The link between interoceptive processing and anxiety in children diagnosed with autism spectrum disorder: Extending adult findings into a developmental sample

The relationship between sleep and interoception

The present study aimed to characterise the relationship between sleep and interoception in two independent studies. Theoretical grounds for such a relationship include a weak relationship between subjectively- and objectively-measured sleep, the covariance of sleep with pain, as well as the mass regulation of a number of visceral biological systems. In addition, such a relationship is often reflected in our language (i.e., 'feeling' tired). In both studies (Study 1: N = 118, 73% female, mean age 20.98 years; Study 2: N = 830, 49% female, mean age 38.04 years) sleep over the last month was self-reported. Confidence in interoceptive accuracy, which is the precision with which a person can monitor visceral signals, was measured using the Interoceptive Accuracy Scale, while interoceptive attention, which is the dispositional tendency to attend to bodily signals, was measured using the Body Perception Questionnaire. Study 1 revealed a relationship between long sleep latency and low confidence in interoceptive accuracy (β = -0.222, p = 0.021) and poor sleep quality and less interoceptive attention (β = -0.226, p = 0.016). Study 2 replicated these results as well as made clear a more general pattern whereby poor sleep-characterised by short duration, poor quality, less efficiency, long latency, and more frequent nighttime awakenings-related to an interoceptive phenotype of less confidence in interoceptive accuracy and more interoceptive attention (all β ≥ 0.047, p ≤ 0.17). In conclusion, results from these two independent studies provide robust cross-sectional evidence for associations between various dimensions of poor sleep and greater interoceptive attention, but less confidence in interoceptive accuracy.

Experiences of interoception and anxiety in autistic adolescents: A reflexive thematic analysis

Most autistic adolescents experience anxiety. Interoception, defined as one's ability to detect and interpret bodily signals, might contribute to this. The aim of this exploratory, qualitative study was to gain a better understanding of interoceptive experiences in autistic adolescents and how this relates to anxiety. Semi-structured 1:1 interviews were conducted with 13 UK-based, autistic adolescents, aged 14-17 years, who reported experiencing significant, day-to-day anxiety. Interviews were analysed using a reflexive thematic analysis approach. Interoception appeared relevant to experiences of anxiety in most participants, although this influence was exerted through various routes. While hypoawareness of interoceptive signals led to a reduced ability to detect and regulate anxiety, hyperawareness became overwhelming and anxiety-inducing. Overly negative evaluations of interoceptive signals, including catastrophising about the signals indicating danger, also triggered anxiety. Relationships between interoception and anxiety appeared bidirectional, with anxiety also affecting interoceptive awareness and evaluation. Interoceptive experiences were variable both across and within participants, with factors such as arousal and cognitive overload affecting experiences. Future research should focus on assessing the feasibility of interventions based on the mechanisms identified here.Lay abstractAnxiety is common in autistic adolescents. The detection and interpretation of signals coming from inside the body (e.g. heartbeat and hunger) is assumed to be related to both anxiety and autism. We interviewed 13 autistic 14- to 17-year-olds who reported experiencing significant anxiety, to explore the role that bodily signals played in their experiences of anxiety. Across most participants, there did appear to be a relationship, although the exact way it was related varied. When participants were very aware of bodily signals, they could become overwhelming, but if they were not aware at all, then it was difficult for them to notice themselves getting anxious until it was too late. If participants interpreted these signals negatively, for example, assuming the signals meant something was wrong with their body, they were also more likely to feel anxious. Whether participants were aware or negatively evaluated these signals was very variable and appeared to be context-dependent.

The role of mastery in Crohn's disease: a cross-sectional study

Background

Crohn's disease (CD) is a chronic autoimmune inflammatory bowel disease. It is estimated that approximately 40% of individuals with CD are non-adherent to medical prescriptions. This lack of adherence to treatment plans has been linked to an increased risk of hospitalisation and surgical procedures, which can have a detrimental impact on the patient's quality of life (QoL). Furthermore, the CD can impose significant stress on individuals, affecting their mental health and sense of mastery. The term 'mastery' is used to describe an individual's awareness of their abilities and capacities that are essential for effectively managing life events and situations.

Objectives

This study aimed to investigate the role of mastery in relation to medical adherence, distress, perceived social support, QoL, depressive and anxious symptoms and interoception in persons with a diagnosis of CD.

Design

This is a cross-sectional study, involving 261 adults diagnosed with CD.

Methods

Participants completed an online questionnaire comprising validated clinical and psychological scales, which lasted approximately 20 min. Participants were permitted to provide their most recently available medical report.

Results

Patients with CD reported discrete levels of mastery. Two factorial ANOVA highlighted statistically significative differences in mastery in relation to clinical conditions (F(2, 253) = 11.22, p < 0.001) and a significative interaction effect between gender and symptomatology (F(2, 253) = 7.22, p < 0.001). Multiple linear regression illustrated a statistically significant association between mastery, clinical conditions, QoL, stress and interoception (adjusted R square = 0.558; F(14, 211) = 21.32, p < 0.001). Concerning the possible mediator role of mastery between psychological state and medical adherence, no statistically significant results emerged from the mediation model analysis.

Conclusion

This study highlighted an effective impairment of mastery in CD patients, especially among men experiencing mild disease activity. A positive association between mastery and enteroception was outlined. The higher prevalence of distress, anxiety and depressive symptoms connected to mastery was substantiated. Future research should deepen the relationship between mastery with medical adherence.

Sensory Processing and Anxiety: Within and Beyond the Autism Spectrum

In this article, we briefly overview how the expression, measurement, and treatment of anxiety in autism may be different from the general population. We review the literature on links between sensory processing differences and anxiety, which show transdiagnostic patterns but are an especially prominent feature of anxiety in autism. Specifically, we focus on how the sense of interoception, i.e., how we perceive sensory information from within our bodies, contributes to anxiety in autism. We present new findings integrating multimodal interoceptive measures and total anxiety symptoms in a sample of n = 38 non-autistic and n = 43 autistic individuals, ages 8-55 years. Using principal components analysis, we found two components relating to interoceptive confusion (i.e., self-reported ability to localize and interpret interoceptive cues): one component that closely relates to anxiety symptoms and one component that is distinct from anxiety. Interoceptive perception (i.e., performance on a lab-based task) was uniformly related to interoceptive confusion when distinguished from anxiety but showed complex relations with total anxiety symptoms. Combined, these findings suggest meaningful subtypes of interoceptive difficulties and their interrelationship with anxiety. We present conclusions and future directions for consideration of individual differences, toward creating a personalized understanding of anxiety-interoception links.

