Self-control and interoception: Linking the neural substrates of craving regulation and the prediction of aversive interoceptive states induced by inspiratory breathing restriction

No evidence for a reciprocal relationship between daily self-control failures and addictive behavior in a longitudinal study

Introduction

We all experience occasional self-control failures (SCFs) in our daily lives, where we enact behaviors that stand in conflict with our superordinate or long-term goals. Based on the assumption that SCFs share common underlying mechanisms with addictive disorders, we tested the hypothesis that a generally higher susceptibility to daily SCFs predicts more addictive behavior, or vice versa.

Methods

At baseline, 338 individuals (19-27 years, 59% female) from a community sample participated in multi-component assessments. These included among others (1) a clinical interview on addictive behaviors (quantity of use, frequency of use, DSM-5 criteria; n = 338) and (2) ecological momentary assessment of SCFs (n = 329, 97%). At the 3-year and 6 year follow-up, participation rates for both assessment parts were 71% (n = 240) and 50% (n = 170), respectively.

Results

Controlling for age, gender, IQ, and baseline addiction level, random-intercept cross-lagged panel models revealed that participants who reported more SCFs also showed pronounced addictive behavior at the between-person level, but we found no evidence of a predictive relationship at the within-person level over time.

Discussion

A higher rate of SCFs is associated with more addictive behavior, while there is no evidence of an intraindividual predictive relationship. Novel hypotheses suggested by additional exploratory results are that (1) only addiction-related SCFs in daily life are early markers of an escalation of use and thus for addictive disorders and that (2) an explicit monitoring of SCFs increases self-reflection and thereby promotes the mobilization of cognitive control in response to goal-desire conflicts.

Altered Functional Connectivity during Mild Transient Respiratory Impairment Induced by a Resistive Load

Background: Previous neuroimaging studies have identified brain regions related to respiratory motor control and perception. However, little is known about the resting-state functional connectivity (FC) associated with respiratory impairment. We aimed to determine the FC involved in mild respiratory impairment without altering transcutaneous oxygen saturation. Methods: We obtained resting-state functional magnetic resonance imaging data from 36 healthy volunteers during normal respiration and mild respiratory impairment induced by resistive load (effort breathing). ROI-to-ROI and seed-to-voxel analyses were performed using Statistical Parametric Mapping 12 and the CONN toolbox. Results: Compared to normal respiration, effort breathing activated FCs within and between the sensory perceptual area (postcentral gyrus, anterior insular cortex (AInsula), and anterior cingulate cortex) and visual cortex (the visual occipital, occipital pole (OP), and occipital fusiform gyrus). Graph theoretical analysis showed strong centrality in the visual cortex. A significant positive correlation was observed between the dyspnoea score (modified Borg scale) and FC between the left AInsula and right OP. Conclusions: These results suggested that the FCs within the respiratory sensory area via the network hub may be neural mechanisms underlying effort breathing and modified Borg scale scores. These findings may provide new insights into the visual networks that contribute to mild respiratory impairments.

Where alcohol use disorder meets interoception: A meta-analytic view on structural and functional neuroimaging data

