I overthink-Therefore I am not: An active inference account of altered sense of self and agency in depersonalisation disorder

Dissociative experiences in individuals with subclinical psychosis and a history of developmental trauma: a qualitative study

Background: Among individuals with psychotic experiences, those with a history of developmental trauma face greater symptom severity and worse clinical outcomes compared to those without. Dissociation constitutes a prominent, characteristic of this group's clinical presentation, whose nuances and associated characteristics remain however understudied in psychosis research. We aimed to address this gap by conducting a qualitative study to investigate the phenomenology, context, and impact of dissociative experiences in individuals with subclinical psychosis and a history of developmental trauma.Methods: 25 UK-based participants with a history of developmental trauma and meeting criteria for subclinical psychosis, based on the CAPE-15, were recruited via social media. Participants attended semi-structured interviews online, which were transcribed verbatim and analysed with thematic analysis by two researchers.Results: Thematic analysis yielded the following themes: (1) Phenomenology of Dissociation; (2) Context of Dissociation; (3) Impact of Dissociation; (4) Dissociation and Psychotic-like Phenomena. Participants described experiences of detachment and compartmentalisation, which when experienced were confusing and often distressing. Dissociation was linked to affective experiences, their history of developmental trauma and psychotic-like experiences.Conclusion: This study elucidates the complex and varied nature of dissociative experiences in individuals with subclinical psychosis with a history of developmental trauma. These findings highlight the need for further research to understand the manifestation of dissociation in this population and the links with distress and other aspects of psychopathology. Importantly, it is essential to use this understanding to inform the development of interventions and improve clinical recognition and management.

Dispositional Traits, Characteristic Adaptations, and Narrative Identity Reconstructions in Individuals With Depersonalization and Derealization

INTRODUCTION

Depersonalization and derealization disorder (DPDR) is a debilitating condition. To date, little was known about the role of personality structure and of perceived social support and loneliness in DPDR.

METHODS

Three studies investigated, respectively: (i) broadband personality traits (five-factor model), maladaptive trait domains (PID-5), and perceived support and loneliness in individuals with self-reported DPDR (N = 160) versus a general population sample (N = 303), using network modeling; (ii) structure and interconnectivity of personality, perceived support and loneliness, and DPDR traits (frequency/duration) in individuals with self-reported DPDR (N = 160); (iii) characteristic adaptations and narrative identities in individuals with self-reported DPDR (N = 19), using thematic analysis.

RESULTS

Study 1 found between-samples differences across several traits, especially psychoticism and negative affect. Differences in networks' global centrality, but not structures or edges, were also found. The graphical model in Study 2 showed a community of dissociative tendencies including DPDR traits and psychoticism. Study 3 highlighted the development of DPDR as a key life transition for those experiencing it, with narratives focusing on feelings of poor agency, isolation, and a disrupted sense of self.

CONCLUSIONS

Individual differences in personality characterize DPDR, especially in psychoticism. Implications for theory and research are discussed.

Trait dissociation is associated with dissociative experiences arising from disrupted multisensory integration

Dissociation is a transdiagnostic mental health symptom involving a sense of detachment from one's own body. A coherent percept of our body relies upon the smooth integration of different senses, such as vision and touch, which are processed by the brain at different speeds. We investigated the association between multi-sensory integration and dissociation in a N = 100 non-clinical sample. An immersive head-mounted display provided participants with a first-person view of their body while their arm was brushed by themselves or by the researcher. This mixed-reality setup allowed for the systematic variation of a delay to the visual feed, resulting in visual information being delayed relative to other senses (e.g. touch). Larger delays were associated with greater self-reported feelings of dis-ownership from the body. In addition, participants with high trait dissociation felt elevated sensations of dis-ownership from the body and were more sensitive to the multi-sensory delay, suggesting an increased tendency to 'fraction' senses in dissociation. Moreover, individuals with higher dissociation displayed similar cardiac reactivity to both self and other touch. These findings highlight two key mechanisms underlying dissociation; altered sensory-integration and increased awareness of self-action.

