Beate M. Herbert

On the relationship between interoceptive awareness and alexithymia - is interoceptive awareness related to emotional awareness?

Interoceptive awareness (IA) is associated with emotional experience, the processing of emotional stimuli, and activation of brain structures that monitor the internal visceral and emotional state of the organism. Alexithymia is characterized by difficulties in identifying and describing ones emotions and externally oriented thinking (EOT) and reflects impairments in emotional awareness and the regulation of emotions. This study examined the relationship between alexithymia and IA in a healthy population of N=155 persons. A well-validated heartbeat perception task to measure interoceptive awareness, the Toronto Alexithymia Scale (TAS-20) and a depression questionnaire (BDI-2) were administered to 88 women and 67 men. IA was inversely associated with all features of alexithymia in the whole sample. When considering sex differences, IA turned out to be a relevant negative predictor for the EOT subscale only in men. This large sample investigation in a nonclinical population indicates that IA represents a relevant negative predictor for alexithymia.

Interoception across Modalities: On the Relationship between Cardiac Awareness and the Sensitivity for Gastric Functions

The individual sensitivity for ones internal bodily signals (“interoceptive awareness”) has been shown to be of relevance for a broad range of cognitive and affective functions. Interoceptive awareness has been primarily assessed via measuring the sensitivity for ones cardiac signals (“cardiac awareness”) which can be non-invasively measured by heartbeat perception tasks. It is an open question whether cardiac awareness is related to the sensitivity for other bodily, visceral functions. This study investigated the relationship between cardiac awareness and the sensitivity for gastric functions in healthy female persons by using non-invasive methods. Heartbeat perception as a measure for cardiac awareness was assessed by a heartbeat tracking task and gastric sensitivity was assessed by a water load test. Gastric myoelectrical activity was measured by electrogastrography (EGG) and subjective feelings of fullness, valence, arousal and nausea were assessed. The results show that cardiac awareness was inversely correlated with ingested water volume and with normogastric activity after water load. However, persons with good and poor cardiac awareness did not differ in their subjective ratings of fullness, nausea and affective feelings after drinking. This suggests that good heartbeat perceivers ingested less water because they subjectively felt more intense signals of fullness during this lower amount of water intake compared to poor heartbeat perceivers who ingested more water until feeling the same signs of fullness. These findings demonstrate that cardiac awareness is related to greater sensitivity for gastric functions, suggesting that there is a general sensitivity for interoceptive processes across the gastric and cardiac modality.

The Body in the Mind: On the Relationship Between Interoception and Embodiment

The processing, representation, and perception of bodily signals (interoception) plays an important role for human behavior. Theories of embodied cognition hold that higher cognitive processes operate on perceptual symbols and that concept use involves reactivations of the sensory-motor states that occur during experience with the world. Similarly, activation of interoceptive representations and meta-representations of bodily signals supporting interoceptive awareness are profoundly associated with emotional experience and cognitive functions. This article gives an overview over present findings and models on interoception and mechanisms of embodiment and highlights its relevance for disorders that are suggested to represent a translation deficit of bodily states into subjective feelings and self-awareness.

On the embodiment of emotion regulation: interoceptive awareness facilitates reappraisal

The ability to cognitively regulate emotional responses to aversive events is essential for mental and physical health. One prerequisite of successful emotion regulation is the awareness of emotional states, which in turn is associated with the awareness of bodily signals [interoceptive awareness (IA)]. This study investigated the neural dynamics of reappraisal of emotional responses in 28 participants who differed with respect to IA. Electroencephalography was used to characterize the time course of emotion regulation. We found that reappraisal was accompanied by reduced arousal and significant modulation of late neural responses. What is more, higher IA facilitated downregulation of affect and was associated with more pronounced modulation of underlying neural activity. Therefore, we conclude that IA not only advances the consolidation of somatic markers required for guiding individual behaviour but also creates processing advantages in tasks referring to these bodily markers.

Intuitive eating is associated with interoceptive sensitivity. Effects on body mass index.

