Interoceptive technologies for psychiatric interventions: From diagnosis to clinical applications

Interoception-the perception of internal bodily signals-has emerged as an area of interest due to its implications in emotion and the prevalence of dysfunctional interoceptive processes across psychopathological conditions. Despite the importance of interoception in cognitive neuroscience and psychiatry, its experimental manipulation remains technically challenging. This is due to the invasive nature of existing methods, the limitation of self-report and unimodal measures of interoception, and the absence of standardized approaches across disparate fields. This article integrates diverse research efforts from psychology, physiology, psychiatry, and engineering to address this oversight. Following a general introduction to the neurophysiology of interoception as hierarchical predictive processing, we review the existing paradigms for manipulating interoception (e.g., interoceptive modulation), their underlying mechanisms (e.g., interoceptive conditioning), and clinical applications (e.g., interoceptive exposure). We suggest a classification for interoceptive technologies and discuss their potential for diagnosing and treating mental health disorders. Despite promising results, considerable work is still needed to develop standardized, validated measures of interoceptive function across domains and before these technologies can translate safely and effectively to clinical settings.

The bodily self from psychosis to psychedelics

The sense of self is a foundational element of neurotypical human consciousness. We normally experience the world as embodied agents, with the unified sensation of our selfhood being nested in our body. Critically, the sense of self can be altered in psychiatric conditions such as psychosis and altered states of consciousness induced by psychedelic compounds. The similarity of phenomenological effects across psychosis and psychedelic experiences has given rise to the "psychotomimetic" theory suggesting that psychedelics simulate psychosis-like states. Moreover, psychedelic-induced changes in the sense of self have been related to reported improvements in mental health. Here we investigated the bodily self in psychedelic, psychiatric, and control populations. Using the Moving Rubber Hand Illusion, we tested (N = 75) patients with psychosis, participants with a history of substantial psychedelic experiences, and control participants to see how psychedelic and psychiatric experience impacts the bodily self. Results revealed that psychosis patients had reduced Body Ownership and Sense of Agency during volitional action. The psychedelic group reported subjective long-lasting changes to the sense of self, but no differences between control and psychedelic participants were found. Our results suggest that while psychedelics induce both acute and enduring subjective changes in the sense of self, these are not manifested at the level of the bodily self. Furthermore, our data show that bodily self-processing, related to volitional action, is disrupted in psychosis patients. We discuss these findings in relation to anomalous self-processing across psychedelic and psychotic experiences.

Attachment Reminders Trigger Widespread Synchrony across Multiple Brains

Infant stimuli elicit widespread neural and behavioral response in human adults, and such massive allocation of resources attests to the evolutionary significance of the primary attachment. Here, we examined whether attachment reminders also trigger cross-brain concordance and generate greater neural uniformity, as indicated by intersubject correlation. Human mothers were imaged twice in oxytocin/placebo administration design, and stimuli included four ecological videos of a standard unfamiliar mother and infant: two infant/mother alone (Alone) and two mother-infant dyadic contexts (Social). Theory-driven analysis measured cross-brain synchrony in preregistered nodes of the parental caregiving network (PCN), which integrates subcortical structures underpinning mammalian mothering with cortical areas implicated in simulation, mentalization, and emotion regulation, and data-driven analysis assessed brain-wide concordance using whole-brain parcellation. Results demonstrated widespread cross-brain synchrony in both the PCN and across the neuroaxis, from primary sensory/somatosensory areas, through insular-cingulate regions, to temporal and prefrontal cortices. The Social context yielded significantly more cross-brain concordance, with PCNs striatum, parahippocampal gyrus, superior temporal sulcus, ACC, and PFC displaying cross-brain synchrony only to mother-infant social cues. Moment-by-moment fluctuations in mother-infant social synchrony, ranging from episodes of low synchrony to tightly coordinated positive bouts, were tracked online by cross-brain concordance in the preregistered ACC. Findings indicate that social attachment stimuli, representing evolutionary-salient universal cues that require no verbal narrative, trigger substantial interbrain concordance and suggest that the mother-infant bond, an icon standing at the heart of human civilization, may function to glue brains into a unified experience and bind humans into social groups.SIGNIFICANCE STATEMENT Infant stimuli elicit widespread neural response in human adults, attesting to their evolutionary significance, but do they also trigger cross-brain concordance and induce neural uniformity among perceivers? We measured cross-brain synchrony to ecological mother-infant videos. We used theory-driven analysis, measuring cross-brain concordance in the parenting network, and data-driven analysis, assessing brain-wide concordance using whole-brain parcellation. Attachment cues triggered widespread cross-brain concordance in both the parenting network and across the neuroaxis. Moment-by-moment fluctuations in behavioral synchrony were tracked online by cross-brain variability in ACC. Attachment reminders bind humans' brains into a unitary experience and stimuli characterized by social synchrony enhance neural similarity among participants, describing one mechanism by which attachment bonds provide the neural template for the consolidation of social groups.