Cotard's: a controlled single case study of putative perceptual, cognitive and psychological risk factors

This case study explores the psychological and neuropsychological traits of a 55-year-old woman, D.R., who has Cotard's, believing her torso has dissolved and food bypasses her legs. Her delusion emerged amid major depressive disorder with psychotic features, following prodromal symptoms like body distortion and somatosensory abnormalities. A neuropsychological assessment during remission revealed low-level visual perceptual deficits in an otherwise intact cognitive profile. Subtle distortions in bodily signals and specific attribution styles were identified as vulnerability factors, suggesting that the delusion may emerge when already strained information processing systems are further challenged. This relates to models of delusion formation.

Self /other recognition and distinction in adolescents with anorexia nervosa: A pilot study using a double mirror paradigm

BACKGROUND

Abnormalities in body perception in patients affected by anorexia nervosa have been widely studied, but without explicit reference to their relationship to others and the social processes involved. Yet, there are a several arguments supporting impairments in interpersonal relationships in these patients. Notably, some evidence suggests that self/other distinction (SOD), the ability to distinguish one's own body, actions and mental representations from those of others could be impaired. But research remains scarce in this area.

MATERIAL AND METHODS

A single-centre, prospective pilot study was conducted to investigate, for the first time, self-recognition and SOD in seven adolescents with anorexia nervosa compared with matched healthy controls (HCs) using the "Alter Ego"TM double mirror paradigm. This innovative device allows the progressive morphing of one's own face to that of another and vice versa between two subjects that interact on opposite sides of the device. Two judgement criteria were used: 1) M1: the threshold at which subjects start to recognize their own face during other-to-self morphing, and 2) M2: the threshold at which subjects start to recognize the other's face during self-to-other morphing. In a second part, SOD was reassessed during five different sensorimotor tasks aimed at increasing body self-consciousness in participants with anorexia nervosa.

RESULTS

The results showed that the participants with anorexia nervosa exhibited earlier self-recognition in the other-to-self sequence and delayed other-recognition in the self-to-other sequence. Furthermore, in contrast with that of HCs, the critical threshold for switching between self and other varied with the direction of morphing in anorexia nervosa participants. Finally, when participants with anorexia were seated in a chair with a backrest and footrest strengthening the median axis of their body, the self-recognition threshold (M1) increased significantly, approaching that of controls.

CONCLUSIONS

Although additional research is needed to replicate the results of this pilot study, it revealed the first behavioural evidence of altered SOD in individuals affected by anorexia nervosa through an embodied, semiecological face-recognition paradigm. The relationships between anomalies in body perception and alterations in interpersonal relationships are discussed within an integrative framework from phenomenology to neuroscience, and new research and therapeutic perspectives are presented.

Ontogenesis of self-disorders in the schizophrenia spectrum: A phenomenological neuro-developmental model

The concept of basic Self-disorders (SD) captures the experiential aspects associated with vulnerability to schizophrenia spectrum disorders (SSD). SD emerge prior to, and constitute the underlying structure for, the emergence of major diagnostic symptoms, including positive psychotic ones. SD are also detectable in populations with familial risk for SSD. This paper proposes a two-stage phenomenological-developmental model, exploring the early deficit in multisensory integration and their impact on the ontogeny of the Minimal Self in the first years of life. It also examines subsequent emergence of schizotaxic vulnerability, which later manifests as typical anomalies of subjectivity, such as basic symptoms and self-disorders.

The Many Roles of Precision in Action

Active inference describes (Bayes-optimal) behaviour as being motivated by the minimisation of surprise of one's sensory observations, through the optimisation of a generative model (of the hidden causes of one's sensory data) in the brain. One of active inference's key appeals is its conceptualisation of precision as biasing neuronal communication and, thus, inference within generative models. The importance of precision in perceptual inference is evident-many studies have demonstrated the importance of ensuring precision estimates are correct for normal (healthy) sensation and perception. Here, we highlight the many roles precision plays in action, i.e., the key processes that rely on adequate estimates of precision, from decision making and action planning to the initiation and control of muscle movement itself. Thereby, we focus on the recent development of hierarchical, "mixed" models-generative models spanning multiple levels of discrete and continuous inference. These kinds of models open up new perspectives on the unified description of hierarchical computation, and its implementation, in action. Here, we highlight how these models reflect the many roles of precision in action-from planning to execution-and the associated pathologies if precision estimation goes wrong. We also discuss the potential biological implementation of the associated message passing, focusing on the role of neuromodulatory systems in mediating different kinds of precision.

