Interoceptive discrimination in intact humans: detection of cardiac activity

Interoceptive training impacts the neural circuit of the anterior insula cortex

Interoception is the perception of afferent information that arises from anywhere and everywhere within the body. Recently, interoceptive accuracy could be enhanced by cognitive training. Given that the anterior insula cortex (AIC) is a key node of interoception, we hypothesized that resting functional connectivity (RSFC) from AIC was involved in an effect of interoceptive training. To address this issue, we conducted a longitudinal intervention study using interoceptive training and obtained RSFC using fMRI before and after the intervention. A heartbeat perception task evaluated interoceptive accuracy. Twenty-two healthy volunteers (15 females, age 19.9 ± 2.0 years) participated. After the intervention, interoceptive accuracy was enhanced, and anxiety levels and somatic symptoms were reduced. Also, RSFC from AIC to the dorsolateral prefrontal cortex (DLPFC), superior marginal gyrus (SMG), anterior cingulate cortex (ACC), and brain stem, including nucleus tractus solitarius (NTS) were enhanced, and those from AIC to the visual cortex (VC) were decreased according to enhanced interoceptive accuracy. The neural circuit of AIC, ACC, and NTS is involved in the bottom-up process of interoception. The neural circuit of AIC, DLPFC, and SMG is involved in the top-down process of interoception, which was thought to represent the cognitive control of emotion. The findings provided a better understanding of neural underpinnings of the effect of interoceptive training on somatic symptoms and anxiety levels by enhancing both bottom-up and top-down processes of interoception, which has a potential contribution to the structure of psychotherapies based on the neural mechanism of psychosomatics.

Heart activity perception: narrative review on the measures of the cardiac perceptual ability

Measures of cardiac perceptual ability (also called cardiac accuracy) are methods of cardiac interoception, the perception of bodily sensation related to heart activity. This narrative review aims to provide an overview of these methods. We differentiate between three main measurement types: (1) change detection, i.e., when the task is to notice the change in the heart rate; also called: heart rate perception tasks, (2) discrimination tasks, i.e., when the task is to compare the internal sensations with external signal(s); also called: heartbeat detection tasks and (3) tracking tasks, i.e., when the task is to follow and report heartbeats via tapping or counting. We describe some of the new methods under "mixed methods," as they share features with more than one of the large measurement types described above. Specific measures differ in various aspects, such as their focus (heart rhythm vs. single beats), their sensitivity to non-conscious sensations and the calculated indices (e.g., whether significance level by hypothesis test is provided). When a measure of cardiac perceptual ability is chosen, it is advisable to take its characteristics into consideration in light of the planned research.

Vague sensations. About the background and consequences of discordance between actual and perceived physiological changes

Empirical evidence consistently shows that discordance, also called dissociation or discrepancy, between actual physiological (mainly visceral) events and their perceived counterparts is substantial. On the one hand, we typically do not perceive actual visceral events occurring in our bodies; on the other hand, sometimes we do perceive bodily changes that do not really take place. This narrative review presents the available empirical findings on the discordance, and summarizes possible explanations that approach the phenomenon from the viewpoint of evolution, cognitive development, and predictive processing. Also, the role of top-down factors, such as expectations and experiences is discussed. Finally, practically relevant consequences of the discordance are presented using the examples of mind-body practices, the placebo and nocebo phenomenon, and medically unexplained symptoms. It is concluded that the discordance between actual and perceived body changes can have a negative impact on health, mainly through issues with adherence and other behavioral factors. The existence of actual-perceived discordance should be taught and demonstrated in the elementary and high school, as well as in many areas of higher education.

A Primer on Interoception and its Importance in Psychiatry

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.