The relationship between self-reported interoception and anxiety: A systematic review and meta-analysis

Interoception, the processing of internal bodily sensations, is associated with various mental health conditions. In particular, anxiety is often considered to be the prototypical interoceptive disorder. However, empirical evidence is mixed, with meta-analytic work reporting no relationship between anxiety and cardiac interoceptive accuracy. Less explored, however, are the mixed results relating to anxiety and self-reported interoception. This meta-analysis of 71 studies explored the relationship between self-report measures of interoception and anxiety. Across 12 measures (20 subscales), anxiety was associated with increased negative evaluations of, frequency of, and sensitivity to, bodily signals. Anxiety was also associated with greater (negative) attention to bodily signals, and difficulties describing bodily signals and emotions. However, anxiety was not associated with the use of bodily signals to inform emotions (e.g., noticing emotionally induced bodily signals). Results are discussed considering the overlap between anxiety and interoception questionnaires, the lack of specificity of certain measures, and the potential confound of individual differences in questionnaire interpretation. We also discuss limitations of anxiety measures and the clinical relevance of findings.

Relationship Between Interoception and Autistic Traits: A Resting-State Functional Connectivity Study

Interoception, the sense of the physiological condition of our body, is impaired in individuals with autism spectrum disorders. Evidence suggests that subclinical autistic traits are mild manifestations of autistic symptoms, present in the general population. We examined the resting-state functional connectivity (rsFC) associating with interoception and autistic traits in 62 healthy young adults. Autistic traits correlated negatively with the rsFC between the lateral ventral anterior insula and anterior cingulate cortex. Interoceptive accuracy and sensibility correlated positively with the rsFC between interoceptive brain networks and the cerebellum, supplementary motor area, and visual regions. The results suggest that a negative relationship between interoception and autistic traits is largely accounted for by both self-report measures and decreased rsFC amongst the interoceptive brain network.

Interoception in anxiety, depression, and psychosis: a review

Research has examined the relationship between interoception and anxiety, depression, and psychosis; however, it is unclear which aspects of interoception have been systematically examined, what the combined findings are, and which areas require further research. To answer these questions, we systematically searched and narratively synthesised relevant reviews, meta-analyses, and theory papers (total n = 34). Existing systematic reviews and meta-analyses (anxiety n = 2; depression n = 2; psychosis n = 0), focus on cardiac interoceptive accuracy (heartbeat perception), and indicate that heartbeat perception is not systematically impaired in anxiety or depression. Heartbeat perception might be poorer in people with psychosis, but further evidence is needed. Other aspects of interoception, such as different body systems and processing levels, have been studied but not systematically reviewed. We highlight studies examining these alternative bodily domains and levels, review the efficacy of interoception-based psychological interventions, and make suggestions for future research.

Funding

Wellcome Trust UK.

The neurobiology of interoception and affect

Scholars have argued for centuries that affective states involve interoception, or representations of the state of the body. Yet, we lack a mechanistic understanding of how signals from the body are transduced, transmitted, compressed, and integrated by the brains of humans to produce affective states. We suggest that to understand how the body contributes to affect, we first need to understand information flow through the nervous system's interoceptive pathways. We outline such a model and discuss how unique anatomical and physiological aspects of interoceptive pathways may give rise to the qualities of affective experiences in general and valence and arousal in particular. We conclude by considering implications and future directions for research on interoception, affect, emotions, and human mental experiences.

The relationship between subjective difficulty in interoceptive processing and accuracy of heartbeat perception in autistic individuals

Most autistic people experience difficulties in sensory processing, including interoceptive processing. For example, they often report subjective difficulties in the interoceptive processing of interoceptive input, such as difficulty in interpreting bodily signals, including hunger, thirst, and fatigue. However, whether these subjective interoceptive difficulties are from underlying problems in interoceptive accuracy remains unclear. This study investigated the relationship between subjective interoceptive difficulty and behavioral interoceptive accuracy in autistic adults and a control group. Subjective interoceptive accuracy was measured using an interoceptive sensitivity questionnaire, and behavioral interoceptive accuracy was measured using a heartbeat counting task. The results showed no significant relationship between subjective interoceptive difficulty and behavioral interoceptive accuracy in the autistic or control groups. This suggests that subjective interoceptive difficulty and behavioral interoceptive accuracy reflect different aspects of interoceptive processing. One possible interpretation is that autistic adults can identify individual local sensory inputs, such as heartbeats, however, they have difficulty integrating multiple inputs and recognizing internal body states such as hunger and fatigue.

Interactive relationship between alexithymia, psychological distress and posttraumatic stress disorder symptomology across time

Alexithymia, psychological distress, and posttraumatic stress disorder (PTSD) are highly related constructs. The ongoing debate about the nature and relationship between these constructs is perpetuated by an overreliance on cross-sectional research. We examined the longitudinal interactive relationship between alexithymia, psychological distress, and PTSD. We hypothesised that there is an interactive relationship between the three constructs. Military personnel (N = 1871) completed the Toronto Alexithymia Scale, the Kessler 10 and a PTSD Checklist (PCL-C) at pre-deployment, post-deployment, and at 3-4 years following the post-deployment assessment. We initially tested whether psychological distress is either a moderator or mediator in the relationship between alexithymia and PTSD across the time points. General psychological distress was a partial mediator of total PTSD severity and hyperarousal symptomology at all three time points. Psychological distress fully mediated re-experiencing and avoidance symptomology at all three time points. Our results suggest that those with alexithymia are at longitudinal risk of developing more severe PTSD symptomology and experiencing hyperarousal irrespective of temporal proximity to traumatic exposure. Further, vulnerability to the emergence of re-experiencing and avoidance symptomology for those with alexithymia is increased when one experiences greater distress. Our results show that alexithymia is a persistent risk factor for PTSD symptomology.

Assessment of Sensory Processing Issues in Children with Neurodevelopmental Disorders and Experiences of Maltreatment

This study aims to identify the sensory characteristics of children with both developmental disabilities such as ASD and ADHD and a history of child maltreatment (DM group), children with developmental disabilities (DD group), and typically developed children (TD group). The sensory characteristics of 24 children were assessed through virtual reality and self-administered questionnaires. The results elucidated that the duration of gazing at the "teacher" (60-75 s) was significantly different with the DM group's gaze being shorter than the DD group's gaze (p = 0.042). The duration of the "others" gaze (45-60 s) was also significantly different with the DM group's gaze being longer than the DD and TD groups' gaze (p = 0.018; p = 0.030). Additionally, the scores for tactile sensitivity, taste/smell sensitivity, under-responsive/seeks sensation, and the total short-term sensory profile were significantly different between the DM-DD and DD-TD groups. The scores of the heart rate perception test and Multidimensional Assessment of Interoceptive Awareness were significantly lower in the DM and DD groups. In conclusion, children who have experienced trauma and developmental disabilities may have different sensory characteristics than children with only developmental disabilities or none, implying the need for further research and tailored care.