Behavioural, autonomic, and neural responsivity in depersonalisation-derealisation disorder: A systematic review of experimental evidence

Depersonalisation-derealisation disorder (DDD) is characterised by distressing experiences of separation from oneself and/or one's surroundings, potentially resulting from alterations in affective, cognitive, and physiological functions. This systematic review aimed to synthesise current experimental evidence of relevance to proposed mechanisms underlying DDD, to appraise existing theoretical models, and to inform future research and theoretical developments. Studies were included if they tested explicit hypotheses in DDD samples, with experimental manipulations of at least one independent variable, alongside behavioural, subjective, neurological, affective and/or physiological dependent variables. Some evidence for diminished subjective responsivity to aversive images and sounds, and hyperactivation in neurocircuits associated with emotional regulation when viewing aversive images emerged, corroborating neurobiological models of DDD. Inconsistencies were present regarding behavioural and autonomic responsivity to facial expressions, emotional memory, and self-referential processing. Common confounds included small sample sizes, medication, and comorbidities. Alterations in affective reactivity and regulation appear to be present in DDD; however, further research employing more rigorous research designs is required to provide stronger evidence for these possible mechanisms.

Examination of self patterns: framing an alternative phenomenological interview for use in mental health research and clinical practice

Mental disorders are increasingly understood as involving complex alterations of self that emerge from dynamical interactions of constituent elements, including cognitive, bodily, affective, social, narrative, cultural and normative aspects and processes. An account of self that supports this view is the pattern theory of self (PTS). The PTS is a non-reductive account of the self, consistent with both embodied-enactive cognition and phenomenological psychopathology; it foregrounds the multi-dimensionality of subjects, stressing situated embodiment and intersubjective processes in the formation of the self-pattern. Indications in the literature already demonstrate the viability of the PTS for formulating an alternative methodology to better understand the lived experience of those suffering mental disorders and to guide mental health research more generally. This article develops a flexible methodological framework that front-loads the self-pattern into a minimally structured phenomenological interview. We call this framework 'Examination of Self Patterns' (ESP). The ESP is unconstrained by internalist or externalist assumptions about mind and is flexibly guided by person-specific interpretations rather than pre-determined diagnostic categories. We suggest this approach is advantageous for tackling the inherent complexity of mental health, the clinical protocols and the requirements of research.

Explicit and implicit sense of agency in depersonalisation experiences

The sense of agency, the feeling of controlling one's bodily actions and the world is altered in Depersonalisation (DP), a condition that makes people feel detached from one's self and body. To investigate the link between depersonalisation and both implicit and explicit sense of agency, an online study was conducted using the influential Intentional Binding paradigm in a sample of non-clinical DP participants. The results did not reveal significant differences between individuals with low and high occurrences of DP experiences on the implicit and explicit sense of agency. However, participants with high occurrences of DP experiences showed a more time-sensitive explicit sense of agency and greater temporal distortions for short intervals in the absence of self-initiated motion. These results suggest that there is a discrepancy between implicit and explicit sense of agency in people with high levels of depersonalisation. Altogether, these findings call for further investigations of the key role of time perception on altered sense of self and agency in both non-clinical and clinical populations, to disentangle the mechanisms associated with the explicit and implicit sense of agency.

Innovative health tracker that provides advanced functionalities to support and guide users in modifying their lifestyle: a Straussian ground theory approach

Objective

Health can be described as the state of homeostasis and optimal functioning across various bio-psycho-social dimensions and processes, allowing an individual to adapt and respond effectively to extrinsic and intrinsic challenges. Our thoughts, choices, behaviors, experiences, and feelings shape our existence. By transitioning from unconscious reactions to conscious responses, we can establish novel habits and behaviors, actively embracing positive shifts in our lifestyle.

Subjects and methods

The presented examination focuses on the smartwatch (SW), analyzing the incorporation of potentially progressive attributes that could enrich our lifestyle pursuits. The objective is not the health disorders themselves but the employment of wearable devices to create a strong sense of coherence in the Straussian grounded theory approach. The study had no subjects.

Results

The potential of the SW has been partially explored in lifestyle intervention, modification, research, and practice.