Brain Neural Underpinnings of Interoception and Decision-Making in Alzheimer's Disease: A Narrative Review

This study reviews recent literature on interoception directing decision-making in Alzheimer's disease (AD). According to the somatic marker hypothesis, signals from the internal body direct decision-making and involve the ventromedial prefrontal cortex (vmPFC). After reviewing relevant studies, we summarize the brain areas related to interoception and decision-making (e.g., vmPFC, hippocampus, amygdala, hypothalamus, anterior cingulate cortex, and insular cortex) and their roles in and relationships with AD pathology. Moreover, we outline the relationship among interoception, the autonomic nervous system, endocrine system, and AD pathology. We discuss that impaired interoception leads to decreased decision-making ability in people with AD from the perspective of brain neural underpinning. Additionally, we emphasize that anosognosia or reduced self-awareness and metacognition in AD are remarkably congruent with the malfunction of the autonomic nervous system regulating the interoceptive network. Furthermore, we propose that impaired interoception may contribute to a loss in the decision-making ability of patients with AD. However, there still exist empirical challenges in confirming this proposal. First, there has been no standardization for measuring or improving interoception to enhance decision-making ability in patients with AD. Future studies are required to better understand how AD pathology induces impairments in interoception and decision-making.

Physical activity and interoceptive processing: Theoretical considerations for future research

Interoception, defined as the sense of the internal bodily state, plays a critical role in physical, cognitive, emotional and social well-being. Regarding physical well-being, contemporary models of exercise regulation incorporate interoceptive processes in the regulation of physical exertion. Top-down processes continuously monitor the physiological condition of the body to ensure allostasis is maintained, however, flagged perturbations also appear to influence these higher order processes in return. More specifically, enhancing one's physiological arousal by means of physical activity is a viable way of manipulating the afferent input entering the interoceptive system, appearing to optimise the integration of early sensory stimulation with later affective responses. Despite this, the relationship between physical activity and top-down regulation is underrepresented in interoceptive research. We here address this gap by integrating findings from different disciplines to support the overlapping mechanisms, with the hope of stimulating further research in this field. Developing our understanding of how interoceptive processes are shaped by physical activity could hold significant clinical implications considering the impact of interoceptive deficits to mental health and well-being.

Delineating implicit and explicit processes in neurofeedback learning

Neurofeedback allows humans to self-regulate neural activity in specific brain regions and is considered a promising tool for psychiatric interventions. Recently, methods have been developed to use neurofeedback implicitly, prompting a theoretical debate on the role of awareness in neurofeedback learning. We offer a critical review of the role of awareness in neurofeedback learning, with a special focus on recently developed neurofeedback paradigms. We detail differences in instructions and propose a fine-grained categorization of tasks based on the degree of involvement of explicit and implicit processes. Finally, we review the methods used to measure awareness in neurofeedback and propose new candidate measures. We conclude that explicit processes cannot be eschewed in most current implicit tasks that have explicit goals, and suggest ways in which awareness could be better measured in the future. Investigating awareness during learning will help understand the learning mechanisms underlying neurofeedback learning and will help shape future tasks.

Effects of interoceptive training on decision making, anxiety, and somatic symptoms

Background

Interoception is the perception of afferent information that arises from any point within the body. Individual differences in interoception have been associated with affective processing and decision-making processing. The somatic marker hypothesis summarizes the potential effects of interoception on decision-making processes. According to this theory, individuals with interoceptive dysfunction exhibit disadvantageous decision making. Recently, enhancement of interoceptive accuracy, an element of interoception assessed by objective decision-making tasks, has been demonstrated using biofeedback. Garfinkle et al. developed an interoceptive training task, modified from the heartbeat perception task, which enhanced interoceptive accuracy and reduced anxiety symptoms. The purpose of this study was to determine the effects of interoceptive training on decision-making processes. Based on improvements in interoceptive accuracy, we hypothesized that decision-making scores would change in a manner indicative of increased rationality.

Methods

This longitudinal interventional study was performed with interoceptive training. Before and after the intervention, interoceptive accuracy and rationality of decision-making processes were assessed using a heartbeat perception task and rational decision-making tasks, respectively. Fourteen healthy volunteers (nine women; mean age, 21.9 ± 4.5 years) participated. The analysis included data from 12 participants. To detect individual differences in the effects of interoceptive accuracy on rationality of decision making, correlation analysis was conducted on change ratios of the indices of interoceptive accuracy and rationality of decision making.

Results

Interoceptive training resulted in significant enhancement of interoceptive accuracy scores and significant reductions in somatic symptom and state anxiety scores. In contrast, interoceptive training did not cause significant changes in decision-making indices. There was a significant positive correlation between change ratios of indices of interoceptive accuracy and rationality of decision making.