Alcohol use disorder (AUD) has been associated with changes in the processing of internal body signals, known as interoception. Changes in brain structure, particularly in the insula, are thought to underlie impaired interoception. As studies specifically investigating this association are largely lacking, this analysis takes an approach that compares meta-analytic results on interoception with recently published meta-analytic results on gray matter reduction in AUD. A systematic literature search identified 25 eligible interoception studies. Activation likelihood estimation (ALE) was used to test for spatial convergence of study results. Overlap between interoception and AUD clusters was tested using conjunction analysis. Meta-analytic connectivity modeling (MACM) and resting-state functional connectivity were used to identify the functional network of interoception and to test where this network overlapped with AUD meta-analytic clusters. The results were characterized using behavioral domain analysis. The interoception ALE identified a cluster in the left middle insula. There was no overlap with clusters of reduced gray matter in AUD. MACM analysis of the interoception cluster revealed a large network located in the insulae, thalami, basal nuclei, cingulate and medial frontal cortices, and pre- and postcentral gyri. Resting state analysis confirmed this result, showing the strongest connections to nodes of the salience- and somatomotor network. Five of the eight clusters that showed a structural reduction in AUD were located within these networks. The behavioral profiles of these clusters were suggestive of higher-level processes such as salience control, somatomotor functions, and skin sensations. The results suggest an altered salience mapping of interoceptive signals in AUD, consistent with current models. Connections to the somatomotor network may be related to action control and integration of skin sensations. Mindfulness-based interventions, pleasurable touch, and (deep) transcranial magnetic stimulation may be targeted interventions that reduce interoceptive deficits in AUD and thus contribute to drug use reduction and relapse prevention.

Interoception and self-regulation of eating behaviors and weight status in college students

OBJECTIVE

To determine the associations between interoception, self-regulation, eating behaviors, and weight status among college students.

PARTICIPANTS

229 female undergraduates, predominantly classified as Juniors (51.1%) and identified as Hispanic/Latinx (75%) with a mean age of 23.4 (SD = 6.3), were examined.

METHODS

Cross-sectional data using baseline measures from a larger, longitudinal study, were examined. Confirmatory factor analyses and structural equation modeling were conducted to test hypotheses.

RESULTS

Interoception was directly associated to self-regulation. Interoception and self-regulation were inversely associated with non-purposeful eating. Non-purposeful eating was directly associated with weight status.

CONCLUSION

This study provided empirical evidence on the associations between interoception, self-regulation, eating behaviors, and weight status. Our results support the need for programs that target college students' cognitive skills to reduce unhealthy eating behaviors and optimize weight status. Future interventions are needed to enhance interoception and self-regulation skills so that college students can be more purposeful in their eating habits.

Cognitive reappraisal of food craving and emotions: a coordinate-based meta-analysis of fMRI studies

Growing evidence supports the effectiveness of cognitive reappraisal in down-regulating food desire. Still, the neural bases of food craving down-regulation via reappraisal, as well as their degree of overlap vs specificity compared with emotion down-regulation, remain unclear. We addressed this gap through activation likelihood estimation meta-analyses of neuroimaging studies on the neural bases of (i) food craving down-regulation and (ii) emotion down-regulation, alongside conjunction and subtraction analyses among the resulting maps. Exploratory meta-analyses on activations related to food viewing compared with active regulation and up-regulation of food craving have also been performed. Food and emotion down-regulation via reappraisal consistently engaged overlapping activations in dorsolateral and ventrolateral prefrontal, posterior parietal, pre-supplementary motor and lateral posterior temporal cortices, mainly in the left hemisphere. Its distinctive association with the right anterior/posterior insula and left inferior frontal gyrus suggests that food craving down-regulation entails a more extensive integration of interoceptive information about bodily states and greater inhibitory control over the appetitive urge towards food compared with emotion down-regulation. This evidence is suggestive of unique interoceptive and motivational components elicited by food craving reappraisal, associated with distinctive patterns of fronto-insular activity. These results might inform theoretical models of food craving regulation and prompt novel therapeutic interventions for obesity and eating disorders.

The role of anticipated emotions in self-control: linking self-control and the anticipatory ability to engage emotions associated with upcoming events

Self-control is typically attributed to "cold" cognitive control mechanisms that top-down influence "hot" affective impulses or emotions. In this study we tested an alternative view, assuming that self-control also rests on the ability to anticipate emotions directed toward future consequences. Using a behavioral within-subject design including an emotion regulation task measuring the ability to voluntarily engage anticipated emotions towards an upcoming event and a self-control task in which subjects were confronted with a variety of everyday conflict situations, we examined the relationship between self-control and anticipated emotions. We found that those individuals (n = 33 healthy individuals from the general population) who were better able to engage anticipated emotions to an upcoming event showed stronger levels of self-control in situations where it was necessary to resist short-term temptations or to endure short-term aversions to achieve long-term goals. This finding suggests that anticipated emotions may play a functional role in self-control-relevant deliberations with respect to possible future consequences and are not only inhibited top-down as implied by "dual system" views on self-control.