Conclusion

Based on our examination, creating an innovative SW capable of aiding individuals in better comprehending their behaviors and motivating them toward comprehensive changes in their lifestyle is a challenging yet attainable endeavor. Our ambition is to bring into existence SW capable of comprehensively measuring and evaluating interoception, circadian rhythm (CR), selected lifestyle pillars, and their associated components, and seamlessly integrating them into current SW features. It focuses on boosting motivation, maintenance, and amelioration regarding one's lifestyle. The novel approach strives to boost both immediate and underlying factors that actively contribute to improving one's metacognition.

Forgetting ourselves in flow: an active inference account of flow states and how we experience ourselves within them

Flow has been described as a state of optimal performance, experienced universally across a broad range of domains: from art to athletics, gaming to writing. However, its phenomenal characteristics can, at first glance, be puzzling. Firstly, individuals in flow supposedly report a loss of self-awareness, even though they perform in a manner which seems to evince their agency and skill. Secondly, flow states are felt to be effortless, despite the prerequisite complexity of the tasks that engender them. In this paper, we unpick these features of flow, as well as others, through the active inference framework, which posits that action and perception are forms of active Bayesian inference directed at sustained self-organisation; i.e., the minimisation of variational free energy. We propose that the phenomenology of flow is rooted in the deployment of high precision weight over (i) the expected sensory consequences of action and (ii) beliefs about how action will sequentially unfold. This computational mechanism thus draws the embodied cognitive system to minimise the ensuing (i.e., expected) free energy through the exploitation of the pragmatic affordances at hand. Furthermore, given the challenging dynamics the flow-inducing situation presents, attention must be wholly focussed on the unfolding task whilst counterfactual planning is restricted, leading to the attested loss of the sense of self-as-object. This involves the inhibition of both the sense of self as a temporally extended object and higher-order, meta-cognitive forms of self-conceptualisation. Nevertheless, we stress that self-awareness is not entirely lost in flow. Rather, it is pre-reflective and bodily. Our approach to bodily-action-centred phenomenology can be applied to similar facets of seemingly agentive experience beyond canonical flow states, providing insights into the mechanisms of so-called selfless experiences, embodied expertise and wellbeing.

Developmental changes of bodily self-consciousness in adolescent girls

The body and the self change markedly during adolescence, but how does bodily self-consciousness, the pre-reflexive experience of being a bodily subject, change? We addressed this issue by studying embodiment towards virtual avatars in 70 girls aged 10-17 years. We manipulated the synchrony between participants' and avatars' touch or movement, as well as the avatar visual shape or size relative to each participant's body. A weaker avatar's embodiment in case of mismatch between the body seen in virtual reality and the real body is indicative of a more robust bodily self-consciousness. In both the visuo-tactile and the visuo-motor experiments, asynchrony decreased ownership feeling to the same extent for all participants, while the effect of asynchrony on agency feeling increased with age. In the visuo-tactile experiment, incongruence in visual appearance did not affect agency feeling but impacted ownership, especially in older teenage girls. These findings highlight the higher malleability of bodily self-consciousness at the beginning of adolescence and suggest some independence between body ownership and agency.

Dissociative Symptoms and Interoceptive Integration

Dissociative symptoms and disorders of dissociation are characterised by disturbances in the experience of the self and the surrounding world, manifesting as a breakdown in the normal integration of consciousness, memory, identity, emotion, and perception. This paper aims to provide insights into dissociative symptoms from the perspective of interoception, the sense of the body's internal physiological state, adopting a transdiagnostic framework.Dissociative symptoms are associated with a blunting of autonomic reactivity and a reduction in interoceptive precision. In addition to the central function of interoception in homeostasis, afferent visceral signals and their neural and mental representation have been shown to shape emotional feeling states, support memory encoding, and contribute to self-representation. Changes in interoceptive processing and disrupted integration of interoceptive signals into wider cognition may contribute to detachment from the body and the world, blunted emotional experience, and altered subjective recall, as experienced by individuals who suffer from dissociation.A better understanding of the role of altered interoceptive integration across the symptom areas of dissociation could thus provide insights into the neurophysiological mechanisms underlying dissociative disorders. As new therapeutic approaches targeting interoceptive processing emerge, recognising the significance of interoceptive mechanisms in dissociation holds potential implications for future treatment targets.