Conclusions

The results suggested a causal relation between interoception and rationality of decision making. These findings will enhance the understanding of mechanisms underlying alterations of decision-making related to psychotherapy by focusing on interoception.

Trial registration

Trial registration number: UMIN000037548.

Stress as a context: Stress causes relapse of inhibited food seeking if it has been associated with prior food seeking

Three experiments with rats explored the hypothesis that inhibited food-seeking can be reinstated by stress if stress has been part of the context of earlier food-seeking. In all experiments, rats first learned to lever press for sucrose pellets and then had the response inhibited through extinction (where responding no longer yielded sucrose pellets). In a final test, inhibited responding was tested after exposure to a stressor or not. Previous research indicates that stress during testing does not normally reinstate extinguished food-seeking, although it reliably does so when animals are responding for drugs. In Experiment 1, stress caused a reinstatement of food seeking if and only if the rats had been exposed to stressors prior to sessions of lever press training. In Experiment 2, a new stressor that had not been associated with response acquisition also caused reinstatement if other stressors had been associated with response acquisition. Experiment 3 then established that stressors must be associated with the acquisition of lever pressing, rather than extinction, in order to allow a stressor to cause relapse of extinguished food seeking. The results support the view that stress can cause relapse of inhibited food seeking if it has been part of the context of original food seeking. The effect is therefore an example of the ABA renewal effect in which inhibited responding recovers after extinction when the response is returned to its training context. Implications for understanding relapse to overeating and other "addictive" behaviors are discussed.

Zur Anwendung der Signalentdeckungstheorie bei der Auswertung von Aufgaben zur motorischen Verfolgung der eigenen Herzschläge

Zusammenfassung. Aufgaben zur Entdeckung und Verfolgung der eigenen Herzschläge werden standardmäßig als ein Maß für eine umfassendere interozeptive Fähigkeit eingesetzt. Bei der Auswertung dieser Aufgaben wird aber nur selten ein echtes Maß für die Sensitivität der Wahrnehmung körpereigener Signale verwendet. Die vorliegende Studie hat sich deshalb dieser Fragestellung angenommen und die Daten einer sogenannten Herzschlagentdeckungsaufgabe (HBDT) mithilfe der Signalentdeckungstheorie (SDT) ausgewertet. Die Ergebnisse (N = 44) zeigen entsprechend, dass der so gewonnene Sensitivitätsindex (d’) deutlich unabhängiger von der reinen Anzahl der in einer motorischen HBDT abgegebenen Reaktionen ist, als herkömmliche Maße der Herzschlagentdeckungsfähigkeit. Mit d’ kann somit eine vielfach kritisierte Konfundierung bei den herkömmlichen Maßen aufgelöst und dadurch die Validität der HBDT erhöht werden. Darüber hinaus konnte, wie schon wiederholt mit einem herkömmlichen Accuracy-Maß gezeigt, auch mit unserem SDT-Index d’ ein Trainingseffekt der interozeptiven Fähigkeit nachgewiesen werden. Ferner ist an dieser Studie innovativ, dass zur Feststellung der tatsächlichen Herztätigkeit erstmalig die Doppler-Sonographie eingesetzt wurde.

Towards a psychophysics of interoceptive processes: the measurement of heartbeat detection

It is difficult to collect objective evidence of interoception. Unlike exteroception, the effective stimuli for interoception are often unknown, and even when identifiable, they are difficult to control experimentally. Furthermore, direct stimulation of the interoceptors is seldom appropriate in human experimentation. Hence, non-invasive behavioural measures of accuracy in heartbeat detection have frequently been adopted to index interoceptive sensitivity. However, there has been little standardization and the two most popular methods for assessing heartbeat detection, heartbeat tracking and two alternative forced choice methods, appear to be biased and of questionable validity. These issues do not arise with other methods that are based on classical psychophysics and that enable subjects to indicate when during the cardiac cycle their heartbeat sensations occur. Not only are these classical methods highly reliable, but they also provide continuous unbiased measures of the temporal locations of heartbeat sensations and the precision with which these sensations are detected.This article is part of the themed issue 'Interoception beyond homeostasis: affect, cognition and mental health'.