From synaptic dysfunction to atypical emotional processing in autism

Autism spectrum disorder (ASD) is a complex neurodevelopmental condition mainly characterized by social impairments and repetitive behaviors. Among these core symptoms, a notable aspect of ASD is the presence of emotional complexities, including high rates of anxiety disorders. The inherent heterogeneity of ASD poses a unique challenge in understanding its etiological origins, yet the utilization of diverse animal models replicating ASD traits has enabled researchers to dissect the intricate relationship between autism and atypical emotional processing. In this review, we delve into the general findings about the neural circuits underpinning one of the most extensively researched and evolutionarily conserved emotional states: fear and anxiety. Additionally, we explore how distinct ASD animal models exhibit various anxiety phenotypes, making them a crucial tool for dissecting ASD's multifaceted nature. Overall, to a proper display of fear response, it is crucial to properly process and integrate sensorial and visceral cues to the fear-induced stimuli. ASD individuals exhibit altered sensory processing, possibly contributing to the emergence of atypical phobias, a prevailing anxiety disorder manifested in this population. Moreover, these individuals display distinctive alterations in a pivotal fear and anxiety processing hub, the amygdala. By examining the neurobiological mechanisms underlying fear and anxiety regulation, we can gain insights into the factors contributing to the distinctive emotional profile observed in individuals with ASD. Such insights hold the potential to pave the way for more targeted interventions and therapies that address the emotional challenges faced by individuals within the autism spectrum.

Characterizing Interoceptive Differences in Autism: A Systematic Review and Meta-analysis of Case-control Studies

Interoception, the body's perception of its own internal states, is thought to be altered in autism, though results of empirical studies have been inconsistent. The current study systematically reviewed and meta-analyzed the extant literature comparing interoceptive outcomes between autistic (AUT) and neurotypical (NT) individuals, determining which domains of interoception demonstrate robust between-group differences. A three-level Bayesian meta-analysis compared heartbeat counting performance, heartbeat discrimination performance, heartbeat counting confidence ratings, and self-reported interoceptive attention between AUT and NT groups (15 studies; nAUT = 467, nNT = 478). Autistic participants showed significantly reduced heartbeat counting performance [g = - 0.333, CrI95% (- 0.535, - 0.138)] and higher confidence in their heartbeat counting abilities [g = 0.430, CrI95% (0.123, 0.750)], but groups were equivalent on other meta-analyzed outcomes. Implications for future interoception research in autism are discussed.

Validation of the Japanese version of the Interoception Sensory Questionnaire for individuals with autism spectrum disorder

The Interoception Sensory Questionnaire (ISQ) is a self-report instrument used to assess the characteristics of interoceptive processing in individuals with autism spectrum disorder (ASD). Previous studies have shown that scores of the ISQ are more appropriate than other subjective measures for evaluating difficulties in interoceptive processing in individuals with ASD. Yet, no prior research has demonstrated the validation of the ISQ in Japanese samples. This study attempted to validate the Japanese version of the ISQ (ISQ-J) by examining its psychometric properties. We confirmed the score distribution, internal consistency, and factor structure in Japanese samples. We also examined the relationships with other interoceptive questionnaires. In addition, we compared the scores of the ISQ-J between adolescents and adults with ASD participants and control participants. Results of confirmatory factor analyses showed that the reliability of the ISQ-J in adults with ASD reached an acceptable level of a one-factor structure with excellent internal consistency (α = 0.963). The result of the ISQ-J showed a significant positive correlation with the measure of awareness of interoceptive sensitivity for localized bodily states; on the other hand, a significant negative correlation was found with those integrated bodily states. In addition, the ISQ-J scores were significantly higher in the ASD group than in the control group. The current findings depend on self-report data (including a diagnosis of ASD) to measure validity constructs. Additionally, since the ISQ-J was surveyed in adults with ASD, it is unclear whether similar the results would be obtained if the ISQ-J were conducted with children. These results indicate the validity and reliability of the ISQ-J and provide a tool for assessing confusion of interoceptive information in Japanese adults with ASD.

The Differential Relationship Between Self-Reported Interoceptive Accuracy and Attention With Psychopathology

Abstract. Background: Only recently has interoception been discussed as a common risk factor for psychopathology. Recent approaches distinguish between the ability to accurately perceive ( interoceptive accuracy) and the propensity to attend ( interoceptive attention) to internal signals. Objective: To examine the latent structure of self-reported interoceptive accuracy and attention and their relationships to psychopathology. Methods: We used a confirmatory factor analysis to clarify the latent structure of interoceptive accuracy and attention. Structural equation modeling was utilized to determine relationships between both abilities with internalizing and somatoform symptomatology according to the HiTOP model ( Kotov et al., 2017 ). Data from N = 619 persons from the German general population were analyzed. Results: Interoceptive attention showed significant positive relationships with all psychopathological traits ( r = .221 to r = .377), whereas interoceptive accuracy was negatively associated with internalizing symptomatology ( r = -.106). Conclusion: The present findings indicate that personal beliefs about interoceptive abilities have different influences on psychopathological developments.

The relationship between school-age children’s interoceptive awareness and executive functioning: An exploratory study

Introduction:

Independently, interoceptive awareness and executive functioning play major roles in children’s abilities to engage in their daily occupations. This study investigated the potential relationship between neurotypical school-age children’s interoceptive awareness and executive functioning.

Method:

A convenience sample of 30 children (8–12 years) completed the Multidimensional Assessment of Interoceptive Awareness–youth and one of their parents completed the Behaviour Rating Inventory of Executive Function® – Second Edition (BRIEF®2). Spearman rho correlations and linear regression analyses with bootstrapping were completed.

Results:

The Multidimensional Assessment of Interoceptive Awareness–youth Emotional Awareness aspect of interoceptive awareness was significantly correlated with and predictive of the following BRIEF®2 executive functioning components: Emotion Regulation Index (ρ = 0.402, R2 = 0.888, p < 0.001), Cognitive Regulation Index (ρ = 0.364, R2 = 0.256, p < 0.001) and the Global Executive Composite (ρ = 0.049, R2 = 0.128, p < 0.012), as well as the following subscales: Organisation of Materials (ρ = 0.422, R2 = 0.150, p < 0.020), Working Memory (ρ = 0.393, R2 = 0.085, p < 0.033), Emotional Control (ρ = 0.394, R2 = 0.176, p < 0.002) and Inhibit (ρ = 0.373, R2 = 0.141, p < 0.003).

Conclusion:

It appears that there is a significant and predictive relationship between neurotypical children’s interoceptive awareness and aspects of their executive functioning.

Relations among parent-reported physical activity and interoception in children

BACKGROUND

Interoception is the sense of one's internal body and emotional state; it plays a critical role in guiding self-regulatory behaviors. Physical activity (PA) can support interoceptive processes, but limited research has examined the association in children. This study explored the relations among parent-reported PA and several interoceptive domains in children aged 3 - 10 years old.