Examining the association between depersonalisation traits and the bodily self in waking and dreaming

Depersonalisation (DP) is characterized by fundamental alterations to the sense of self that include feelings of detachment and estrangement from one's body. We conducted an online study in healthy participants (n = 514) with DP traits to investigate and quantify the subjective experience of body and self during waking and dreaming, as the vast majority of previous studies focussed on waking experience only. Investigating dreams in people experiencing DP symptoms may help us understand whether the dream state is a 'spared space' where people can temporarily 'retrieve' their sense of self and sense of bodily presence. We found that higher DP traits-i.e. higher scores on the Cambridge Depersonalisation Scale (CDS)-were associated with more frequent dream experiences from an outside observer perspective (r = 0.28) and more frequent dream experiences of distinct bodily sensations (r = 0.23). We also found that people with higher CDS scores had more frequent dream experiences of altered bodily perception (r = 0.24), more frequent nightmares (r = 0.33) and higher dream recall (r = 0.17). CDS scores were negatively correlated with body boundary scores (r = - 0.31) in waking states and there was a negative association between CDS scores and the degree of trust in interoceptive signals (r = - 0.52). Our study elucidates the complex phenomenology of DP in relation to bodily selfhood during waking and dreaming and suggests avenues for potential therapeutic interventions in people with chronic depersonalisation (depersonalisation -derealisation disorder).

Self-Disorder in Schizophrenia: A Revised View (1. Comprehensive Review-Dualities of Self- and World-Experience)

A growing body of research supports the role of self-disorders as core phenotypic features of schizophrenia-spectrum disorders. Self-disorders comprise various alterations of conscious experience whose theoretical understanding continues to present a challenge. The following 2 articles aim to provide further clarification of the nature of self-disorders in schizophrenia by offering a comprehensive review (article 1) and theoretical revision (article 2) of the currently most influential model of altered selfhood in schizophrenia: the basic-self-disturbance or ipseity-disorder model (IDM). This article presents a state-of-the-art overview of the current self-disturbance model and critically assesses its descriptive adequacy with respect to the clinical variability and heterogeneity of the alterations in self- and world-awareness characteristic of schizophrenia. Special attention is paid to experiences of exaggerated basic self, increased "grip" or "hold" on the world, and paradoxical combinations. The next article proposes a theoretical revision of the self-disturbance model by considering how hyperreflexivity might form the crucial common thread or generating factor that unifies the phenomenologically heterogeneous, and sometimes even contradictory features of schizophrenic self-disorders. We outline the implications of our revised model for explanatory research, therapeutic practice, and our general understanding of the abnormalities in question.

Clinical potential of sensory neurites in the heart and their role in decision-making

The process of decision-making is quite complex involving different aspects of logic, emotion, and intuition. The process of decision-making can be summarized as choosing the best alternative among a given plethora of options in order to achieve the desired outcome. This requires establishing numerous neural networks between various factors associated with the decision and creation of possible combinations and speculating their possible outcomes. In a nutshell, it is a highly coordinated process consuming the majority of the brain's energy. It has been found that the heart comprises an intrinsic neural system that contributes not only to the decision-making process but also the short-term and long-term memory. There are approximately 40,000 cells present in the heart known as sensory neurites which play a vital role in memory transfer. The heart is quite a mysterious organ, which functions as a blood-pumping machine and an endocrine gland, as well as possesses a nervous system. There are multiple factors that affect this heart ecosystem, and they directly affect our decision-making capabilities. These interlinked relationships hint toward the sensory neurites which modulate cognition and mood regulation. This review article aims to provide deeper insights into the various roles played by sensory neurites in decision-making and other cognitive functions. The article highlights the pivotal role of sensory neurites in the numerous brain functions, and it also meticulously discusses the mechanisms through which they modulate their effects.

The effect of burnout syndrome on the job satisfaction of employees in the municipalities of South Lima: a cross-sectional study

Introduction and importance

Nowadays, improving the performance of employees is essential to increase productivity and achieve continuous improvement; therefore, it is necessary to achieve job satisfaction among all members of the organisation to avoid negative attitudes, professional burnout, health problems and a lack of commitment. Therefore, our objective was to determine the level of burnout and its relationship with the level of job satisfaction among employees in the municipalities of southern Lima.