Multisensory decisions from self to world

Classic Bayesian models of perceptual inference describe how an ideal observer would integrate 'unisensory' measurements (multisensory integration) and attribute sensory signals to their origin(s) (causal inference). However, in the brain, sensory signals are always received in the context of a multisensory bodily state-namely, in combination with other senses. Moreover, sensory signals from both interoceptive sensing of one's own body and exteroceptive sensing of the world are highly interdependent and never occur in isolation. Thus, the observer must fundamentally determine whether each sensory observation is from an external (versus internal, self-generated) source to even be considered for integration. Critically, solving this primary causal inference problem requires knowledge of multisensory and sensorimotor dependencies. Thus, multisensory processing is needed to separate sensory signals. These multisensory processes enable us to simultaneously form a sense of self and form distinct perceptual decisions about the external world. In this opinion paper, we review and discuss the similarities and distinctions between multisensory decisions underlying the sense of self and those directed at acquiring information about the world. We call attention to the fact that heterogeneous multisensory processes take place all along the neural hierarchy (even in forming 'unisensory' observations) and argue that more integration of these aspects, in theory and experiment, is required to obtain a more comprehensive understanding of multisensory brain function. This article is part of the theme issue 'Decision and control processes in multisensory perception'.

Disentangling the Neural Correlates of Agency, Ownership and Multisensory Processing

The experience of the self as an embodied agent in the world is an essential aspect of human consciousness. This experience arises from the feeling of control over one's bodily actions, termed the Sense of Agency, and the feeling that the body belongs to the self, Body Ownership. Despite long-standing philosophical and scientific interest in the relationship between the body and brain, the neural systems involved in Body Ownership and Sense of Agency, and especially their interactions, are not yet understood. In this preregistered study using the Moving Rubber Hand Illusion inside an MR-scanner, we aimed to uncover the relationship between Body Ownership and Sense of Agency in the human brain. Importantly, by using both visuomotor and visuotactile stimulations and measuring online trial-by-trial fluctuations in the illusion magnitude, we were able to disentangle brain systems related to objective sensory stimulation and subjective judgments of the bodily-self. Our results indicate that at both the behavioral and neural levels, Body Ownership and Sense of Agency are strongly interrelated. Multisensory regions in the occipital and fronto-parietal regions encoded convergence of sensory stimulation conditions. The subjective judgments of the bodily-self were related to BOLD fluctuations in the Somatosensory cortex and in regions not activated by the sensory conditions, such as the insular cortex and precuneus. Our results highlight the convergence of multisensory processing in specific neural systems for both Body Ownership and Sense of Agency with partially dissociable regions for subjective judgments in regions of the Default Mode Network.

ChillsDB: A Gold Standard for Aesthetic Chills Stimuli

We introduce ChillsDB the first validated database of audiovisual stimuli eliciting aesthetic chills (goosebumps, psychogenic shivers) in a US population. To discover chills stimuli "in the wild", we devised a bottom-up, ecologically-valid method consisting in searching for mentions of the emotion' somatic markers in user comments throughout social media platforms (YouTube and Reddit). We successfully captured 204 chills-eliciting videos of three categories: music, film, and speech. We then tested the top 50 videos in the database on 600+ participants and validated a gold standard of 10 stimuli with a 0.9 probability of generating chills. All ChillsDB tools and data are fully available on GitHub for researchers to be able to contribute and perform further analysis.

Impaired sense of agency and associated confidence in psychosis

The Sense of Agency (SoA), our sensation of control over our actions, is a fundamental mechanism for delineating the Self from the environment and others. SoA arises from implicit processing of sensorimotor signals as well as explicit higher-level judgments. Psychosis patients suffer from difficulties in the sense of control over their actions and accurate demarcation of the Self. Moreover, it is unclear if they have metacognitive insight into their aberrant abilities. In this pre-registered study, we examined SoA and its associated confidence judgments using an embodied virtual reality paradigm in psychosis patients and controls. Our results show that psychosis patients not only have a severely reduced ability for discriminating their actions but they also do not show proper metacognitive insight into this deficit. Furthermore, an exploratory analysis revealed that the SoA capacities allow for high levels of accuracy in clinical classification of psychosis. These results indicate that SoA and its metacognition are core aspects of the psychotic state and provide possible venues for understanding the underlying mechanisms of psychosis, that may be leveraged for novel clinical purposes.

The Scientific Study of Consciousness Cannot and Should Not Be Morally Neutral

A target question for the scientific study of consciousness is how dimensions of consciousness, such as the ability to feel pain and pleasure or reflect on one's own experience, vary in different states and animal species. Considering the tight link between consciousness and moral status, answers to these questions have implications for law and ethics. Here we point out that given this link, the scientific community studying consciousness may face implicit pressure to carry out certain research programs or interpret results in ways that justify current norms rather than challenge them. We show that because consciousness largely determines moral status, the use of nonhuman animals in the scientific study of consciousness introduces a direct conflict between scientific relevance and ethics-the more scientifically valuable an animal model is for studying consciousness, the more difficult it becomes to ethically justify compromises to its well-being for consciousness research. Finally, in light of these considerations, we call for a discussion of the immediate ethical corollaries of the body of knowledge that has accumulated and for a more explicit consideration of the role of ideology and ethics in the scientific study of consciousness.