METHODS

Baseline data were analyzed from a cluster-randomized controlled study examining a yoga intervention (N = 122). Parents completed a questionnaire that included the Caregiver Questionnaire for Interoceptive Awareness, Second Edition (CQIA-2) and two measures of PA, the PROMIS Parent-Proxy Short Form (PROMIS-PA) and the adapted Burdette Proxy Report (aBPR-PA). Psychometrics of the CQIA-2 subscales were assessed and then used in subsequent analyses to examine the association between PA and interoceptive sensibility.

RESULTS

Seventy percent of the surveys were completed by mothers (30% by fathers), and their children (56% female, M_age = 5.81 ± 1.7 years) were predominately white. Across all children, PA had a significant positive relationship with interoceptive domains related to emotion and physical energy (p < 0.01). Children who met the PROMIS-PA "good" cutoff had a clearer sense of emotion and physical energy (F(2,115) = 4.30, p = 0.016, R² = 0.070), compared to children who did not. Children's age predicted interoceptive sensibility of illness and toileting needs (F(1,116) = 14.16, p < 0.001, R² = 0.109).

CONCLUSION

Children with higher PA levels were perceived to have better interoceptive sensibility of emotion and physical energy. Children's age was predictive of interoceptive domains representing the awareness of illness and toileting needs. Future work should consider incorporating direct measures of PA and child-reported interoceptive sensibility. A better understanding of their relationship will likely help guide the design of more effective interventions for health behavior development.

Early Sensory Profile in Autism Spectrum Disorders Predicts Emotional and Behavioral Issues

Background: Abnormal sensory reactivity is considered one of the diagnostic criteria for autism spectrum disorders (ASD) and has been associated with autism severity, poorer functional outcomes, and behavioral difficulties across the lifespan. Its early characterization could provide valuable insights into the processes favoring the instantiation of maladaptive behaviors. Objectives: The present study has two aims: (1) to describe the sensory profile of preschool children with ASD compared with an age-matched population of children with a diagnosis of language disorder (DLD) and typically developing (TD) control peers; (2) to explore within each group whether the sensory alterations play a predictive role in the instantiation of emotional and behavioral issues. Methods: The parents of 42 ASD, 18 DLD, and 56 TD filled out the Sensory Processing Measure—Preschool (SPM-P). To gather information on competencies, behaviors, and emotional problems of children, the Child Behavior Checklist 1½-5 (CBCL 1½-5) was also administered. Results: On the SPM-P, ASD and DLD samples generally had scores more compromised than control peers. The contrast between ASD and DLD was reflected in a higher (and highly significant) impairment on the social participation and hearing subscales, suggesting a greater sensitivity and a possible specificity of these scores for ASD. More importantly, linear regression analyses revealed a strong and predictive association for ASD children with SPM total scores explaining more than 50% of the variance of the CBCL 1½-5 total scores (p < 0.001). Conclusions: Our findings reinforce the need to detect the abnormal sensory profiles of ASD already at an early stage and during clinical evaluations. Due to the impact on the emotional and behavioral manifestations, such a procedure has significant clinical and social implications, potentially guiding the development of new interventions relying on multisensory strategies.

Interoceptive pathways to understand and treat mental health 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.

Rhesus monkeys have an interoceptive sense of their beating hearts

SignificanceThe capacity to sense interoceptive signals is thought to be fundamental to broad functions including, but not limited to, homeostasis and the experience of the self. While neuroanatomical evidence suggests that nonhuman animals-namely, nonhuman primates-may possess features necessary for interoceptive processing in a way that is similar to humans, behavioral evidence of this capacity is slim. We presented macaques with audiovisual stimuli that were either synchronous or asynchronous with their heartbeat and demonstrated that they view asynchronous stimuli, whether faster or slower, for a significantly longer period than they do synchronous stimuli.

The role of interoception in the overlap between eating disorders and autism: Methodological considerations

Significant comorbidity has been demonstrated between feeding and eating disorders and autism. Atypical interoception (perception of bodily signals) may, at least in part, be responsible for this association, as it has been implicated in the aetiology of both conditions. However, significant methodological limitations are impeding progress in this area. This paper provides a brief overview of how interoception has been linked to autism and feeding and eating disorders in both adolescent and adult populations before identifying several issues with current measures of interoception. We suggest that methodological issues may be contributing to the inconsistency in the empirical literature, and provide suggestions for future research.

Atypical interoception is linked to both feeding and eating disorders, and autism and may contribute to the comorbidity between the two.

Existing measures of interoception across cardiac, gastric and respiratory domains are severely limited.

Novel and better‐validated measures of interoception will allow us to better understand the clinical potential of interoceptive training.

Anxiety and Trauma-Related Disorders in Children on the Autism Spectrum

PURPOSE OF REVIEW

To summarize recent findings regarding anxiety and trauma-related disorders in children diagnosed with autism spectrum disorder (autism), focusing on the distinct ways in which these conditions may be expressed, as well as advances in evidence-based assessment and treatment.

RECENT FINDINGS

Current findings suggest both anxiety and trauma-related disorders may be more prevalent, yet more complicated to address in autistic relative to non-autistic children. Overlapping symptoms and distinct manifestations of these disorders pose challenges for the accurate identification, assessment, and treatment of anxiety and trauma-related disorders in autistic children. Emerging evidence recommends adapting traditional assessment and treatment approaches to better meet the needs of autistic children. Recent research suggests autism-centered conceptualizations, which accommodate complexity in how anxiety and trauma-related disorders are experienced and expressed by autistic people, are needed to enhance the psychiatric care of this population.

What do measures of self-report interoception measure? Insights from a systematic review, latent factor analysis, and network approach

Recent conceptualizations of interoception suggest several facets to this construct, including "interoceptive sensibility" and "self-report interoceptive scales", both of which are assessed with questionnaires. Although these conceptual efforts have helped move the field forward, uncertainty remains regarding whether current measures converge on their measurement of a common construct. To address this question, we first identified -via a systematic review- the most cited questionnaires of interoceptive sensibility. Then, we examined their correlations, their overall factorial structure, and their network structure in a large community sample (n = 1003). The results indicate that these questionnaires tap onto distinct constructs, with low overall convergence and interrelationships between questionnaire items. This observation mitigates the interpretation and replicability of findings in self-report interoception research. We call for a better match between constructs and measures.

