new technologies, testing novel agents for symptom control, and improving patient functioning and quality of life both during and after cancer treatment. With an expert editorial team led by Charles S. Cleeland, an internationally-recognized leader in cancer pain assessment and treatment, this is essential reading for surgical, clinical and medical oncologists, academic researchers, and pharmaceutical companies developing new agents to control symptom expression.
Anxiety is common in older adults with mild cognitive impairment (MCI), and Alzheimer's disease and related dementias (ADRD). Anxiety has also been identified as a risk factor for cognitive decline. Brief interventions targeting risk mechanisms of anxiety, such as anxiety sensitivity (AS), have been effective in reducing overall anxiety in a variety of populations. This case series investigated the feasibility and efficacy of a brief AS intervention in anxious older adults with MCI (n = 9). Paired samples t-test results indicate that this intervention is capable of significantly reducing AS as measured by the Anxiety Sensitivity Index-3 (Δ = 5.11, Hedges g = 0.82, P < 0.05). Given these large AS reductions and high acceptability, further investigation of this intervention is warranted in older adults with MCI.
Interoception includes signals from inner organs and thin afferents in the skin, providing information about the body’s physiological state. However, the functional relationships between interoceptive submodalities are unclear, and thermosensation as skin-based interoception has rarely been considered. We used five tasks to examine the relationships among cardiac awareness, thermosensation, affective touch, and nociception. Thermosensation was probed with a classic temperature detection task and the new dynamic thermal matching task, where participants matched perceived moving thermal stimuli in a range of colder/warmer stimuli around thermoneutrality. We also examined differences between hairy and non-hairy skin and found superior perception of dynamic temperature and static cooling on hairy skin. Notably, no significant correlations were observed across interoceptive submodality accuracies (except for cold and pain perception in the palm), which indicates that interoception at perceptual levels should be conceptualised as a set of relatively independent processes and abilities rather than a single construct.
Data availability statement
Data of this study are available as a supplementary file.
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 support the scientific study of interoception and this special issue brings together a diverse array of novel interoceptive methods and assessments, spanning psychophysiology, experimental psychology, affective neuroscience and computational approaches, divided into 5 core sections. Section 1 presents novel theoretical and computational models of interoception, while section two brings together a range of perspectives on questionnaire measures of interoception. Section 3 is devoted to the development of novel methods to assess interoception in behavioral tasks and section 4 focuses on the validity and confounds present in a range of methods used to assess interoception. Finally, section 5 details new methodological insights of interoception in the domains of emotion, cognition and health. Improved interoceptive methods are needed to progress this field; greater precision in techniques and core interoceptive constructs will aid in the mapping of interoceptive measures to cognition and emotion factors, as well as help to elucidate precise interoceptive alterations observed in clinical conditions.
Although the amygdala plays an important part in the pathogenesis of anxiety and generation of exteroceptive fear, recent discoveries have challenged the directionality of this brain-behavior relationship with respect to interoceptive fear. Here we highlight several paradoxical findings including: (1) amygdala lesion patients who experience excessive fear and panic following inhalation of carbon dioxide (CO2), (2) clinically anxious patients who have significantly smaller (rather than larger) amygdalae and a pronounced hypersensitivity toward CO2, and (3) epilepsy patients who exhibit apnea immediately following stimulation of their amygdala yet have no awareness that their breathing has stopped. The above findings elucidate an entirely novel role for the amygdala in the induction of apnea and inhibition of CO2-induced fear. Such a role is plausible given the strong inhibitory connections linking the central nucleus of the amygdala with respiratory and chemoreceptive centers in the brainstem. Based on this anatomical arrangement, we propose a model of Apnea-induced Anxiety (AiA) which predicts that recurring episodes of apnea are being unconsciously elicited by amygdala activation, resulting in transient spikes in CO2 that provoke fear and anxiety, and lead to characteristic patterns of escape and avoidance behavior in patients spanning the spectrum of anxiety. If this new conception of AiA proves to be true, and activation of the amygdala can repeatedly trigger states of apnea outside of one’s awareness, then it remains possible that the chronicity of anxiety disorders is being interoceptively driven by a chemoreceptive system struggling to maintain homeostasis in the midst of these breathless states.