New Constraint on the Local Relic Neutrino Background Overdensity with the First KATRIN Data Runs

We report on the direct search for cosmic relic neutrinos using data acquired during the first two science campaigns of the KATRIN experiment in 2019. Beta-decay electrons from a high-purity molecular tritium gas source are analyzed by a high-resolution MAC-E filter around the end point at 18.57 keV. The analysis is sensitive to a local relic neutrino overdensity ratio of η<9.7×10^{10}/α (1.1×10^{11}/α) at a 90% (95%) confidence level with α=1 (0.5) for Majorana (Dirac) neutrinos. A fit of the integrated electron spectrum over a narrow interval around the end point accounting for relic neutrino captures in the tritium source reveals no significant overdensity. This work improves the results obtained by the previous neutrino mass experiments at Los Alamos and Troitsk. We furthermore update the projected final sensitivity of the KATRIN experiment to η<1×10^{10}/α at 90% confidence level, by relying on updated operational conditions.

Judgments of agency are affected by sensory noise without recruiting metacognitive processing

Acting in the world is accompanied by a sense of agency, or experience of control over our actions and their outcomes. As humans, we can report on this experience through judgments of agency. These judgments often occur under noisy conditions. We examined the computations underlying judgments of agency, in particular under the influence of sensory noise. Building on previous literature, we studied whether judgments of agency incorporate uncertainty in the same way that confidence judgments do, which would imply that the former share computational mechanisms with metacognitive judgments. In two tasks, participants rated agency, or confidence in a decision about their agency, over a virtual hand that tracked their movements, either synchronously or with a delay and either under high or low noise. We compared the predictions of two computational models to participants’ ratings and found that agency ratings, unlike confidence, were best explained by a model involving no estimates of sensory noise. We propose that agency judgments reflect first-order measures of the internal signal, without involving metacognitive computations, challenging the assumed link between the two cognitive processes.

Aesthetic chills cause an emotional drift in valence and arousal

Aesthetic chills are an embodied peak emotional experience induced by stimuli such as music, films, and speeches and characterized by dopaminergic release. The emotional consequences of chills in terms of valence and arousal are still debated and the existing empirical data is conflicting. In this study, we tested the effects of ChillsDB, an open-source repository of chills-inducing stimuli, on the emotional ratings of 600+ participants. We found that participants experiencing chills reported significantly more positive valence and greater arousal during the experience, compared to participants who did not experience chills. This suggests that the embodied experience of chills may influence one's perception and affective evaluation of the context, in favor of theoretical models emphasizing the role of interoceptive signals such as chills in the process of perception and decision-making. We also found an interesting pattern in the valence ratings of participants, which tended to harmonize toward a similar mean after the experiment, though initially disparately distributed. We discuss the significance of these results for the diagnosis and treatment of dopaminergic disorders such as Parkinson's, schizophrenia, and depression.

Agency Deficits in a Human Genetic Model of Schizophrenia: Insights From 22q11DS Patients

Schizophrenia is a chronic and disabling mental illness characterized by a disordered sense of self. Current theories suggest that deficiencies in the sense of control over one's actions (Sense of Agency, SoA) may underlie some of the symptoms of schizophrenia. However, it is not clear if agency deficits are a precursor or a result of psychosis. Here, we investigated full body agency using virtual reality in a cohort of 22q11 deletion syndrome participants with a genetic propensity for schizophrenia. In two experiments employing virtual reality, full body motion tracking, and online feedback, we investigated SoA in two separate domains. Our results show that participants with 22q11DS had a considerable deficit in monitoring their actions, compared to age-matched controls in both the temporal and spatial domain. This was coupled with a bias toward erroneous attribution of actions to the self. These results indicate that nonpsychotic 22q11DS participants have a domain general deficit in the conscious sensorimotor mechanisms underlying the bodily self. Our data reveal an abnormality in the SoA in a cohort with a genetic predisposition for schizophrenia, but without psychosis, providing evidence that deficits in delineation of the self may be a precursor rather than a result of the psychotic state.

Neural Representation of the Parent-Child Attachment from Infancy to Adulthood

Attachment theory is built on the assumption of consistency; the mother–infant bond is thought to underpin the life-long representations individuals construct of attachment relationships. Still, consistency in the individual’s neural response to attachment-related stimuli representing his or her entire relational history has not been investigated. Mothers and children were followed across two decades and videotaped in infancy (3–6 months), childhood (9–12 years) and young adulthood (18–24 years). In adulthood, participants underwent functional magnetic resonance imaging while exposed to videos of own mother–child interactions (Self) vs unfamiliar interactions (Other). Self-stimuli elicited greater activations across preregistered nodes of the human attachment network, including thalamus-to-brainstem, amygdala, hippocampus, anterior cingulate cortex (ACC), insula and temporal cortex. Critically, self-stimuli were age-invariant in most regions of interest despite large variability in social behavior, and Bayesian analysis showed strong evidence for lack of age-related differences. Psycho–physiological interaction analysis indicated that self-stimuli elicited tighter connectivity between ACC and anterior insula, consolidating an interface associating information from exteroceptive and interceptive sources to sustain attachment representations. Child social engagement behavior was individually stable from infancy to adulthood and linked with greater ACC and insula response to self-stimuli. Findings demonstrate overlap in circuits sustaining parental and child attachment and accord with perspectives on the continuity of attachment across human development.