A Preliminary Study of Assessing Gaze, Interoception and School Performance among Children with Neurodevelopmental Disorders: The Feasibility of VR Classroom

Children with developmental disabilities (DDs) have sensory modulation disorders that interrelate school performance. Virtual reality (VR) has demonstrated the potential to become a neuropsychological assessment modality. This study was conducted to explore the feasibility of the VR classroom for assessing their characteristics of gaze, school performance, and interoception. School-aged children were assigned to the DD group or control group. A VR classroom was designed to evaluate their gaze patterns to distracting events. Interoception was assessed using the Heart Rate Perception test and the Multidimensional Assessment of Interoceptive Awareness (MAIA). The DD group had a significantly longer gaze duration on the virtual teacher during 30–45 s of the VR classroom event (p < 0.05). The mean score of the quiz and the Heart Rate Perception test showed a significant tendency to be lower than the children of the control group. The DD group scored significantly lower in six of eight subscales of the MAIA. These results showed the potential of VR classroom to evaluate the difference of sensory modulation between school-aged children with DDs and typically developed children. Future research is necessary to investigate the validity of the VR environment used in this study.

Decreased interoceptive accuracy in children with autism spectrum disorder and with comorbid attention deficit/hyperactivity disorder

Interoception refers to the awareness of internal physiological state. Several previous studies reported that people with autism spectrum disorders (ASD) and adults with attention-deficit/hyperactivity disorder (ADHD) have diverse patterns of interoception, but the extent of literature is limited and inconsistent. This study aimed to investigate the interoceptive accuracy (IA) in children with ASD, children with comorbid ASD and ADHD, and typically developing (TD) children with high and low levels of autistic traits. We administered the eye-tracking interoceptive accuracy task (EIAT) to 30 children with ASD, 20 children with comorbid ASD and ADHD, and 63 TD controls with high and low levels of autistic traits. Parent-report scales concerning ASD and ADHD symptoms were collected. ASD children with and without comorbid ADHD both exhibited lower IA than TD children. Reduced IA was also found in TD children with high-autistic traits relative to those with low-autistic traits. IA was negatively correlated with autistic and ADHD symptoms. Atypical cardiac interoception could be found in children with ASD. Difficulties in sensing and comprehending internal bodily signals in childhood may be related to both ASD and ADHD symptoms.

Altered Interoceptive Sensibility in Adults With Chronic Tic Disorder

BACKGROUND

Interoception refers to the sensing, interpretation, integration, and regulation of signals about the body's internal physiological state. Interoceptive sensibility is the subjective evaluation of interoceptive experience, as assessed by self-report measures, and is abnormal in numerous neuropsychiatric disorders. Research examining interoceptive sensibility in individuals with chronic tic disorders (CTDs), however, has yielded conflicting results, likely due to methodologic differences between studies and small sample sizes.

OBJECTIVE

We sought to compare interoceptive sensibility between adults with CTD and healthy controls, adjusting for co-occurring psychiatric symptoms, and to examine the relationship of interoceptive sensibility with other CTD clinical features, in particular, premonitory urge.

METHODS

We recruited adults with CTDs and sex- and age-matched healthy controls to complete the Multidimensional Assessment of Interoceptive Awareness, Version 2 (MAIA-2), as well as a battery of measures assessing psychiatric symptoms prevalent in CTD populations. CTD participants additionally completed scales quantifying tic severity, premonitory urge severity, and health-related quality of life. We conducted between-group contrasts (Wilcoxon rank-sum test) for each MAIA-2 subscale, analyzed the effect of psychiatric symptoms on identified between-group differences (multivariable linear regression), and examined within-group relationships between MAIA-2 subscales and other clinical measures (Spearman rank correlations, multivariable linear regression).

RESULTS

Between adults with CTD (n = 48) and healthy controls (n = 48), MAIA-2 Noticing and Not-Worrying subscale scores significantly differed. After adjusting for covariates, lower MAIA-2 Not-Worrying subscale scores were significantly associated with female sex (β = 0.42, p < 0.05) and greater severity of obsessive-compulsive symptoms (β = -0.028, p < 0.01), but not with CTD diagnosis. After adjusting for severity of tics and obsessive-compulsive symptoms, a composite of MAIA-2 Noticing, Attention Regulation, Emotional Awareness, Self-Regulation, Body Listening, and Trusting subscales (β = 2.52, p < 0.01) was significantly associated with premonitory urge.

CONCLUSION

Study results revealed three novel findings: adults with CTD experience increased anxiety-associated somatization and increased general body awareness relative to healthy controls; anxiety-associated somatization is more closely associated with sex and obsessive-compulsive symptoms than with CTD diagnosis; and increased general body awareness is associated with greater severity of premonitory urges.

Dissociations between self-reported interoceptive accuracy and attention: evidence from the interoceptive attention scale

Models of interoception highlight the importance of considering participants' beliefs regarding their interoceptive ability. Research focusing on such beliefs suggests a dissociation between self-reported interoceptive accuracy and attention. However, it remains unclear whether such dissociations are driven by differences in the sensations rated across these questionnaires, or a genuine dissociation between different facets of self-reported interoception. Here we examined the relationship between self-report measures of interoceptive accuracy and attention using a novel measure- the Interoceptive Attention Scale- designed to match the interoceptive sensations included in an existing questionnaire measure of interoceptive accuracy. In addition, we examined whether the interpretation of questionnaire measures of interoception altered associations across measures. Results support the proposed distinction between self-reported interoceptive attention and accuracy and highlight the importance of considering the interpretation of questionnaire measures of interoception. The implications of these findings for theory, future research, and interpretation of existing research are discussed.

Exploring the Cognitive Model of Social Anxiety in Autistic Young People-The Central Role of Bodily Symptoms

We explored the role of negative performance beliefs and self-focused attention considered central to psychological models of social anxiety but not studied in autism. Firstly, we compared self- and observer ratings of performance on a social task for 71 young autistic people, 41 high and 30 low in social anxiety, finding a significant main effect of social anxiety but not rater. Subsequently, 76 autistic young people, 46 high and 30 low social anxiety completed measures of interoceptive sensibility and focus of attention following a social task. Only heightened interoceptive sensibility fully mediated the relationship between self-ratings of social performance and social anxiety. These findings suggest awareness of bodily sensations are critical to anxiety in social situations with implications for treatment.

Sex differences in interoceptive accuracy: A meta-analysis

Interoceptive accuracy, the ability to correctly perceive internal signals arising from the body, is thought to be disrupted in numerous mental and physical health conditions. Whilst evidence suggests poorer interoceptive accuracy in females compared to males, raising the possibility that interoceptive differences may relate to sex differences in mental and physical health, results concerning sex differences in interoceptive accuracy are mixed. Given such ambiguity, this meta-analysis aimed to establish the presence or absence of sex differences in interoceptive accuracy across cardiac, respiratory, and gastric domains. A review of 7956 abstracts resulted in 93 eligible studies. Results demonstrated superior accuracy in males across cardiac, but not gastric, tasks, while findings on respiratory tasks were mixed. Effect sizes were consistent across cardiac tasks, but instability and/or moderate heterogeneity was observed across other domains, likely due to the small number of eligible studies. Despite such limitations, results indicate the possibility of sex differences across interoception tasks and domains. Methodological limitations concerning the influence of physiological factors, and directions for future research are discussed.

