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Cobbaert L, Hay P, Mitchell PB, Roza SJ, Perkes I. Sensory processing across eating disorders: A systematic review and meta-analysis of self-report inventories. Int J Eat Disord 2024. [PMID: 38511825 DOI: 10.1002/eat.24184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 02/22/2024] [Accepted: 02/22/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE This review investigated the extant literature regarding the relationship between eating disorder diagnoses and sensory processing as measured by validated and reliable self-report inventories. Increasing evidence highlights the role of sensory processing in cognitive functions. Sensory processing is implicated in mental-ill health, including eating disorders (ED) and body image disturbances. However, the pathophysiological underpinnings of sensory processing, encompassing exteroception and interoception, in relation to ED remain underexplored. METHOD We included studies involving participants aged 15 years or older with an eating disorder diagnosis confirmed by semi-structured or structured interviews. We further limited inclusion to articles using validated and reliable self-report instruments to measure sensory processing. Our meta-analysis focused on studies using the interoceptive awareness subscale from the second version of the Eating Disorder Inventory. We used the Critical Appraisal checklist for quasi-experimental studies to assess the quality of included articles. RESULTS There were 19 studies that met our inclusion criteria. Most studies showed moderate-to-high quality. Anorexia nervosa (AN) and bulimia nervosa (BN) were associated with heightened exteroception. Moreover, people with AN reported a heightened sense of taste compared to those with BN. Our meta-analysis comprising 10 studies, 19 samples, and 6382 participants revealed that AN (binge-purge subtype) and BN were associated with increased interoceptive difficulties compared to AN (restrictive subtype) or binge-eating disorder. DISCUSSION Overall, this review emphasizes the need for a deeper investigation into sensory processing, spanning both exteroception and interoception, in relation to ED. This may prove important for individualizing person-centered care. PUBLIC SIGNIFICANCE How people process internal, for example, hunger, and external, for example, taste and sensations is known to influence cognition and mental-ill health, including ED and body image disturbances. However, the ways in which sensory processing may contribute to ED are incompletely understood. We found that individuals with AN or BN experienced heightened exteroception, while people with an eating disorder characterized by purging reported increased interoceptive difficulties. These patterns could inform the development of more personalized treatments.
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Affiliation(s)
- Laurence Cobbaert
- Faculty of Medicine and Health, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Phillipa Hay
- School of Medicine, Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
- Mental Health Services, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Philip B Mitchell
- Faculty of Medicine and Health, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Sabine J Roza
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Iain Perkes
- Faculty of Medicine and Health, Discipline of Paediatrics and Child Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Psychological Medicine, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
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Hu L, He H, Roberts N, Chen J, Yan G, Pu L, Song X, Luo C. Insular dysfunction of interoception in major depressive disorder: from the perspective of neuroimaging. Front Psychiatry 2023; 14:1273439. [PMID: 37840807 PMCID: PMC10568471 DOI: 10.3389/fpsyt.2023.1273439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 09/14/2023] [Indexed: 10/17/2023] Open
Abstract
Interoception plays a crucial role in maintaining bodily homeostasis and promoting survival, and is considered the basis of human emotion, cognition, and self-formation. A malfunction of interoception is increasingly suggested to be a fundamental component of different mental health conditions, and depressive disorders have been especially closely associated. Interoceptive signaling and processing depends on a system called the "interoceptive pathway," with the insula, located in the deep part of the lateral fissure, being the most important brain structure in this pathway. Neuroimaging studies have revealed alterations in the structure and function of the insula in a large number of individuals with depression, yet the precise relationship between these alterations and interoceptive dysfunction remains unclear. The goal of this review is to examine the evidence that exists for dysfunction of interoception in people with Major Depressive Disorder (MDD), and to determine the associated specific alterations in the structure and function of the insula revealed by neuroimaging. Overall, three aspects of the potential relationship between interoceptive dysfunction and alterations in insular function in people with depression have been assessed, namely clinical symptoms, quantitative measures of interoceptive function and ability, and interoceptive modulation. To conclude, several specific limitations of the published studies and important lines of enquiry for future research are offered.