Fronto-Temporal Disconnection Within the Presence Hallucination Network in Psychotic Patients With Passivity Experiences

Psychosis, characterized by hallucinations and delusions, is a common feature of psychiatric disease, especially schizophrenia. One prominent theory posits that psychosis is driven by abnormal sensorimotor predictions leading to the misattribution of self-related events. This misattribution has been linked to passivity experiences (PE), such as loss of agency and, more recently, to presence hallucinations (PH), defined as the conscious experience of the presence of an alien agent while no person is actually present. PH has been observed in schizophrenia, Parkinson's disease, and neurological patients with brain lesions and, recently, the brain mechanisms of PH (PH-network) have been determined comprising bilateral posterior middle temporal gyrus (pMTG), inferior frontal gyrus (IFG), and ventral premotor cortex (vPMC). Given that the experience of an alien agent is a common feature of PE, we here analyzed the functional connectivity within the PH-network in psychotic patients with (N = 39) vs without PE (N = 26). We observed reduced fronto-temporal functional connectivity in patients with PE compared to patients without PE between the right pMTG and the right and left IFG of the PH-network. Moreover, when seeding from these altered regions, we observed specific alterations with brain regions commonly linked to auditory-verbal hallucinations (such as Heschl's gyrus). The present connectivity findings within the PH-network extend the disconnection hypothesis for hallucinations to the specific case of PH and associates the PH-network with key brain regions for frequent psychotic symptoms such as auditory-verbal hallucinations, showing that PH are relevant to the study of the brain mechanisms of psychosis and PE.

Trust as Extended Control: Human-Machine Interactions as Active Inference

In order to interact seamlessly with robots, users must infer the causes of a robot's behavior-and be confident about that inference (and its predictions). Hence, trust is a necessary condition for human-robot collaboration (HRC). However, and despite its crucial role, it is still largely unknown how trust emerges, develops, and supports human relationship to technological systems. In the following paper we review the literature on trust, human-robot interaction, HRC, and human interaction at large. Early models of trust suggest that it is a trade-off between benevolence and competence; while studies of human to human interaction emphasize the role of shared behavior and mutual knowledge in the gradual building of trust. We go on to introduce a model of trust as an agent' best explanation for reliable sensory exchange with an extended motor plant or partner. This model is based on the cognitive neuroscience of active inference and suggests that, in the context of HRC, trust can be casted in terms of virtual control over an artificial agent. Interactive feedback is a necessary condition to the extension of the trustor's perception-action cycle. This model has important implications for understanding human-robot interaction and collaboration-as it allows the traditional determinants of human trust, such as the benevolence and competence attributed to the trustee, to be defined in terms of hierarchical active inference, while vulnerability can be described in terms of information exchange and empowerment. Furthermore, this model emphasizes the role of user feedback during HRC and suggests that boredom and surprise may be used in personalized interactions as markers for under and over-reliance on the system. The description of trust as a sense of virtual control offers a crucial step toward grounding human factors in cognitive neuroscience and improving the design of human-centered technology. Furthermore, we examine the role of shared behavior in the genesis of trust, especially in the context of dyadic collaboration, suggesting important consequences for the acceptability and design of human-robot collaborative systems.

Modulation of Bodily Self-Consciousness by Self and External Touch

The full body illusion (FBI) is a bodily illusion based on the application of multisensory conflicts that induce changes in bodily self-consciousness (BSC). This has been used to study cognitive brain mechanisms underlying body ownership and related aspects of self-consciousness. Typically, such paradigms employ external passive multisensory stimulation, thus neglecting the possible contributions of self-generated action and haptic cues to body ownership. In this article, the effects of both external and voluntary self-touch on BSC were examined with a robotics-based FBI paradigm. We compared the effects of classical passive visuotactile stimulation and active self-touch (in which experimental participants had a sense of agency over the tactile stimulation) on the FBI. We evaluated these effects using a questionnaire, crossmodal congruency task, and measurements of changes in self-location. The results indicated that both synchronous passive visuotactile stimulation and synchronous active self-touch induced illusory ownership over a virtual body, without significant differences in their magnitudes. However, the FBI induced by active self-touch was associated with a larger drift in self-location towards the virtual body. These results show that movement-related signals arising from self-touch impact the BSC not only for hand ownership but also for torso-centered body ownership and related aspects of BSC.

Mother brain is wired for social moments

Reorganization of the maternal brain upon childbirth triggers the species-typical maternal social behavior. These brief social moments carry profound effects on the infant's brain and likely have a distinct signature in the maternal brain. Utilizing a double-blind, within-subject oxytocin/placebo administration crossover design, mothers' brain was imaged twice using fMRI while observing three naturalistic maternal-infant contexts in the home ecology; 'unavailable', 'unresponsive', and 'social', when mothers engaged in synchronous peek-a-boo play. The social condition elicited greater neural response across the human caregiving network, including amygdala, VTA, hippocampus, insula, ACC, and temporal cortex. Oxytocin impacted neural response primarily to the social condition and attenuated differences between social and non-social stimuli. Greater temporal consistency emerged in the 'social' condition across the two imaging sessions, particularly in insula, amygdala, and TP. Findings describe how mother's brain varies by caregiving experiences and gives salience to moments of social synchrony that support infant development and brain maturation.