Atypical interoception as a common risk factor for psychopathology: A review

The inadequacy of a categorial approach to mental health diagnosis is now well-recognised, with many authors, diagnostic manuals and funding bodies advocating a dimensional, trans-diagnostic approach to mental health research. Variance in interoception, the ability to perceive one's internal bodily state, is reported across diagnostic boundaries, and is associated with atypical functioning across symptom categories. Drawing on behavioural and neuroscientific evidence, we outline current research on the contribution of interoception to numerous cognitive and affective abilities (in both typical and clinical populations), and describe the interoceptive atypicalities seen in a range of psychiatric conditions. We discuss the role that interoception may play in the development and maintenance of psychopathology, as well as the ways in which interoception may differ across clinical presentations. A number of important areas for further research on the role of interoception in psychopathology are highlighted.

Interoceptive training to target anxiety in autistic adults (ADIE): A single-center, superiority randomized controlled trial

BACKGROUND

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

METHODS

In this superiority randomized controlled trial, autistic adults (18-65 years) from clinical and community settings in Southern England were randomly assigned (1:1) to receive six sessions of ADIE or an active 'exteroceptive' control therapy (emotional prosody identification). Researchers conducting outcome assessments were blind to allocation. ADIE combines two modified heartbeat detection tasks with performance feedback and physical activity manipulation that transiently increases cardiac arousal. Participants were followed-up one-week (T1) and 3-months post-intervention (T2). The primary outcome was Spielberger Trait Anxiety Score (STAI-T) at T2. Outcomes were assessed on an intention-to-treat basis using multiple imputation for dealing with missing values. This trial was registered at International Standard Randomized Controlled Trial Registry, ISRCTN14848787.

FINDINGS

Between July 01, 2017, and December 31, 2019, 121 participants were randomly allocated to ADIE (n = 61) or prosody (n = 60) intervention groups. Data at T1 was provided by 85 (70%) participants (46 [75%] ADIE; 39 [65%] prosody). Data at T2 was provided by 61 (50%) participants (36 [59%] ADIE; 25 [42%] prosody). One adverse event (cardiac anxiety following ADIE) was recorded. A statistically significant group effect of ADIE on trait anxiety continued at T2 (estimated mean difference 3•23 [95% CI 1•13 to 5•29]; d = 0•30 [95% CI 0•09 to 0•51]; p = 0•005) with 31% of ADIE group participants meeting trial criteria for recovery (compared to 16% in the control group).

INTERPRETATION

ADIE can reduce anxiety in autistic adults, putatively improving regulatory control over internal stimuli. With little reliance on language and emotional insight, ADIE may constitute an inclusive intervention.

FUNDING MQ

Transforming Mental Health PsyImpact Grant.

Measuring interoception: The phase adjustment task

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.

Interactions between interoception and perspective-taking: Current state of research and future directions

Interoception, the sense of the physiological state of the body, and perspective-taking, the ability to take another's point of view, are two fundamental components contributing to our perception and interaction with the external world. However, whether the perception of our inner body influences how we perceive the external world and other people remains poorly understood. Here, we review recent behavioural and neuroimaging evidence investigating the links between dimensions of interoception (i.e., accuracy, sensibility and awareness) and perspective-taking (i.e., affective, cognitive and visual). So far, only a limited subset of these dimensions has been investigated together and the results suggest that interoceptive abilities may only interact with perspective-taking when embodied mental transformations are required. Furthermore, mainly the emotional aspects of perspective-taking are related to interoception, influencing the ability to empathise with others. Future research should systematically investigate the links between all dimensions of interoception and perspective-taking to provide full understanding of the specific role interoception has on how we perceive the world and take another's point of view.

A Developmental Framework for Embodiment Research: The Next Step Toward Integrating Concepts and Methods

Embodiment research is at a turning point. There is an increasing amount of data and studies investigating embodiment phenomena and their role in mental processing and functions from across a wide range of disciplines and theoretical schools within the life sciences. However, the integration of behavioral data with data from different biological levels is challenging for the involved research fields such as movement psychology, social and developmental neuroscience, computational psychosomatics, social and behavioral epigenetics, human-centered robotics, and many more. This highlights the need for an interdisciplinary framework of embodiment research. In addition, there is a growing need for a cross-disciplinary consensus on level-specific criteria of embodiment. We propose that a developmental perspective on embodiment is able to provide a framework for overcoming such pressing issues, providing analytical tools to link timescales and levels of embodiment specific to the function under study, uncovering the underlying developmental processes, clarifying level-specific embodiment criteria, and providing a matrix and platform to bridge disciplinary boundaries among the involved research fields.

Research Review: The relationship between social anxiety and social cognition in children and adolescents: a systematic review and meta-analysis

BACKGROUND

Childhood Social Anxiety Disorder (SAD) is common and impairing. The recommended treatment is a disorder specific form of cognitive behavioural therapy (CBT) that includes social skills training and, whilst they appear to be more effective than more general treatments, it is not clear whether social skills training is the critical component involved in improved outcomes, particularly given that evidence for the relationship between social anxiety and social skills deficits in children is inconsistent. This may be partly due to an overlap in their observable features, and because the nature of the association may vary in different contexts (e.g. according to child age). An alternative approach is to examine the association between social anxiety and the social cognitive capacities that underpin social skills. This paper aims to examine the association between social anxiety and social cognition in children and adolescents, and examine conceptual and methodological moderators of this relationship.

METHODS

Papers published between 1980 and 2019 were screened systematically. Fifty studies were identified from which an effect size could be calculated for the relationship between social anxiety and social cognition, including 15,411 children and adolescents.

RESULTS

An overall significant, but moderate effect (r = -.15) was identified, where increased social anxiety was associated with lower social cognitive ability. Moderation analyses revealed specific associations within studies examining social anxiety among participants with and without ASD who were older than 7 years old, and studies assessing the relationship between social anxiety and specific aspects of Theory of Mind (ToM). No significant association was identified between social anxiety and emotion recognition.

CONCLUSIONS

Significant associations between social anxiety and social cognitive abilities appear to be accounted for by elevated social anxiety among children with ASD, and those with difficulties in specific aspects of ToM but not broader social skills, such as emotion recognition. This reinforces the importance of accurately identifying and treating social anxiety within ASD populations. In addition, treatments for social anxiety among neurotypical populations may benefit from targeting particular aspects of ToM rather than emotion recognition and other broad social skills.