Methods

The research is basic research, with a quantitative approach and a cross-sectional, nonexperimental, correlational design. The survey technique was used and the data collection instrument was a questionnaire addressed to 271 workers of the municipalities of South Lima on the variable burnout syndrome with the dimensions depersonalisation and emotional exhaustion, as well as on the variable job satisfaction with the dimensions work benefits, administrative policies and social relations, with a Cronbach's alpha reliability of 0.801.

Results

The results show that 50.2% of the employees state that they have an overload of mental effort that causes a high level of emotional exhaustion, 50.2% state that the work develops in them negative and insensitive attitudes that increase their level of depersonalisation and 77.9% state that the company is unable to satisfy the personal demands of the employees through the work benefits it offers.

Conclusions

These findings reflect that burnout is a common illness in organisations due to workload, poor organisational climate and neglect of employees' emotional health. Therefore, more research is needed on the role of organisations in reducing levels of occupational burnout in order to promote improvements in mental health.

Touching and being touched: where knowing and feeling meet

Philosophers maintain that touch confers a sense of reality or grounding to perceptual experience. In touching oneself, one is simultaneously both subject and object of touch, a template for experiencing oneself as subject and object of intentions, feelings, and motivations, or intersubjectivity. Here, I explore a form of self-touch carefully documented by Winnicott in observing how the infant engages the transitional object. I compare the processes of self-loss in transitional states, including absorption in art, empathic immersion, drug-induced ego dissolution, and depersonalization. I use examples drawn from Rodin, Dante, and the Beatles; research correlating neurophysiological findings with aspects of self-representation; predictive processing-based models; Hohwy's concepts of minimal and narrative self; Clark's notion of the extended mind; and phenomenological perspectives on touch, to postulate a role for self-touch in the pre-reflective sense of mine-ness, or grounding, in transitional states.

The Self-Simulational Theory of temporal extension

Subjective experience is experience in time. Unfolding in a continuous river of moments, our experience, however, consists not only in the changing phenomenological content per se but, further, in additional retrodiction and prospection of the moments that immediately preceded and followed it. It is in this way that William James's 'specious present' presents itself as extending between the past and future. While the phenomenology of temporality always happens, in normal waking states, to someone, and the notions of self-representation and temporal experience have continuously been associated with each other, there has not yet been an explicit account of their relationship. In this paper, the emergence of the subjective experience of temporal extension will be conceived of as arising out of a difference-relation between counterfactual and actual self-representations. After presenting the proposed relationship on both a conceptual level and a formalized and neuronally realistic level of description using information theory, convergent empirical evidence from general findings about temporal experience and inference, altered states of consciousness, and mental illness is examined. The Self-Simulational Theory of temporal extension is able to explain systematic variations in the subjectively experienced length of the temporal Now across numerous domains and holds potentially wide implications for the neuroscience of consciousness, as well as for a deeper understanding of different forms of mental illness.

Towards a Neurophenomenological Understanding of Self-Disorder in Schizophrenia Spectrum Disorders: A Systematic Review and Synthesis of Anatomical, Physiological, and Neurocognitive Findings

The concept of anomalous self-experience, also termed Self-Disorder, has attracted both clinical and research interest, as empirical studies suggest such experiences specifically aggregate in and are a core feature of schizophrenia spectrum disorders. A comprehensive neurophenomenological understanding of Self-Disorder may improve diagnostic and therapeutic practice. This systematic review aims to evaluate anatomical, physiological, and neurocognitive correlates of Self-Disorder (SD), considered a core feature of Schizophrenia Spectrum Disorders (SSDs), towards developing a neurophenomenological understanding. A search of the PubMed database retrieved 285 articles, which were evaluated for inclusion using PRISMA guidelines. Non-experimental studies, studies with no validated measure of Self-Disorder, or those with no physiological variable were excluded. In total, 21 articles were included in the review. Findings may be interpreted in the context of triple-network theory and support a core dysfunction of signal integration within two anatomical components of the Salience Network (SN), the anterior insula and dorsal anterior cingulate cortex, which may mediate connectivity across both the Default Mode Network (DMN) and Fronto-Parietal Network (FPN). We propose a theoretical Triple-Network Model of Self-Disorder characterized by increased connectivity between the Salience Network (SN) and the DMN, increased connectivity between the SN and FPN, decreased connectivity between the DMN and FPN, and increased connectivity within both the DMN and FPN. We go on to describe translational opportunities for clinical practice and provide suggestions for future research.