Thought consciousness and source monitoring depend on robotically controlled sensorimotor conflicts and illusory states

Thought insertion (TI) is characterized by the experience that certain thoughts, occurring in one's mind, are not one's own, but the thoughts of somebody else and suggestive of a psychotic disorder. We report a robotics-based method able to investigate the behavioral and subjective mechanisms of TI in healthy participants. We used a robotic device to alter body perception by providing online sensorimotor stimulation, while participants performed cognitive tasks implying source monitoring of mental states attributed to either oneself or another person. Across several experiments, conflicting sensorimotor stimulation reduced the distinction between self- and other-generated thoughts and was, moreover, associated with the experimentally generated feeling of being in the presence of an alien agent and subjective aspects of TI. Introducing a new robotics-based approach that enables the experimental study of the brain mechanisms of TI, these results link TI to predictable self-other shifts in source monitoring and specific sensorimotor processes.

Assessing the Relationship between Sense of Agency, the Bodily-Self and Stress: Four Virtual-Reality Experiments in Healthy Individuals

The bodily-self, our experience of being a body, arises from the interaction of several processes. For example, embodied Sense of Agency (SoA), the feeling of controlling our body’s actions, is a fundamental facet of the bodily-self. SoA is disturbed in psychosis, with stress promoting its inception. However, there is little knowledge regarding the relationship between SoA, stress, and other facets of the bodily-self. In four experiments manipulating embodied SoA using a virtual hand (VH), we examined (1) How is embodied SoA related to other facets of the bodily-self?; and (2) How is SoA impacted by stress? We found that increased alteration of the VH significantly decreased subjective ratings of SoA and body ownership (Exp. 1), supporting the close relation between SoA and body ownership. Interoceptive accuracy and SoA were positively correlated (Exp. 3), connecting awareness to one’s actions and cardiac signals. Contrary to our expectations, SoA was not related to trait anxiety (Exp. 3), nor did induced stress impair SoA (Exp. 4). Finally, we found a negative correlation between self-reported prodromal symptoms and SoA. These results strongly support the connection between SoA and the bodily-self. Whereas, SoA was not impaired by stress, and weakly related to psychotic symptoms.

Sensorimotor Induction of Auditory Misattribution in Early Psychosis

Dysfunction of sensorimotor predictive processing is thought to underlie abnormalities in self-monitoring producing passivity symptoms in psychosis. Experimentally induced sensorimotor conflict can produce a failure in bodily self-monitoring (presence hallucination [PH]), yet it is unclear how this is related to auditory self-monitoring and psychosis symptoms. Here we show that the induction of sensorimotor conflict in early psychosis patients induces PH and impacts auditory-verbal self-monitoring. Participants manipulated a haptic robotic system inducing a bodily sensorimotor conflict. In experiment 1, the PH was measured. In experiment 2, an auditory-verbal self-monitoring task was performed during the conflict. Fifty-one participants (31 early psychosis patients, 20 matched controls) participated in the experiments. The PH was present in all participants. Psychosis patients with passivity experiences (PE+) had reduced accuracy in auditory-verbal self-other discrimination during sensorimotor stimulation, but only when sensorimotor stimulation involved a spatiotemporal conflict (F(2, 44) = 6.68, P = .002). These results show a strong link between robotically controlled alterations in sensorimotor processing and auditory misattribution in psychosis and provide evidence for the role of sensorimotor processes in altered self-monitoring in psychosis.

UnReal? Investigating the Sense of Reality and Psychotic Symptoms with Virtual Reality

Distortions of reality, such as hallucinations, are common symptoms of many psychiatric conditions. Accordingly, sense of reality (SoR), the ability to discriminate between true and false perceptions, is a central criterion in the assessment of neurological and psychiatric health. Despite the critical role of the SoR in daily life, little is known about how this is formed in the mind. Here, we propose a novel theoretical and methodological framework to study the SoR and its relation to psychotic symptoms. In two experiments, we employed a specialized immersive virtual reality (VR) environment allowing for well-controlled manipulations of visual reality. We first tested the impact of manipulating visual reality on objective perceptual thresholds (just noticeable differences). In a second experiment, we tested how these manipulations affected subjective judgments of reality. The results revealed that the objective perceptual thresholds were robust and replicable, demonstrating that SoR is a stable psychometric property that can be measured experimentally. Furthermore, reality alterations reduced subjective reality judgments across all manipulated visual aspects. Finally, reduced sensitivity to changes in visual reality was related to self-reported prodromal psychotic symptoms. These results provide evidence for the relevance of SoR in the assessment of psychosis and other mental disorders in which reality is distorted.