The Impact of Anxiety on the Participation of Children on the Autism Spectrum

Anxiety is common in children on the autism spectrum, however its impacts are not fully understood. Participation is an important outcome, linked to the health and wellbeing of children. This study examined the relationship between anxiety and participation using parent reports for 131 children on the autism spectrum, aged 6-13 years. Hierarchical multiple regressions explored child and family factors in relation to participation in Home and Community settings. Anxiety was a unique, significant predictor of the frequency of children's participation (but not involvement in activities) in both settings, when controlling for autism characteristics, communication skills and family income. Anxiety symptomatology may contribute to the less frequent participation of children on the autism spectrum in home and community activities.

Psychometric validation and refinement of the Interoception Sensory Questionnaire (ISQ) in adolescents and adults on the autism spectrum

BACKGROUND

Individuals on the autism spectrum are reported to display alterations in interoception, the sense of the internal state of the body. The Interoception Sensory Questionnaire (ISQ) is a 20-item self-report measure of interoception specifically intended to measure this construct in autistic people. The psychometrics of the ISQ, however, have not previously been evaluated in a large sample of autistic individuals.

METHODS

Using confirmatory factor analysis, we evaluated the latent structure of the ISQ in a large online sample of adults on the autism spectrum and found that the unidimensional model fit the data poorly. Using misspecification analysis to identify areas of local misfit and item response theory to investigate the appropriateness of the seven-point response scale, we removed redundant items and collapsed the response options to put forth a novel eight-item, five-response choice ISQ.

RESULTS

The revised, five-response choice ISQ (ISQ-8) showed much improved fit while maintaining high internal reliability. Differential item functioning (DIF) analyses indicated that the items of the ISQ-8 were answered in comparable ways by autistic adolescents and adults and across multiple other sociodemographic groups.

LIMITATIONS

Our results were limited by the fact that we did not collect data for typically developing controls, preventing the analysis of DIF by diagnostic status. Additionally, while this study proposes a new 5-response scale for the ISQ-8, our data were not collected using this method; thus, the psychometric properties for the revised version of this instrument require further investigation.

CONCLUSION

The ISQ-8 shows promise as a reliable and valid measure of interoception in adolescents and adults on the autism spectrum, but additional work is needed to examine its psychometrics in this population. A free online score calculator has been created to facilitate the use of ISQ-8 latent trait scores for further studies of autistic adolescents and adults (available at https://asdmeasures.shinyapps.io/ISQ_score/ ).

The relationship between sensory reactivity differences and mental health symptoms in preschool-age autistic children

There is growing evidence for an association between sensory reactivity and mental health in autism. This study set out to explore the relationship between sensory reactivity and mental health in preschool-aged autistic children. In total 54 preschool-aged children with an Autism Spectrum Condition took part. Sensory and mental health symptoms were obtained from the Sensory Processing Scale Inventory, Sensory Assessment of Neurodevelopmental Differences and the Behavioral Assessment System for Children-3. Correlational analyses showed a relationship between sensory reactivity and mental health symptoms in autistic preschool-aged children. Results also indicate divergence in sensory-mental health profiles between autistic preschool-aged children who are verbal and those who use few to no words. For the first time this study has revealed a relationship between sensory hyper-reactivity, as well as sensory seeking, and mental health symptoms outside of anxiety in autism. Of note, this relationship between sensory hyper-reactivity and internalizing symptoms appears to be driven by those with few to no words. This has implications for both research and clinical interventions, in particular for our understanding of the factors underlying mental health symptoms in different autistic phenotypes, as well as the possible role of functional communication in mitigating the development of mental health symptoms. LAY SUMMARY: The present study found that in autistic preschoolers, externalizing mental health symptoms, such as hyperactivity, are related to sensory seeking (seeking out or being fascinated with sensory stimuli), and internalizing mental health symptoms, such as depression, are related to sensory hyper-reactivity (sensitivity to sensory stimuli). Our results also show that whilst the relationships between externalizing symptoms and sensory seeking is seen across participants, the relationship between internalizing symptoms and sensory hyper-reactivity was only seen in autistic preschoolers who used few to no words. This has important implications for the assessment of sensory differences as part of more rigorous mental health assessments, especially in autistic people who use few to no words.

The Lost Neural Hierarchy of the Autistic Self-Locked-Out of the Mental Self and Its Default-Mode Network

Autism spectrum disorder (ASD) is characterized by a fundamental change in self-awareness including seemingly paradoxical features like increased ego-centeredness and weakened self-referentiality. What is the neural basis of this so-called "self-paradox"? Conducting a meta-analytic review of fMRI rest and task studies, we show that ASD exhibits consistent hypofunction in anterior and posterior midline regions of the default-mode network (DMN) in both rest and task with decreased self-non-self differentiation. Relying on a multilayered nested hierarchical model of self, as recently established (Qin et al. 2020), we propose that ASD subjects cannot access the most upper layer of their self, the DMN-based mental self-they are locked-out of their own DMN and its mental self. This, in turn, results in strong weakening of their self-referentiality with decreases in both self-awareness and self-other distinction. Moreover, this blocks the extension of non-DMN cortical and subcortical regions at the lower layers of the physical self to the DMN-based upper layer of the mental self, including self-other distinction. The ASD subjects remain stuck and restricted to their intero- and exteroceptive selves as manifested in a relative increase in ego-centeredness (as compared to self-referentiality). This amounts to what we describe as "Hierarchical Model of Autistic Self" (HAS), which, characterizing the autistic self in hierarchical and spatiotemporal terms, aligns well with and extends current theories of ASD including predictive coding and weak central coherence.

Reduced differentiation of emotion-associated bodily sensations in autism

LAY ABSTRACT

More research has been conducted on how autistic people understand and interpret other people's emotions, than on how autistic people experience their own emotions. The experience of emotion is important however, because it can relate to difficulties like anxiety and depression, which are common in autism. In neurotypical adults and children, different emotions have been associated with unique maps of activity patterns in the body. Whether these maps of emotion are comparable in autism is currently unknown. Here, we asked 100 children and adolescents, 45 of whom were autistic, to color in outlines of the body to indicate how they experienced seven emotions. Autistic adults and children sometimes report differences in how they experience their internal bodily states, termed interoception, and so we also investigated how this related to the bodily maps of emotion. In this study, the autistic children and adolescents had comparable interoception to the non-autistic children and adolescents, but there was less variability in their maps of emotion. In other words, they showed more similar patterns of activity across the different emotions. This was not related to interoception, however. This work suggests that there are differences in how autistic people experience emotion that are not explained by differences in interoception. In neurotypical people, less variability in emotional experiences is linked to anxiety and depression, and future work should seek to understand if this is a contributing factor to the increased prevalence of these difficulties in autism.

Exploring the cognitive, emotional and sensory correlates of social anxiety in autistic and neurotypical adolescents

BACKGROUND

Social anxiety is common in autistic adolescents. While emerging evidence indicates the importance of several mechanisms (including intolerance of uncertainty (IU), alexithymia and sensory processing) for maintaining anxiety, limited research has explored how these factors are associated with social anxiety in autistic adolescents.