Interoception and stress

Afferent neural signals are continuously transmitted from visceral organs to the brain. Interoception refers to the processing of visceral-afferent neural signals by the central nervous system, which can finally result in the conscious perception of bodily processes. Interoception can, therefore, be described as a prominent example of information processing on the ascending branch of the brain–body axis. Stress responses involve a complex neuro-behavioral cascade, which is elicited when the organism is confronted with a potentially harmful stimulus. As this stress cascade comprises a range of neural and endocrine pathways, stress can be conceptualized as a communication process on the descending branch of the brain–body axis. Interoception and stress are, therefore, associated via the bi-directional transmission of information on the brain–body axis. It could be argued that excessive and/or enduring activation (e.g., by acute or chronic stress) of neural circuits, which are responsible for successful communication on the brain–body axis, induces malfunction and dysregulation of these information processes. As a consequence, interoceptive signal processing may be altered, resulting in physical symptoms contributing to the development and/or maintenance of body-related mental disorders, which are associated with stress. In the current paper, we summarize findings on psychobiological processes underlying acute and chronic stress and their interaction with interoception. While focusing on the role of the physiological stress axes (hypothalamic-pituitary-adrenocortical axis and autonomic nervous system), psychological factors in acute and chronic stress are also discussed. We propose a positive feedback model involving stress (in particular early life or chronic stress, as well as major adverse events), the dysregulation of physiological stress axes, altered perception of bodily sensations, and the generation of physical symptoms, which may in turn facilitate stress.

Differential changes in self-reported aspects of interoceptive awareness through 3 months of contemplative training

Interoceptive body awareness (IA) is crucial for psychological well-being and plays an important role in many contemplative traditions. However, until recently, standardized self-report measures of IA were scarce, not comprehensive, and the effects of interoceptive training on such measures were largely unknown. The Multidimensional Assessment of Interoceptive Awareness (MAIA) questionnaire measures IA with eight different scales. In the current study, we investigated whether and how these different aspects of IA are influenced by a 3-months contemplative intervention in the context of the ReSource project, in which 148 subjects engaged in daily practices of "Body Scan" and "Breath Meditation." We developed a German version of the MAIA and tested it in a large and diverse sample (n = 1,076). Internal consistencies were similar to the English version (0.56-0.89), retest reliability was high (rs: 0.66-0.79), and the MAIA showed good convergent and discriminant validity. Importantly, interoceptive training improved five out of eight aspects of IA, compared to a retest control group. Participants with low IA scores at baseline showed the biggest changes. Whereas practice duration only weakly predicted individual differences in change, self-reported liking of the practices and degree of integration into daily life predicted changes on most scales. Interestingly, the magnitude of observed changes varied across scales. The strongest changes were observed for the regulatory aspects of IA, that is, how the body is used for self-regulation in daily life. No significant changes were observed for the Noticing aspect (becoming aware of bodily changes), which is the aspect that is predominantly assessed in other IA measures. This differential pattern underscores the importance to assess IA multi-dimensionally, particularly when interested in enhancement of IA through contemplative practice or other mind-body interventions.

The Autonomic Nervous System and Emotion

In many evolutionary/functionalist theories, emotions organize the activity of the autonomic nervous system (ANS) and other physiological systems. Two kinds of patterned activity are discussed: (a) coherence (i.e., emotions organize and coordinate activity within the ANS, and between the ANS and other response systems such as facial expression and subjective experience), and (b) specificity (i.e., emotions activate different patterns of ANS response for different emotions). For each kind of patterning, significant methodological obstacles are considered that need to be overcome before empirical studies can adequately test theories and resolve controversies. Finally, links that coherence and specificity have with health and well-being are considered.