The Willpower Paradox: Possible and Impossible Conceptions of Self-Control

Self-control denotes the ability to override current desires to render behavior consistent with long-term goals. A key assumption is that self-control is required when short-term desires are transiently stronger (more preferred) than long-term goals and people would yield to temptation without exerting self-control. We argue that this widely shared conception of self-control raises a fundamental yet rarely discussed conceptual paradox: How is it possible that a person most strongly desires to perform a behavior (e.g., eat chocolate) and at the same time desires to recruit self-control to prevent themselves from doing it? A detailed analysis reveals that three common assumptions about self-control cannot be true simultaneously. To avoid the paradox, any coherent theory of self-control must abandon either the assumption (a) that recruitment of self-control is an intentional process, or (b) that humans are unitary agents, or (c) that self-control consists in overriding the currently strongest desire. We propose a taxonomy of different kinds of self-control processes that helps organize current theories according to which of these assumptions they abandon. We conclude by outlining unresolved questions and future research perspectives raised by different conceptions of self-control and discuss implications for the question of whether self-control can be considered rational.

Dynamic heartbeat tracking beyond the laboratory: Introducing the novel Graz Ambulatory Interoception Task (GRAIT)

We present a novel ambulatory method, the Graz Ambulatory Interoception Task (GRAIT), to assess the accuracy of interoceptive beliefs (AccIB). This method captures both between- and within-person variations of AccIB by having participants counting perceived heartbeats in daily life. Reliability analyses showed high between-person (RkR = 0.99) and moderate within-person reliability (RCn = 0.62). Validity was supported by associations with an established laboratory task (r = 0.87). Within-person associations revealed that interoceptive sensibility, heart rate variability, and states of low arousal coupled with positive affect were linked to AccIB. Study 2 replicated these findings and showed a relationship between AccIB and self-control in everyday life, highlighting the importance of cardiac interoception and its relevance for health.

Multidimensional assessment of anticipated and experienced interoceptive states

As the sense of the body's internal state, interoception represents the afferent component of the brain-body feedback loop essential for linking internal sensation with body regulation, thereby minimizing erroneous feedback and maintaining homeostasis. The anticipation of potential future interoceptive states enables organisms to take regulatory actions to meet demands before they arise, and alterations of anticipation have been implicated in the pathophysiology of medical and psychiatric conditions. However, laboratory approaches operationalizing the anticipation of interoceptive states are missing. Therefore, we developed two interoceptive awareness paradigms, the Accuracy of Interoceptive Anticipation paradigm, and the Interoceptive Discrepancy paradigm, which we tested in 52 healthy participants on two sensory modalities: nociception and respiroception. Ten participants took part in a retest. The Accuracy of Interoceptive Anticipation paradigm focused on assessing how individuals anticipate and experience interoceptive stimuli of varying strengths. The Interoceptive Discrepancy paradigm extended this measure by manipulating previously learned expectations to induce discrepancies between anticipated and experienced stimuli. We found that anticipation and experience ratings successfully related to stimulus strength in both paradigms and modalities and were stable between test-retest. Furthermore, the Interoceptive Discrepancy paradigm successfully induced the expected discrepancies between anticipation and experience conditions, and discrepancy values were correlated across sensory modalities. Thus, both paradigms are valid and reliable tools for assessing the anticipation of future interoceptive states, and the Interoceptive Discrepancy paradigm is additionally suited to evaluate discrepancy awareness.