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Affiliation(s)
- Lan Hu
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
- The Fourth People’s Hospital of Chengdu, Chengdu, China
| | - Hui He
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
- The Fourth People’s Hospital of Chengdu, Chengdu, China
| | - Neil Roberts
- Centre for Reproductive Health (CRH), School of Clinical Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Jiajia Chen
- The Fourth People’s Hospital of Chengdu, Chengdu, China
| | - Guojian Yan
- The Fourth People’s Hospital of Chengdu, Chengdu, China
| | - Li Pu
- The Fourth People’s Hospital of Chengdu, Chengdu, China
| | - Xufeng Song
- The Fourth People’s Hospital of Chengdu, Chengdu, China
| | - Cheng Luo
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
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Davis LW, Schmid AA, Daggy JK, Yang Z. Mediators of improved PTSD symptoms in veterans and civilians following a yoga program. Acta Neuropsychiatr 2023; 35:232-240. [PMID: 36710002 DOI: 10.1017/neu.2023.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Although yoga shows some promise as an intervention for post-traumatic stress disorder (PTSD), little is known about how yoga reduces PTSD symptoms. The current study hypothesised that aspects of interoceptive awareness would mediate the effect of a yoga intervention on PTSD symptoms. METHODS We used data from our recently completed randomised controlled trial of a 16-week holistic yoga programme for veterans and civilians diagnosed with PTSD (n = 141) that offered weekly 90-minute sessions. We conducted a mediation analysis using interoceptive awareness and other variables that were associated with PTSD symptom reduction at mid-treatment and treatment end. RESULTS Although measures of anxiety, interoceptive awareness, and spirituality were identified in individual mediator models, they were no longer found to be significant mediators when examined jointly in multiple mediator models. When examining the multiple mediator models, the strongest mediator of the yoga intervention on PTSD symptoms was mental well-being at mid-treatment and stigma at the treatment end. The total effect of yoga on CAPS and PCL at the treatment end mediated by stigma was 37.1% (-1.81/-4.88) and 33.6% (-1.91/-5.68), respectively. CONCLUSION Investigation of mental well-being and mental illness stigma as potential mediators is warranted in future studies of yoga as a treatment for PTSD as they may prove to be important foci for yoga interventions.
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Affiliation(s)
- Louanne W Davis
- Research Department, Roudebush VA Medical Center, Indianapolis, Indiana, USA
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Arlene A Schmid
- Department of Occupational Therapy, Colorado State University System, Denver, Colorado, USA
| | - Joanne K Daggy
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ziyi Yang
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Wallman-Jones A, Palser ER, Benzing V, Schmidt M. Acute physical-activity related increases in interoceptive ability are not enhanced with simultaneous interoceptive attention. Sci Rep 2022; 12:15054. [PMID: 36064565 PMCID: PMC9445090 DOI: 10.1038/s41598-022-19235-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/25/2022] [Indexed: 01/23/2023] Open
Abstract
Interoception, the sense of the internal body, is proposed to support self-regulation, and consequently influence mental health. Researchers have therefore shown interest in improving the ability to accurately monitor internal signals (i.e., interoceptive accuracy, IAcc). Research suggests that cardiac IAcc is modifiable by both manipulations of interoceptive attention (guided attention towards the internal body), and interoceptive exposure (strategically inducing somatic signals e.g., via physical activity). Whilst successful in isolation, it is unclear whether a combined approach (i.e., directing attention towards the internal body when signals are more salient) could elicit greater benefits. In a 2 × 2 within-subject design, 48 healthy adults (Mage = 25.98 ± 4.73 years, 50% female) completed four 20-min conditions varying in both attentional focus (interoceptive vs exteroceptive) and physical activity (active vs rest), with cardiac IAcc measured immediately after. Results revealed a main effect for physical activity (p < 0.001), however, there was no effect for attentional focus (p = 0.397), and no interaction effect (p = 0.797). Differential analyses showed that a higher sporting background increased sensitivity to physical activity-related increases in cardiac IAcc (p = 0.031). Findings indicate that (irrespective of attentional focus) moderate-vigorous physical activity-based interventions have the potential to increase cardiac IAcc, with certain individuals potentially benefiting more.
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Affiliation(s)
- A Wallman-Jones
- Institute of Sport Science, University of Bern, 145 Bremgartenstrasse, 3012, Bern, Switzerland.