Cardiac Perception Enhances Stress Experience

In the present study we aimed to investigate the impact of the ability to perceive bodily changes as indexed by the perception of one’s heartbeat (cardiac perception) on emotional experience when being confronted with a mental stressor. To induce stress, participants high and low in cardiac perception performed a computerized mental arithmetic test while listening to a white noise increasing in volume. Emotional experience and heart rate were assessed as indices of stress response. Our results show that participants high in cardiac perception reported more negative emotions during the stress period compared to participants low in cardiac perception, though heart rate did not differ between the groups. Our findings suggest that cardiac perception moderates the stress experience by enhancing the perceived emotion. Thus we were able to demonstrate that cardiac perception contributes as a factor explaining the variance in individuals’ emotional response to a stressor.

The relationship between sexual concordance and interoception in anxious and nonanxious women

INTRODUCTION

Sexual concordance refers to the association between physiological and self-reported sexual arousal. Women typically exhibit lower sexual concordance scores than men. There is also a sex difference in interoception--awareness of (nonsexual) physiological states or responses--such that women, compared with men, tend to be less aware of and less accurate at detecting changes in their physiological responses. Women with anxiety problems tend to have better interoceptive abilities than nonanxious women.

AIM

To investigate whether women's lower sexual concordance is associated with interoception using a sample likely to show high variation in interoceptive abilities.

METHOD

Sixteen anxious and 15 nonanxious women were presented with twelve 90 seconds sexual and nonsexual film clips while their genital response, heart rate, and respiration rate were measured. A heartbeat mental tracking task was also employed.

MAIN OUTCOME MEASURES

Genital response was measured with a vaginal photoplethysmograph. Heart rate was measured with an electrocardiogram and respiration rate with a thermistor. Participants estimated their physiological responses after each film. A mental tracking task was also used to assess participants' awareness of heart rate. Within-subject correlations were computed for each physiological/self-reported response combination.

RESULTS

Overall, sexual concordance (i.e., the correlation between genital responses and perceptions of genital response) was not significantly associated with heart rate awareness or respiration rate awareness. Anxious women did not exhibit significantly higher sexual concordance or heart rate awareness than nonanxious women; the nonanxious women actually exhibited higher respiration rate awareness.

CONCLUSION

The results suggest that sexual concordance may be a distinct phenomenon from interoception and in need of its own explanation.

Mindfulness meditation training alters cortical representations of interoceptive attention

One component of mindfulness training (MT) is the development of interoceptive attention (IA) to visceral bodily sensations, facilitated through daily practices such as breath monitoring. Using functional magnetic resonance imaging (fMRI), we examined experience-dependent functional plasticity in accessing interoceptive representations by comparing graduates of a Mindfulness-Based Stress Reduction course to a waitlisted control group. IA to respiratory sensations was contrasted against two visual tasks, controlling for attentional requirements non-specific to IA such as maintaining sensation and suppressing distraction. In anatomically partitioned analyses of insula activity, MT predicted greater IA-related activity in anterior dysgranular insula regions, consistent with greater integration of interoceptive sensation with external context. MT also predicted decreased recruitment of the dorsomedial prefrontal cortex (DMPFC) during IA, and altered functional connectivity between the DMPFC and the posterior insula, putative primary interoceptive cortex. Furthermore, meditation practice compliance predicted greater posterior insula and reduced visual pathway recruitment during IA. These findings suggest that interoceptive training modulates task-specific cortical recruitment, analogous to training-related plasticity observed in the external senses. Further, DMPFC modulation of IA networks may be an important mechanism by which MT alters information processing in the brain, increasing the contribution of interoception to perceptual experience.

Interoception

During the last two decades, research on interoception has experienced a surprising renaissance. New experimental approaches and methods have revealed much about the processing of afferent signals from the inner organs of the body, and have allowed more accurate descriptions of these processes, as well as a more accurate determination of their functional significance in the experience and behavior of humans. Besides neuromuscular, respiratory, and gastrointestinal interoceptive processes, the cardiovascular afferent influences are now known to be very important. Invariably, the central questions concern sensitivity to signals from the body, factors which may influence judgement of perception, and the degree to which conventional hypotheses regarding the interoceptive capabilities of humans may require revision. Findings from general psychological and clinical studies have shown that humans may attain remarkable levels of interoceptive performance. On the other hand, they also show how deep the chasm is between visceral processes and perception, and between that which is perceived and the reports thereof. Only interdisciplinary approaches to these complex processes promise success.