Sensorimotor conflicts alter metacognitive and action monitoring

While sensorimotor signals are known to modulate perception, little is known about their influence on higher-level cognitive processes. Here, we applied sensorimotor conflicts while participants performed a perceptual task followed by confidence judgments. Results showed that sensorimotor conflicts altered metacognitive monitoring by decreasing metacognitive performance. In a second experiment, we replicated this finding and extended our results by showing that sensorimotor conflicts also altered action monitoring, as measured implicitly through intentional binding. In a third experiment, we replicated the same effects on intentional binding with sensorimotor conflicts related to the hand rather than to the trunk. However, effects of hand sensorimotor conflicts on metacognitive monitoring were not significant. Taken together, our results suggest that metacognitive and action monitoring may involve endogenous, embodied processes involving sensorimotor signals which are informative regarding the state of the decider.

Augmented manipulation ability in humans with six-fingered hands

Neurotechnology attempts to develop supernumerary limbs, but can the human brain deal with the complexity to control an extra limb and yield advantages from it? Here, we analyzed the neuromechanics and manipulation abilities of two polydactyly subjects who each possess six fingers on their hands. Anatomical MRI of the supernumerary finger (SF) revealed that it is actuated by extra muscles and nerves, and fMRI identified a distinct cortical representation of the SF. In both subjects, the SF was able to move independently from the other fingers. Polydactyly subjects were able to coordinate the SF with their other fingers for more complex movements than five fingered subjects, and so carry out with only one hand tasks normally requiring two hands. These results demonstrate that a body with significantly more degrees-of-freedom can be controlled by the human nervous system without causing motor deficits or impairments and can instead provide superior manipulation abilities.

The boundaries of the self: The sense of agency across different sensorimotor aspects

The sense of agency (SoA) is the sensation of control over our actions. SoA is thought to rely mainly upon the comparison of predictions regarding the sensory outcomes of one's actions and the actual sensory outcomes. Previous studies have shown that when a discrepancy is introduced between one's actions and the sensory feedback, the reported SoA is reduced. Experimental manipulations of SoA are typically induced by introducing a discrepancy between a motor action and visual feedback of a specific sensorimotor aspect. For example, introducing a delay or a spatial deviation between the action and its sensory feedback reduces SoA. However, it is yet unclear whether the sensorimotor prediction processes underlying SoA are related between different aspects. Here in one exploratory and one preregistered experiment we tested the sense of agency across temporal, spatial, and anatomical aspects in a within-subject design. Using a novel virtual-reality task allowing the manipulation of the visual feedback of a motor action across different aspects, we show that the sensitivity of agency is different across aspects, agency judgments are correlated across aspects within subjects and bias toward attributing the viewed action to the self or to an external source is correlated as well. Our results suggest that sensorimotor prediction mechanisms underlying SoA are related between different aspects and that people have a predisposition for the directionality of agency judgments. These findings reveal the psychophysical attributes of SoA across sensorimotor aspects. Data and preregistration are available at https://goo.gl/SkbGrb.

The Principles of Art Therapy in Virtual Reality

In recent years, the field of virtual reality (VR) has shown tremendous advancements and is utilized in entertainment, scientific research, social networks, artistic creation, as well as numerous approaches to employ VR for psychotherapy. While the use of VR in psychotherapy has been widely discussed, little attention has been given to the potential of this new medium for art therapy. Artistic expression in VR is a novel medium which offers unique possibilities, extending beyond classical expressive art mediums. Creation in VR includes options such as three-dimensional painting, an immersive creative experience, dynamic scaling, and embodied expression. In this perspective paper, we present the potentials and challenges of VR for art therapy and outline basic principles for its implementation. We focus on the novel qualities offered by this creative medium (the virtual environment, virtual materials, and unreal characteristics) and on the core aspects of VR (such as presence, immersivity, point of view, and perspective) for the practice of art therapy.

Rethinking Body Ownership in Schizophrenia: Experimental and Meta-analytical Approaches Show no Evidence for Deficits

Schizophrenia is a severe psychiatric disorder, in which patients experience an abnormal sense of self. While deficits in sensorimotor self-representation (agency) are well documented in schizophrenia, less is known about other aspects of bodily self-representation (body ownership). Here, we tested a large cohort (N = 59) of chronic schizophrenia patients and matched controls (N = 30) on a well-established body illusion paradigm, the Full Body Illusion (FBI). In this paradigm, changes in body ownership are induced through prolonged multisensory stimulation, in which participants are stroked on their back while seeing the stroking on the back of a virtual body. When the felt and seen stroking are synchronous, participants typically feel higher identification with the seen body as well as a drift in self-location towards it. However, when the stroking is asynchronous, no such changes occur. Our results show no evidence for abnormal body ownership in schizophrenia patients. A meta-analysis of previous work corroborates this result. Thus, while schizophrenia patients may be impaired in the sense of agency, their multisensory bodily self-representation, as tested here, seems to be unaffected by the illness.

Insula mediates heartbeat related effects on visual consciousness

Interoceptive signals, such as the heartbeat, are processed in a network of brain regions including the insular cortex. Recent studies have shown that such signals modulate perceptual and cognitive processing, and that they impact visual awareness. For example, visual stimuli presented synchronously to the heartbeat take longer to enter visual awareness than the same stimuli presented asynchronously to the heartbeat, and this is reflected in anterior insular activation. This finding demonstrated a link between the processing of interoceptive and exteroceptive signals as well as visual awareness in the insular cortex. The advantage for visual stimuli which are asynchronous to the heartbeat to enter visual consciousness may indicate a role for the anterior insula in the suppression of the sensory consequences of cardiac signals. Here, we present data from the detailed investigation of two patients with insular lesions (as well as four patients with non-insular lesions and healthy age matched controls) indicating that a lesion of the anterior insular cortex, but not of other regions, abolished this cardio-visual suppression effect. The present data provide causal evidence for the role of the anterior insula in the integration of internal interoceptive and external sensory signals for visual awareness.