| | - E R Palser
- Department of Neurology, University of California, San Francisco, CA, 94158, USA
| | - V Benzing
- Institute of Sport Science, University of Bern, 145 Bremgartenstrasse, 3012, Bern, Switzerland
| | - M Schmidt
- Institute of Sport Science, University of Bern, 145 Bremgartenstrasse, 3012, Bern, Switzerland
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Oka T, Lkhagvasuren B. Effects of practicing yoga on alexisomia: an open-label trial. Biopsychosoc Med 2022; 16:14. [PMID: 35659341 PMCID: PMC9166595 DOI: 10.1186/s13030-022-00243-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 05/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Alexisomia refers to difficulties in the awareness and expression of somatic feelings. This idea was proposed by Dr. Yujiro Ikemi as a characteristic observed in patients with psychosomatic diseases and is based on his observations that patients with psychosomatic diseases have difficulty in the awareness and expression of not only their emotions, i.e., alexithymia, but also somatic feelings and sensations, i.e., alexisomia. He also proposed that treating alexisomia is important in the treatment of psychosomatic diseases and that yoga might help improve alexisomia. However, no study has investigated if yoga actually affects alexisomia. This open-label pilot study investigated whether practicing yoga in a class results in change in patients with alexisomia and alexithymia. METHODS The Shitsu-taikan-sho Scale (STSS) and the Toronto Alexithymia Scale (TAS-20) were administered to 305 participants, including 64 healthy participants, 111 participants who had subjective symptoms without abnormal findings, and 130 participants with chronic diseases. Participants were tested before and 3 months after attending yoga classes. RESULTS Yoga practice reduced the STSS and the TAS-20 difficulty in identifying feelings (DIF) subscale scores. Multiple linear regression indicated that a reduction in the TAS-20 DIF subscale scores predicted a decrease in the STSS score, whereas reductions in the STSS difficulty in identifying bodily feelings (DIB) and the lack of health management based on bodily feelings (LHM) subscale scores predicted a decrease in the TAS-20 scores. CONCLUSION We found that regular yoga practice improves alexisomia. Yoga-induced improvement of alexisomia may be mediated, at least in part, by an improvement of DIF in alexithymia. Yoga would be a promising therapeutic approach to improve alexisomia.
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Affiliation(s)
- Takakazu Oka
- Department of Psychosomatic Medicine, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba, 286-8520, Japan.
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Battuvshin Lkhagvasuren
- Department of Psychosomatic Medicine, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba, 286-8520, Japan
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Toutain M, Gauthier A, Leconte P. Exercise therapy in the treatment of anorexia nervosa: Its effects depending on the type of physical exercise-A systematic review. Front Psychiatry 2022; 13:939856. [PMID: 36339831 PMCID: PMC9627498 DOI: 10.3389/fpsyt.2022.939856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/12/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND AND PURPOSE Clinical research focusing on the effectiveness of exercise therapy (ET) in patients with anorexia nervosa (AN) shows increasing interest in the last decade. The aim of this systematic review was to provide an overview of quantitative studies that have examined the impact of ET in AN patients and to examine its specific effects on physical and mental health according to the type of physical exercise (PE) practiced. METHODS The review was carried out based on the PRISMA 2020. Electronic databases PubMed, Web of Science, Embase, and Wiley were searched from inception to December 2021. Quantitative studies assessing the effects of ET interventions on AN patients were included and study quality was assessed using the PEDro scale. RESULTS A total of 27 studies were selected, including 13 randomized controlled trials. Regarding outcomes measured, results showed that aerobic and resistance exercise improved muscle strength, that mind-body PE decreased main symptoms of AN and mental health, and that combined PE reduced dysfunctional exercise and improved weight gain. CONCLUSION The findings suggest that ET intervention can induce benefits and has no deleterious effects on patients. In addition, specific effects on anorexia symptoms and physical and mental health have been observed according to the type of PE. However, this review reported several methodological weaknesses, including a lack of control group or randomization and statistical misconduct. Finally, ET intervention parameters were heterogeneous, and ET intervention generally lacked details, making reproducibility and comparability difficult. All these limitations underscore the need for a more rigorous methodology for further research.
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Affiliation(s)
- Marc Toutain
- UNICAEN, INSERM, COMETE, GIP CYCERON, Normandie University, Caen, France
| | - Antoine Gauthier
- UNICAEN, INSERM, COMETE, GIP CYCERON, Normandie University, Caen, France
| | - Pascale Leconte
- UNICAEN, INSERM, COMETE, GIP CYCERON, Normandie University, Caen, France
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Effects of a Single Yoga Session on Cardiac Interoceptive Accuracy and Emotional Experience. Brain Sci 2021; 11:brainsci11121572. [PMID: 34942874 PMCID: PMC8699040 DOI: 10.3390/brainsci11121572] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/24/2021] [Accepted: 11/26/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND There is an increasing body of research supporting the idea that cardiac interoceptive accuracy (IAc) can be improved by training. Findings concerning the effects of a single yoga session on IAc and the related construct emotional experience are sparse. The aim of this study was to examine if a single yoga session increases IAc and improves emotional experience. METHODS 137 students were randomly assigned to a 20-min yoga session (n = 47), an endurance session (n = 46), or an inactive control condition (n = 44). IAc and emotional experience were assessed before and after the sessions. RESULTS There were no significant changes in IAc, or positive and negative affect. IAc at baseline and the change in positive effect were found as predictors for IAc after the yoga session. CONCLUSION A 20-min yoga session seems to be not applicable to improve IAc and emotional experience. Future studies should investigate long-term interventions and diverse healthy and clinical populations.
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