Interoception Within the Context of Impulsivity and Addiction

Purpose of Review

The goal of this review is to examine the relationship between impulsivity and interoception in addiction, to summarize the current understanding of the topic, identify any gaps in knowledge, and provide directions for future research.

Research Findings

Interoception may be a contributing factor to impulsive behaviour and, thus, addiction. Substance abuse can negatively impact the brain's ability to process interoceptive information and impact the reward system, leading to decreased sensitivity to natural rewards and increased sensitivity to drugs. There is potential for new therapies, such as mindfulness, interoceptive training, brain stimulation, or vagal nerve stimulation to target both impulsivity and interoception in the treatment of addiction.

Summary

Despite a growing interest in interoception in addiction research, further research is needed to better understand the role of interoception in addiction and to develop new methods for studying how individuals with addiction process and perceive internal bodily sensations.

Breathing control, brain, and bodily self-consciousness: Toward immersive digiceuticals to alleviate respiratory suffering

Breathing is peculiar among autonomic functions through several characteristics. It generates a very rich afferent traffic from an array of structures belonging to the respiratory system to various areas of the brain. It is intimately associated with bodily movements. It bears particular relationships with consciousness as its efferent motor control can be automatic or voluntary. In this review within the scope of "respiratory neurophysiology" or "respiratory neuroscience", we describe the physiological organisation of breathing control. We then review findings linking breathing and bodily self-consciousness through respiratory manipulations using virtual reality (VR). After discussing the currently admitted neurophysiological model for dyspnea, as well as a new Bayesian model applied to breathing control, we propose that visuo-respiratory paradigms -as developed in cognitive neuroscience- will foster insights into some of the basic mechanisms of the human respiratory system and will also lead to the development of immersive VR-based digital health tools (i.e. digiceuticals).

Interoception of breathing and its relationship with anxiety

Interoception, the perception of internal bodily states, is thought to be inextricably linked to affective qualities such as anxiety. Although interoception spans sensory to metacognitive processing, it is not clear whether anxiety is differentially related to these processing levels. Here we investigated this question in the domain of breathing, using computational modeling and high-field (7 T) fMRI to assess brain activity relating to dynamic changes in inspiratory resistance of varying predictability. Notably, the anterior insula was associated with both breathing-related prediction certainty and prediction errors, suggesting an important role in representing and updating models of the body. Individuals with low versus moderate anxiety traits showed differential anterior insula activity for prediction certainty. Multi-modal analyses of data from fMRI, computational assessments of breathing-related metacognition, and questionnaires demonstrated that anxiety-interoception links span all levels from perceptual sensitivity to metacognition, with strong effects seen at higher levels of interoceptive processes.

The breathing brain: The potential of neural oscillations for the understanding of respiratory perception in health and disease

Dyspnea or breathlessness is a symptom occurring in multiple acute and chronic illnesses, however, the understanding of the neural mechanisms underlying its subjective experience is limited. In this topical review, we propose neural oscillatory dynamics and cross-frequency coupling as viable candidates for a neural mechanism underlying respiratory perception, and a technique warranting more attention in respiration research. With the evidence for the potential of neural oscillations in the study of normal and disordered breathing coming from disparate research fields with a limited history of interdisciplinary collaboration, the main objective of the review was to converge the existing research and suggest future directions. The existing findings show that distinct limbic and cortical activations, as measured by hemodynamic responses, underlie dyspnea, however, the time-scale of these activations is not well understood. The recent findings of oscillatory neural activity coupled with the respiratory rhythm could provide the solution to this problem, however, more research with a focus on dyspnea is needed. We also touch on the findings of distinct spectral patterns underlying the changes in breathing due to experimental manipulations, meditation and disease. Subsequently, we suggest general research directions and specific research designs to supplement the current knowledge using neural oscillation techniques. We argue for the benefits of interdisciplinary collaboration and the converging of neuroimaging and behavioral methods to best explain the emergence of the subjective and aversive individual experience of dyspnea.