The felt-presence experience: from cognition to the clinic

The felt presence experience is the basic feeling that someone else is present in the immediate environment, without clear sensory evidence. Ranging from benevolent to distressing, personified to ambiguous, felt presence has been observed in neurological case studies and within psychosis and paranoia, associated with sleep paralysis and anxiety, and recorded within endurance sports and spiritualist communities. In this Review, we summarise the philosophical, phenomenological, clinical, and non-clinical correlates of felt presence, as well as current approaches that use psychometric, cognitive, and neurophysiological methods. We present current mechanistic explanations for felt presence, suggest a unifying cognitive framework for the phenomenon, and discuss outstanding questions for the field. Felt presence offers a sublime opportunity to understand the cognitive neuroscience of own-body awareness and social agency detection, as an intuitive, but poorly understood, experience in health and disorder.

Online structured dance/movement therapy reduces bodily detachment in depersonalization-derealization disorder

BACKGROUND

Depersonalization-derealization disorder (DDD) is a dissociative disorder encompassing pronounced disconnections from the self and from external reality. As DDD is inherently tied to a detachment from the body, dance/movement therapy could provide an innovative treatment approach.

MATERIALS AND METHODS

We developed two online dance tasks to reduce detachment either by training body awareness (BA task) or enhancing the salience of bodily signals through dance exercise (DE task). Individuals with DDD (n = 31) and healthy controls (n = 29) performed both tasks individually in a cross-over design. We assessed symptom severity (Cambridge Depersonalization Scale), interoceptive awareness (Multidimensional Assessment of Interoceptive Awareness - II), mindfulness (Five Facet Mindfulness Questionnaire), and body vigilance (Body Vigilance Scale) before, during and after the tasks.

RESULTS

At baseline, individuals with DDD exhibited elevated depersonalization-derealization symptoms alongside lower levels of interoceptive awareness and mindfulness compared to controls. Both tasks reduced symptoms in the DDD group, though dance exercise was perceived as easier. The DE task increased mindfulness in those with DDD more than the BA task, whereas controls showed the opposite pattern. In the DDD group, within-subject correlations showed that lower levels of symptoms were associated with task-specific elevations in interoceptive awareness and mindfulness.

CONCLUSION

Individual and structured dance/movement practice, performed at home without an instructor present, offers an effective tool to reduce symptoms in DDD and can be tailored to address specific cognitive components of a mindful engagement with the body.

Depersonalization disorder as a systematic downregulation of interoceptive signals

Depersonalisation disorder (DPD) is a psychopathological condition characterised by a feeling of detachment from one's own body and surrounding, and it is understood as emerging from the downregulation of interoceptive afferents. However, the precise mechanisms that drive this 'interoceptive silencing' are yet to be clarified. Here we present a computational and neurobiologically plausible model of DPD within the active inference framework. Specifically, we describe DPD as arising from disrupted interoceptive processing at higher levels of the cortical hierarchy where the interoceptive and exteroceptive streams are integrated. We simulated the behaviour of an agent subjected to a situation of high interoceptive activation despite the absence of a perceivable threat in the external environment. The simulation showed how a similar condition, if perceived as inescapable, would result in a downregulation of interoceptive signals, whilst leaving the exteroceptive ones unaffected. Such interoceptive silencing would force the agent to over-rely on exteroceptive information and would ultimately lead to the DPD phenomenology. Finally, our simulation shows that repeated exposure to similar situations over time will lead the agent to increasingly disengage from bodily responses even in the face of a less triggering situation, explaining how a single episode of depersonalization can lead to chronic DPD.