Feedback and autonomic awareness: the ability to discriminate the direction of spontaneous changes in peripheral body temperature

Forty-eight Ss were requested to discriminate spontaneous changes of at least 0.1 degree C in their peripheral finger temperature (PFT). They were randomly assigned to one of 3 groups: in the first group ("KR") Ss were given a feedback after each discrimination; in the second group ("NKR") Ss were given no feedback after each discrimination; in the third group ("RKR") Ss were given a random feedback after each discrimination. Results indicated that in the "Knowledge-of-Results" group discrimination was significantly higher than in both "No-Knowledge-of-Results" and "Random-Knowledge-of-Results" groups. Within the first group, there was a significant difference in a discrimination index between Ss "aware" and Ss "unaware" of their PFT changes, which remained significant even when the effects of individual variability of PFT and of the regularity of PFT changes were partialled out.

The relationship between cardiovascular reactivity and heartbeat detection

This experiment tested the hypothesis that inotropic cardiovascular reactivity to stress is related to performance on heartbeat discrimination tasks. The experiment also compared the efficacy of a specific modification of two popular heartbeat discrimination paradigms, Whitehead's and Katkin's. Subjects were 48 male undergraduates who performed both discrimination tasks and then were subjected to mental arithmetic stress. Results indicated that high cardiovascular reactors were better detectors than low reactors. Results also indicated that subjects performed better on the modified Whitehead task than on the modified Katkin task.

Panic attacks and interoceptive acuity for cardiac sensations

It has been suggested that perception of visceral changes, and cognitive reactions to such changes, may be important for triggering panic attacks. It remains to be determined, however, whether people with panic attacks are actually characterized by enhanced perceptual acuity for interoceptive stimuli. The purpose of this study was to explore the relationship between panic attacks and awareness for cardiac sensations using an objective heartbeat discrimination procedure. Twenty panickers and 20 nonpanickers were given 60 trials of the Whitehead heartbeat discrimination procedure. Thirty trials were given during rest and 30 following hyperventilation. Results indicated that panic attacks were not related to enhanced interoceptive acuity for cardiac sensations, either at rest or following hyperventilation. These results are discussed in terms of their relevance to cognitive models of panic.

Individual differences in the perception of bodily sensations: the role of trait anxiety and coping style

Thirty young women participated in an experiment in which heart rate, blood pressure, respiration rate, skin conductance level and palmar sweat index were monitored at rest and during the administration of mental arithmetic, mirror drawing and cold pressor tasks. The accuracy of perception of somatic states was estimated by calculating within-subject correlations between four bodily sensations (racing heart, high blood pressure, shortness of breath and sweaty hands) and corresponding physiological parameters, assessed on eight occasions during the experiment. The accuracy of heart rate perception was highest, with a mean correlation between actual heart rate and ratings of racing heart of 0.76 and 66% of participants showing significant within-subject effects. The mean accuracy was 0.55 for systolic blood pressure, 0.48 for respiration rate, 0.47 for skin conductance level, and 0.64 for palmar sweat index. Accurate perception across physiological parameters did not cluster within individuals, and was not dependent on the range either of physiological changes or sensation ratings. Trait anxiety was not significantly associated with accuracy of somatic perception. Subjects with high trait anxiety reported larger increases in shortness of breath during tasks than did low anxious subjects, but this was not reflected in objective physiological measures. Information-seeking coping style, indexed by the monitoring scale of the Miller Behavioral Style Scale, was related to the accuracy of perception of skin conductance level and heart rate. The use of within-subject correlational strategies for assessing individual differences in perception of bodily states is discussed.

The temporal locations of heartbeat sensations

This experiment examined individual differences in the temporal location of heartbeat sensations and the reliability of their detection. Following practice on a familiarization task in judging light-tone simultaneity, 50 subjects were studied for two sessions on a heartbeat detection task, which required judging the simultaneity of heartbeat sensations and tones presented at six intervals following the onset of ventricular contraction. Subjects inspected the heartbeat-tone intervals as frequently and for as long as desired before choosing the one in which heartbeat sensations and tones were most simultaneous. The temporal locations of heartbeat sensations in subjects classified as "good heartbeat perceivers" (n = 16) ranged from 131 and 363 ms following ventricular contraction (mean = 228 ms). Correlations between the familiarization and heartbeat detection tasks in the accuracy of simultaneity judgments and in the frequency and duration of interval inspections suggest that general perceptual abilities and strategies may underlie success in detecting heartbeat sensations.