METHODS

We investigated whether IU, emotional and sensory processing are related to social anxiety in autistic and neurotypical adolescents, gathering experimental and questionnaire data from 61 autistic and 62 neurotypical 11- to 17-year-olds recruited to have similarly high levels of anxiety.

RESULTS

In autistic and neurotypical adolescents matched for social anxiety, similar significant associations were observed between social anxiety and IU, alexithymia, maladaptive emotion regulation, sensory hypersensitivity and interoceptive sensibility. Taking a dimensional approach, we found that child- and parent-reported IU, alexithymia and sensory hypersensitivity mediated the relationship between autistic traits and social anxiety symptoms in the combined group of adolescents.

CONCLUSIONS

Our findings indicate that similar correlates of social anxiety are evident in autistic and neurotypical youths experiencing social anxiety and further our understanding of mechanisms that may contribute towards social anxiety in both groups.

Exploring the Multidimensional Assessment of Interoceptive Awareness in youth aged 7-17 years

OBJECTIVE

This study aimed to adapt the Multidimensional Assessment of Interoceptive Awareness (MAIA) questionnaire for younger respondents.

METHOD

The language of the MAIA was revised and children aged 7-10 years (n = 212) and adolescents aged 11-17 years (n = 217) completed the questionnaire.

RESULTS

The original eight-factor model was tested for fit using confirmatory factor analysis. The model had an acceptable fit in the total sample and younger subsample and overall fit in the older subsample was adequate following modification. Internal consistency was good, except for the Noticing, Not-Distracting and Not-Worrying scales. Results also demonstrated a negative linear relationship between the trusting scale and age, suggesting that youths may lose trust in their body as they age.

CONCLUSION

The adapted MAIA can be used with a younger population and, depending on the research question, individual MAIA scales may be selected. The survey is available at https://osher.ucsf.edu/maia.

The relationship between heartbeat counting and heartbeat discrimination: A meta-analysis

Interoception concerns the perception of the body's internal state. Despite the importance of this ability for health and aspects of higher-order cognition, its measurement remains problematic. Most studies of interoception employ one of two tasks: the heartbeat counting or heartbeat discrimination task. These tasks are thought to index common abilities, an assertion often used to justify the use of a single measure of cardiac interoception. However, mixed findings regarding the relationship between performance on these tasks raises the question of whether they can be used interchangeably to assess interoceptive accuracy, confidence and awareness ('metacognition'). The present study employed a meta-analytical approach to assess the association between these tasks. Pooled findings from 22 studies revealed a small relationship between accuracy scores on the measures. Additional analyses demonstrated a moderate relationship between confidence ratings but no association between measures of interoceptive awareness. These findings question the interchangeable use of the two tasks.

Do interoceptive accuracy and interoceptive sensibility predict emotion regulation?

INTRODUCTION

Interoception refers to awareness, interpretation, and integration of sensations in the body. While interoceptive accuracy has long been regarded as a core component of emotional experience, less is known about the relationship of interoceptive accuracy and related facets of interoception to emotion regulation deficits. This study explores how interoceptive accuracy and interoceptive sensibility relate to emotion regulation in a non-clinical sample.

METHODS

Undergraduate participants completed a heartbeat perception task and the Multidimensional Assessment of Interoceptive Awareness (Noticing and Body Listening sub-scales), and rated their confidence in performance on the heartbeat perception task. Participants also completed self-report measures of emotional awareness and regulation (Profile of Emotional Competence, intrapersonal emotion identification and emotion regulation sub-scales), and rated their use of different coping strategies (Brief COPE).

RESULTS

Noticing predicted emotion identification, emotion regulation, and the use of adaptive but not maladaptive coping strategies. Heartbeat perception accuracy did not significantly contribute to the prediction of any outcome variables.

DISCUSSION

Future work is needed to extend these findings to clinical populations. The results from this study support the use of interoceptive training interventions to promote emotional wellbeing.

Dissociation in How Core Autism Features Relate to Interoceptive Dimensions: Evidence from Cardiac Awareness in Children

Interoception in autism is receiving increasing research attention. Previously, differences were identified in autism on both objective and subjective measures of interoception, and an association with anxiety. Yet, it is currently unknown how interoception relates to core autism features. Here, in 49 autistic children, we consider how interoceptive accuracy (measured with heartbeat detection tasks) and sensibility (subjective judgements of awareness) relate to overall severity on the Autism Diagnostic Observation Schedule, and symptom domains of social-affective and repetitive, restricted behaviors. Socio-affective features were related to interoceptive sensibility, while repetitive restricted behaviors were related to interoceptive accuracy. This dissociation suggests disparate interoceptive mechanisms for the formation and/or maintenance of autistic features.

An Active Inference Approach to Interoceptive Psychopathology

Interoception refers to the process by which the nervous system senses and integrates signals originating from within the body, providing a momentary mapping of the body's internal landscape and its relationship to the outside world. Active inference is based on the premise that afferent sensory input to the brain is constantly shaped and modified by prior expectations. In this review we propose that interoceptive psychopathology results from two primary interoceptive dysfunctions: First, individuals have abnormally strong expectations of the situations that elicit bodily change (i.e., hyperprecise priors), and second, they have great difficulty adjusting these expectations when the environment changes (i.e., context rigidity). Here we discuss how these dysfunctions potentially manifest in mental illness and how interventions aimed at altering interoceptive processing can help the brain create a more realistic model of its internal state.

Autistic traits moderate relations between cardiac autonomic activity, interoceptive accuracy, and emotion processing in college students

The autonomic nervous system (ANS) plays a key role in maintaining physiological homeostasis, and research with neurotypical and autistic individuals has found relations between cardiac autonomic responses, as well as awareness of one's cardiac responses, and social and emotional processing. The current study examined relations between cardiac autonomic activity, heartbeat perception, emotion processing, and levels of autistic traits in a group of college students. Cardiac ANS at baseline and during an emotional picture task was measured, and a heartbeat perception task was used to assess interoceptive accuracy (IA). Questionnaires then assessed autistic traits, alexithymia (difficulties processing one's own emotions), and emotion recognition. Consistent with past work, greatest heart rate deceleration was seen in response to negative images. In the overall sample, no correlations were found between cardiac ANS, IA, autistic traits, and aspects of emotion processing, but when examining individuals high and low on autistic traits separately, distinct associations were found. Within the group of participants with elevated autistic traits, greater baseline respiratory sinus arrhythmia (RSA) was predictive of lower levels of alexithymia and autistic traits, as well as higher IA, but these associations were not seen in participants low on autistic traits. These findings suggest that variability in autistic traits in a non-autistic sample can lead to differential relations between cardiac autonomic responses, awareness of one's cardiac responses, and emotion processing.