Active inference, morphogenesis, and computational psychiatry

Active inference is a leading theory in neuroscience that provides a simple and neuro-biologically plausible account of how action and perception are coupled in producing (Bayes) optimal behavior; and has been recently used to explain a variety of psychopathological conditions. In parallel, morphogenesis has been described as the behavior of a (non-neural) cellular collective intelligence solving problems in anatomical morphospace. In this article, we establish a link between the domains of cell biology and neuroscience, by analyzing disorders of morphogenesis as disorders of (active) inference. The aim of this article is three-fold. We want to: (i) reveal a connection between disorders of morphogenesis and disorders of active inference as apparent in psychopathological conditions; (ii) show how disorders of morphogenesis can be simulated using active inference; (iii) suggest that active inference can shed light on developmental defects or aberrant morphogenetic processes, seen as disorders of information processing, and perhaps suggesting novel intervention and repair strategies. We present four simulations illustrating application of these ideas to cellular behavior during morphogenesis. Three of the simulations show that the same forms of aberrant active inference (e.g., deficits of sensory attenuation and low sensory precision) that have been used to explain psychopathological conditions (e.g., schizophrenia and autism) also produce familiar disorders of development and morphogenesis when implemented at the level of the collective behavior of a group of cells. The fourth simulation involves two cells with too high precision, in which we show that the reduction of concentration signaling and sensitivity to the signals of other cells treats the development defect. Finally, we present the results of an experimental test of one of the model's predictions in early Xenopus laevis embryos: thioridazine (a dopamine antagonist that may reduce sensory precision in biological systems) induced developmental (anatomical) defects as predicted. The use of conceptual and empirical tools from neuroscience to understand the morphogenetic behavior of pre-neural agents offers the possibility of new approaches in regenerative medicine and evolutionary developmental biology.

The brain-body disconnect: A somatic sensory basis for trauma-related disorders

Although the manifestation of trauma in the body is a phenomenon well-endorsed by clinicians and traumatized individuals, the neurobiological underpinnings of this manifestation remain unclear. The notion of somatic sensory processing, which encompasses vestibular and somatosensory processing and relates to the sensory systems concerned with how the physical body exists in and relates to physical space, is introduced as a major contributor to overall regulatory, social-emotional, and self-referential functioning. From a phylogenetically and ontogenetically informed perspective, trauma-related symptomology is conceptualized to be grounded in brainstem-level somatic sensory processing dysfunction and its cascading influences on physiological arousal modulation, affect regulation, and higher-order capacities. Lastly, we introduce a novel hierarchical model bridging somatic sensory processes with limbic and neocortical mechanisms regulating an individual's emotional experience and sense of a relational, agentive self. This model provides a working framework for the neurobiologically informed assessment and treatment of trauma-related conditions from a somatic sensory processing perspective.

Embodying the (Dis)embodiment: Narrating Depersonalization-Derealization Disorder

Depersonalization-Derealization Disorder is an under-researched condition that is often left out of the larger discourse surrounding mental health and mental illness. This autoethnography examines the material and discursive tensions that are a product of my experience with Depersonalization-Derealization Disorder. In this critical self-exploration, I use communication privacy management theory, communication theory of resilience, and stigma management communication theory to unpack the communicative negotiations that accompany my disembodied experience, with the overarching goal of spreading awareness about Depersonalization-Derealization Disorder to help others make sense of their own diagnosis.

Brain-heart interactions in the neurobiology of consciousness

Recent experimental evidence on patients with disorders of consciousness revealed that observing brain-heart interactions helps to detect residual consciousness, even in patients with absence of behavioral signs of consciousness. Those findings support hypotheses suggesting that visceral activity is involved in the neurobiology of consciousness, and sum to the existing evidence in healthy participants in which the neural responses to heartbeats reveal perceptual and self-consciousness. More evidence obtained through mathematical modeling of physiological dynamics revealed that emotion processing is prompted by an initial modulation from ascending vagal inputs to the brain, followed by sustained bidirectional brain-heart interactions. Those findings support long-lasting hypotheses on the causal role of bodily activity in emotions, feelings, and potentially consciousness. In this paper, the theoretical landscape on the potential role of heartbeats in cognition and consciousness is reviewed, as well as the experimental evidence supporting these hypotheses. I advocate for methodological developments on the estimation of brain-heart interactions to uncover the role of cardiac inputs in the origin, levels, and contents of consciousness. The ongoing evidence depicts interactions further than the cortical responses evoked by each heartbeat, suggesting the potential presence of non-linear, complex, and bidirectional communication between brain and heartbeat dynamics. Further developments on methodologies to analyze brain-heart interactions may contribute to a better understanding of the physiological dynamics involved in homeostatic-allostatic control, cognitive functions, and consciousness.