Individual differences in cortical evoked potentials as a function of heartbeat detection ability

Much work has been done to assess individual differences in the ability to detect visceral activity, and most of this work has focused on heartbeat detection ability. This experiment attempted to determine if some underlying cortical event is associated with heartbeat detection ability, and further, to assess whether this cortical event is lateralized to the right hemisphere. Event-related cortical potentials, time-locked to the EKG R-wave and averaged over 400 samples, were studied at Fz, Cz, F7, and F8 in 12 subjects. The primary dependent measure of heartbeat detection accuracy was the standard deviation of the mean temporal latency, measured from peak EKG R-waves to the subjects' report of physical sensation of heartbeats. A significant relationship was found between the amplitudes of event related potentials (ERPs) in the right hemisphere and heartbeat detection accuracy.

Heartbeat perception, instructions, and biofeedback in the control of heart rate

The present study was designed to examine the possibility that individual differences in heartbeat perception and instructions to control heart rate (HR) may influence the acquisition of voluntary control. Good (n = 20) and poor (n = 20) perceivers of cardiac activity were selected on the basis of their performance according to Whitehead et al. (1977) heartbeat discrimination procedure. Measures of state and trait anxiety (the State-Trait Anxiety Inventory Form X-1 and Form X-2) and Tellegen's Absorption Scale (TAS) were used to assess emotionality and absorptive ability. Good and poor heartbeat perceivers (a) were given non-motivating instructions to try to either increase or decrease their heart rate (HR) with, or (b) without the use of HR-feedback, and (c) were given motivating instructions to try to either increase or decrease their HR with, or (d) without HR-feedback. Heart rate, skin conductance (SC), and EMG activity were monitored. Subjects were also requested to indicate the cognitive strategies used during their HR control training. No relationship between heartbeat perception and state-trait anxiety measures was found. The results did not support the idea that individual differences in heartbeat perception are related to individual differences in HR-control. They did indicate, however, that motivating instructions improve the capacity to increase or decrease HR. Subjects were able to voluntarily increase or decrease their HRs with or without a feedback signal. However, more pronounced HR increases were obtained in the feedback as compared with the no-feedback condition. SC and EMG activity were in accordance with arousal levels demanded by HR decrease and increase tasks. Subjects used cognitive strategies concerning activation responses during HR-increase and relaxation responses during HR-decrease conditions.

Heartbeat and arrhythmia perception in diabetic autonomic neuropathy

A comparative study of diabetics with autonomic neuropathy (N = 13) as against non-neuropathic diabetics (N = 16) and healthy control persons (N = 20) was carried out with respect to heart rate both at rest and under stress, frequency of cardiac arrhythmias in a 24-h ECG and accuracy of heartbeat and arrhythmia perception. In the subjects with diabetic autonomic neuropathy, the spontaneous variability and stress-induced reactivity of the heart rate as well as the number of tachycardic episodes were reduced, whereas the frequency of ventricular extrasystoles was somewhat increased. Impaired heartbeat perception and a complete loss of perception of arrhythmias as a consequence of neuropathic deafferentation could be demonstrated. Cardiac perception disorders also play a vital role in other clinical problems, e.g. silent myocardial infarction and lack of awareness of hypoglycaemia in diabetes mellitus.

Effects of paced respiration on anxiety reduction in a clinical population

The purpose of this study was to examine the effects of paced respiration on autonomic and self-report indices of affect within a clinical population. Thirty-six alcohol-dependent inpatients scoring high in trait anxiety were randomly assigned to either a pacing or attention control group. The paced subjects received 10 minutes of slow-breathing training during the first experimental session, while control subjects simply counted the pacing tones. In a second session, paced subjects were asked to breathe at the same lowered rate (10 cycles per minute) on their own, while the remaining subjects were instructed to relax. Prior to and following each session, self-ratings of tension level and state anxiety were collected. As expected, paced subjects evidenced greater reductions in self-rated tension, state anxiety, and skin conductance levels compared to the control subjects. It was concluded that respiratory pacing is an easily learned self-control strategy and potentially may be a useful therapeutic tool.