Characterizing first and third person viewpoints and their alternation for embodied interaction in virtual reality

Empirical research on the bodily self has shown that the body representation is malleable, and prone to manipulation when conflicting sensory stimuli are presented. Using Virtual Reality (VR) we assessed the effects of manipulating multisensory feedback (full body control and visuo-tactile congruence) and visual perspective (first and third person perspective) on the sense of embodying a virtual body that was exposed to a virtual threat. We also investigated how subjects behave when the possibility of alternating between first and third person perspective at will was presented. Our results support that illusory ownership of a virtual body can be achieved in both first and third person perspectives under congruent visuo-motor-tactile condition. However, subjective body ownership and reaction to threat were generally stronger for first person perspective and alternating condition than for third person perspective. This suggests that the possibility of alternating perspective is compatible with a strong sense of embodiment, which is meaningful for the design of new embodied VR experiences.

Upper limb cortical maps in amputees with targeted muscle and sensory reinnervation

Neuroprosthetics research in amputee patients aims at developing new prostheses that move and feel like real limbs. Targeted muscle and sensory reinnervation (TMSR) is such an approach and consists of rerouting motor and sensory nerves from the residual limb towards intact muscles and skin regions. Movement of the myoelectric prosthesis is enabled via decoded electromyography activity from reinnervated muscles and touch sensation on the missing limb is enabled by stimulation of the reinnervated skin areas. Here we ask whether and how motor control and redirected somatosensory stimulation provided via TMSR affected the maps of the upper limb in primary motor (M1) and primary somatosensory (S1) cortex, as well as their functional connections. To this aim, we tested three TMSR patients and investigated the extent, strength, and topographical organization of the missing limb and several control body regions in M1 and S1 at ultra high-field (7 T) functional magnetic resonance imaging. Additionally, we analysed the functional connectivity between M1 and S1 and of both these regions with fronto-parietal regions, known to be important for multisensory upper limb processing. These data were compared with those of control amputee patients (n = 6) and healthy controls (n = 12). We found that M1 maps of the amputated limb in TMSR patients were similar in terms of extent, strength, and topography to healthy controls and different from non-TMSR patients. S1 maps of TMSR patients were also more similar to normal conditions in terms of topographical organization and extent, as compared to non-targeted muscle and sensory reinnervation patients, but weaker in activation strength compared to healthy controls. Functional connectivity in TMSR patients between upper limb maps in M1 and S1 was comparable with healthy controls, while being reduced in non-TMSR patients. However, connectivity was reduced between S1 and fronto-parietal regions, in both the TMSR and non-TMSR patients with respect to healthy controls. This was associated with the absence of a well-established multisensory effect (visual enhancement of touch) in TMSR patients. Collectively, these results show how M1 and S1 process signals related to movement and touch are enabled by targeted muscle and sensory reinnervation. Moreover, they suggest that TMSR may counteract maladaptive cortical plasticity typically found after limb loss, in M1, partially in S1, and in their mutual connectivity. The lack of multisensory interaction in the present data suggests that further engineering advances are necessary (e.g. the integration of somatosensory feedback into current prostheses) to enable prostheses that move and feel as real limbs.

Enhanced discriminability for nonbiological motion violating the two-thirds power law

The two-thirds power law describes the relationship between velocity and curvature in human motor movements. Interestingly, this motor law also affects visual motion perception, in which stimuli moving according to the two-thirds power law are perceived to have a constant velocity compared to stimuli actually moving at constant velocity. Thus, visual motion adhering to biological motion principles causes a kinematic illusion of smooth and velocity-invariant motion. However, it is yet unclear how this motion law affects the discrimination of visual stimuli and if its encoding requires attention. Here we tested the perceptual discrimination of stimuli following biological (two-thirds power law) or nonbiological movement under conditions in which the stimuli were degraded or masked through continuous flash suppression. Additionally, we tested subjective perception of naturalness and velocity consistency. Our results show that the discriminability of a visual target is inversely related to the perceived "naturalness" of its movement. Discrimination of stimuli following the two-thirds power law required more time than the same stimuli moving at constant velocity or nonecological variants of the two-thirds power law and was present for both masked and degraded stimuli.

Consciousness is more than meets the eye: a call for a multisensory study of subjective experience

Over the last 30 years, our understanding of the neurocognitive bases of consciousness has improved, mostly through studies employing vision. While studying consciousness in the visual modality presents clear advantages, we believe that a comprehensive scientific account of subjective experience must not neglect other exteroceptive and interoceptive signals as well as the role of multisensory interactions for perceptual and self-consciousness. Here, we briefly review four distinct lines of work which converge in documenting how multisensory signals are processed across several levels and contents of consciousness. Namely, how multisensory interactions occur when consciousness is prevented because of perceptual manipulations (i.e. subliminal stimuli) or because of low vigilance states (i.e. sleep, anesthesia), how interactions between exteroceptive and interoceptive signals give rise to bodily self-consciousness, and how multisensory signals are combined to form metacognitive judgments. By describing the interactions between multisensory signals at the perceptual, cognitive, and metacognitive levels, we illustrate how stepping out the visual comfort zone may help in deriving refined accounts of consciousness, and may allow cancelling out idiosyncrasies of each sense to delineate supramodal mechanisms involved during consciousness.