The adaptive regulation of bodily and interoceptive parameters, such as body temperature, thirst and hunger is a central problem for any biological organism. Here, we present a series of simulations using the framework of active inference to formally characterize interoceptive control and some of its dysfunctions. We start from the premise that the goal of interoceptive control is to minimize a discrepancy between expected and actual interoceptive sensations (i.e., a prediction error or free energy). Importantly, living organisms can achieve this goal by using various forms of interoceptive control: homeostatic, allostatic and goal-directed. We provide a computationally-guided analysis of these different forms of interoceptive control, by showing that they correspond to distinct generative models within Active inference. We discuss how these generative models can support empirical research through enabling fine-grained predictions about physiological and brain signals that may accompany both adaptive and maladaptive interoceptive control.
The brain regulates the body by anticipating its needs and attempting to meet them before they arise – a process called allostasis. Allostasis requires a model of the changing sensory conditions within the body, a process called interoception. In this paper, we examine how interoception may provide performance feedback for allostasis. We suggest studying allostasis in terms of control theory, reviewing control theory’s applications to related issues in physiology, motor control, and decision making. We synthesize these by relating them to the important properties of allostatic regulation as a control problem. We then sketch a novel formalism for how the brain might perform allostatic control of the viscera by analogy to skeletomotor control, including a mathematical view on how interoception acts as performance feedback for allostasis. Finally, we suggest ways to test implications of our hypotheses.
Feelings are conscious mental events that represent body states as they undergo homeostatic regulation. Feelings depend on the interoceptive nervous system (INS), a collection of peripheral and central pathways, nuclei and cortical regions which continuously sense chemical and anatomical changes in the organism. How such humoral and neural signals come to generate conscious mental states has been a major scientific question. The answer proposed here invokes (1) several distinctive and poorly known physiological features of the INS; and (2) a unique interaction between the body (the ‘object’ of interoception) and the central nervous system (which generates the 'subject' of interoception). The atypical traits of the INS and the direct interactions between neural and non‐neural physiological compartments of the organism, neither of which is present in exteroceptive systems, plausibly explain the qualitative and subjective aspects of feelings, thus accounting for their conscious nature.
We review recent work on the functions of interoceptive processing, by which the nervous system anticipates, senses, and integrates signals originating from the body. We focus on several exemplar functions of interoception, including energy regulation (ingestion and excretion), memory, affective and emotional experience, and the psychological sense of self. We emphasize two themes across these functions. First, the anatomy of interoceptive afferents makes it difficult to manipulate or directly measure interoceptive signaling in humans. Second, recent evidence shows that multimodal integration occurs across interoceptive modalities and between interoceptive and exteroceptive modalities. Whereas exteroceptive multimodal integration has been studied relatively extensively, fundamental questions remain regarding multimodal integration that involves interoceptive modalities. Future empirical work is required to better understand how and where multimodal interoceptive integration occurs.
The present paper considers recent progress in our understanding of the afferent/ascending neural pathways and neural circuits of interoception. Of particular note is the extensive role of rostral neural systems, including cortical systems, in the recognition of internal body states, and the reciprocal role of efferent/descending systems in the regulation of those states. Together these reciprocal interacting networks entail interoceptive circuits that play an important role in a broad range of functions beyond the homeostatic maintenance of physiological steady-states. These include the regulation of behavioral, cognitive, and affective processes across conscious and nonconscious levels of processing. We highlight recent advances and knowledge gaps that are important for accelerating progress in the study of interoception.
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 forms of adaptive behavior that take interoceptive context, experiences, and expectations into account. Specifically, we define a landscape for computational models of interoception, body regulation, and forecasting, address these models’ unique challenges in relation to translational research efforts, and discuss what they can teach us about cognition as well as physical and mental health.