From the heart to the brain: a study of heartbeat contingent scalp potentials

Heartbeat perception has become the most widely studied example of visceral perception. In the present study scalp potentials contingent to the visceral event "heartbeat" were investigated. Scalp potentials, averaged time-locked to the EKG-R-wave, were studied at Fz, Cz, and Pz under four conditions: resting (baseline), heartbeat discrimination task, signal detection task, and heartbeat discrimination task after physical exercise. 22 subjects were assigned to the two groups "good" and "poor" perceivers, according to their performance in an initial heartbeat perception test. Event related potentials (ERPs) of "good" perceivers were more stable across conditions than those of "poor" perceivers. Peak latency within the range of 200 to 300 ms differed significantly between conditions. A principal component analysis performed on the ERP averages extracted five components. Subsequent ANOVAs across factor scores yielded significant main effects for the "groups" factor, experimental conditions and electrode sites. The strongest effects occurred over the frontal region in the latency range of 250-400 ms (following the EKG-R-wave). These were found to be not due to artifactual EKG influences.

Heart beat interoception: a study of individual differences

There were two principal aims of the study: to carry out preliminary evaluation of a novel heartbeat tracking technique for objectively measuring cardiac interoception; and to determine whether good and poor heartbeat perceivers could be differentiated with respect to other parameters reflecting individual differences in emotionality, including gender and 'emotional character'. Subjects first completed a battery of self-report questionnaires designed to measure characteristics of emotional experience, and then underwent a series of heartbeat tracking trials in which they used the index finger to tap in synchrony with their ongoing heartbeat activity (interoceptive tracking) and also with an audiotape of pre-recorded heartbeat sounds (exteroceptive tracking). The perceptual index was based on the variability of beat to tap latency. Concurrent validity findings suggested that the tracking index reflects a promising measure of cardiac interoceptive acuity. Good perceivers were found to have higher heart-rate measures than poor perceivers. With regard to 'emotional character' good perceivers had higher state anxiety, and were less emotionally expressive, although these differences were only marginally significant (P less than 0.08) with multivariate testing. Applications of the heartbeat tracking technique for further empirical evaluation of the role of interoception in emotion are discussed.

Heart rate discrimination and heart rate control: A test of Brener's theory

Three experiments were conducted to examine predictions from Brener's theory regarding the relationship between autonomic discrimination and autonomic control. Experiment 1 examined the possibility that training subjects to discriminate their heart rates would enhance their skill at controlling that response. Twenty subjects participated in two sessions during which one group of 10 subjects received training (knowledge of results) on the Ashton discrimination technique. The second group performed the discrimination task but received no training. All subjects then took part in a third session of heart rate (HR) control (both increase and decrease) where half of each of the aforementioned groups received feedback during the control task, while the other half performed the HR control task without feedback. Results indicated that for the control of both HR increases and decreases, there was no significant difference between those subjects trained to discriminate their HR, and those who had received no training to discriminate HR. The second experiment investigated the hypothesis that training subjects with feedback to control their HR would enhance their capacity to discriminate their heart activity. Ten subjects participated in two sessions of HR control during which half the subjects received feedback training to increase HR. During a third session, all subjects underwent a test of discrimination ability using the Ashton technique, and no knowledge of results regarding performance was provided. Results confirmed the hypothesis. The final experiment in the series investigated the discrimination/control relationship within a problem-solving framework and used 20 subjects. Results confirmed the hypothesis that subjects forewarned at the time of discrimination training that a heart rate control task was to follow would perform better than 10 subjects receiving no forewarning of the task objective. This effect took place independently of cardiac discrimination ability. A second finding from this experiment was that subjects trained to discriminate heart rate were better able to increase heart rate than untrained subjects. This result contradicts that of Experiment 1, and reasons for this anomaly are discussed in detail.