Interplay between Narrative and Bodily Self in Access to Consciousness: No Difference between Self- and Non-self Attributes

The construct of the “self” is conceived as being fundamental in promoting survival. As such, extensive studies have documented preferential processing of self-relevant stimuli. For example, attributes that relate to the self are better encoded and retrieved, and are more readily consciously perceived. The preferential processing of self-relevant information, however, appears to be especially true for physical (e.g., faces), as opposed to psychological (e.g., traits), conceptions of the self. Here, we test whether semantic attributes that participants judge as self-relevant are further processed unconsciously than attributes that were not judged as self-relevant. In Experiment 1, a continuous flash suppression paradigm was employed with “self” and “non-self” attribute words being presented subliminally, and we asked participants to categorize unseen words as either self-related or not. In a second experiment, we attempted to boost putative preferential self-processing by relation to its physical conception, that is, one’s own body. To this aim, we repeated Experiment 1 while administrating acoustic stimuli either close or far from the body, i.e., within or outside peripersonal space. Results of both Experiment 1 and 2 demonstrate no difference in breaking suppression for self and non-self words. Additionally, we found that while participants were able to process the physical location of the unseen words (above or below fixation) they were not able to categorize these as self-relevant or not. Finally, results showed that sounds presented in the extra-personal space elicited a more stringent response criterion for “self” in the process of categorizing unseen visual stimuli. This shift in criterion as a consequence of sound location was restricted to the self, as no such effect was observed in the categorization of attributes occurring above or below fixation. Overall, our findings seem to indicate that subliminally presented stimuli are not semantically processed, at least inasmuch as to be categorized as self-relevant or not. However, we do demonstrate that the distance at which acoustic stimuli are presented may alter the balance between self- and non-self biases.

Changing motor perception by sensorimotor conflicts and body ownership

Experimentally induced sensorimotor conflicts can result in a loss of the feeling of control over a movement (sense of agency). These findings are typically interpreted in terms of a forward model in which the predicted sensory consequences of the movement are compared with the observed sensory consequences. In the present study we investigated whether a mismatch between movements and their observed sensory consequences does not only result in a reduced feeling of agency, but may affect motor perception as well. Visual feedback of participants’ finger movements was manipulated using virtual reality to be anatomically congruent or incongruent to the performed movement. Participants made a motor perception judgment (i.e. which finger did you move?) or a visual perceptual judgment (i.e. which finger did you see moving?). Subjective measures of agency and body ownership were also collected. Seeing movements that were visually incongruent to the performed movement resulted in a lower accuracy for motor perception judgments, but not visual perceptual judgments. This effect was modified by rotating the virtual hand (Exp.2), but not by passively induced movements (Exp.3). Hence, sensorimotor conflicts can modulate the perception of one’s motor actions, causing viewed “alien actions” to be felt as one’s own.

Numerical Priming Between Touch and Vision Depends on Tactile Discrimination

Although the interaction between vision and touch is of crucial importance for perceptual and bodily self-consciousness, only little is known regarding the link between conscious access and tactile processing. Here, we tested whether the numerical encoding of tactile stimuli depends on conscious discrimination. On each trial, participants received between zero and three taps at low, medium, or high intensity and had to enumerate the number of visual items subsequently presented as a visual target. We measured tactovisual numerical priming, that is, the modulation of reaction times according to the numerical distance between the visual target and tactile prime values. While numerical priming and repetition priming were respectively elicited by high and medium intensity stimuli, no effect was found for low intensity stimuli that were not discriminable. This suggests that numerical priming between touch and vision depends on tactile discrimination. We discuss our results considering recent advances in unconscious visual numerical priming.

Voluntary self-touch increases body ownership

Experimental manipulations of body ownership have indicated that multisensory integration is central to forming bodily self-representation. Voluntary self-touch is a unique multisensory situation involving corresponding motor, tactile and proprioceptive signals. Yet, even though self-touch is frequent in everyday life, its contribution to the formation of body ownership is not well understood. Here we investigated the role of voluntary self-touch in body ownership using a novel adaptation of the rubber hand illusion (RHI), in which a robotic system and virtual reality allowed participants self-touch of real and virtual hands. In the first experiment, active and passive self-touch were applied in the absence of visual feedback. In the second experiment, we tested the role of visual feedback in this bodily illusion. Finally, in the third experiment, we compared active and passive self-touch to the classical RHI in which the touch is administered by the experimenter. We hypothesized that active self-touch would increase ownership over the virtual hand through the addition of motor signals strengthening the bodily illusion. The results indicated that active self-touch elicited stronger illusory ownership compared to passive self-touch and sensory only stimulation, and show an important role for active self-touch in the formation of bodily self.