Intuitive eating is relevant for adaptive eating, body weight and well-being and impairments are associated with dieting and eating disorders. It is assumed to depend on the ability to recognize ones signs of hunger and fullness and to eat accordingly. This suggests a link to the individual ability to perceive and processes bodily signals (interoceptive sensitivity, IS) which has been shown to be associated with emotion processing and behavior regulation. This study was designed to clarify the relationships between IS as measured by a heartbeat perception task, intuitive eating and body mass index (BMI) in N=111 healthy young women. Intuitive eating was assessed by the Intuitive Eating Scale (IES) with three facets, reliance on internal hunger and satiety cues (RIH), eating for physical rather than emotional reasons (EPR), and unconditional permission to eat when hungry (UPE). IS was not only positively related to total IES score and RIH and EPR, and negatively predicted BMI, but also proved to fully mediate the negative relationship between RIH, as well as EPR and BMI. Additionally, the subjective appraisal of ones interoceptive signals independently predicted EPR and BMI. IS represents a promising mechanism in research on eating behavior and body weight.

Cardiac awareness and autonomic cardiac reactivity during emotional picture viewing and mental stress

This study investigated the relationship between autonomic cardiovascular reactivity and cardiac awareness during the following conditions: baseline, emotional picture viewing, mental stress, and heartbeat tracking. Cardiac parameters were examined by using power spectrum analysis of heart rate variability and impedance cardiography. According to their performance in a heartbeat tracking task, 38 participants were classified as good (n=19) or poor (n=19) heartbeat perceivers. Neither group differed during baseline and heartbeat tracking, but good compared to poor heartbeat perceivers demonstrated greater sympathetic reactivity during mental stress and more vagal reactivity and subjective arousal during emotional picture viewing. The results suggest that cardiac awareness is related to greater responsivity of the autonomic nervous system during situations evoking autonomic reactivity.

Impaired central processing of emotional faces in anorexia nervosa.

Objectives: To elucidate the potential relationship between classification of emotional faces and impaired central processing in eating disorders and to investigate the potential mediatory role of alexithymia and depression in this relationship. Methods: Visual-evoked potentials (VEPs) to emotional faces and classification performance were assessed in 12 anorexic females and matched healthy controls. Results: Patients with anorexia nervosa showed no modulation of emotional face processing and displayed significantly increased N200 amplitudes in response to all emotional categories and decreased VEPs in response to unpleasant emotional faces in the P300 time range as compared with healthy controls. They also made more mistakes in emotional face recognition, in particular, for neutral, sad, and disgusted content. Conclusions: There are marked differences in evoked potentials and emotion recognition performances of patients with anorexia nervosa and controls in facial processing. Differences in brain dynamics might contribute to difficulties in the correct recognition of facially expressed emotions, deficits in social functioning, and in turn the maintenance of eating disorders. ED = eating disorder; ERP = event-related potential; VEP = visual-evoked potential; AN = anorexia nervosa; MDD = major depressive disorder; EEG = electroencephalography; TAS = Toronto Alexithymia Scale; BMI = body mass index; BDI = Beck Depression Inventory; STAI = State Trait Anxiety Inventory.

His or mine? The time course of self–other discrimination in emotion processing

This electroencephalography (EEG) study investigated at which temporal processing stages self–other discrimination in emotion processing occurs. EEG was recorded in 23 healthy participants during silent reading of unpleasant, pleasant, and neutral pronoun–noun and article–noun expressions that were related to the participants themselves, related to an unknown third person, or had no self–other reference at all. Self- and other-related pronoun–noun pairs elicited larger cortical negativity relative to the processing of article–noun pairs at left posterior electrodes as early as 200 ms after stimulus onset. In the same time windows (from 200 ms to 300 ms and 300 ms to 400 ms) the emotionality of the words enhanced event-related brain potential (ERP) amplitudes at parieto-occipital electrodes. From 350 ms onwards, processing of self-related unpleasant words elicited larger frontal negativity compared to unpleasant words that were related to the other or that had no reference at all. In addition, processing of pleasant words vs. neutral or unpleasant words elicited larger positive amplitudes over parietal electrodes from 450 ms after stimulus onset, in particular when words were self-related. Our findings demonstrate that for verbal emotional stimuli, self–other discrimination first occurs at higher-order, cortical processing stages. This is consistent with the view that categorization of information according to certain stimulus aspects (self–other reference, emotionality) occurs before its meaning is integrated.

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

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

Attenuated interoceptive sensitivity in overweight and obese individuals.

OBJECTIVE Perceiving internal signals of hunger and satiety is related to the regulation of food intake. Recent data suggest that interoception (perception of bodily signals) and interoceptive sensitivity (sensitivity for internal signals) might be a crucial variable for the regulation of behavior associated with feelings of satiety. It is yet unclear whether interoceptive sensitivity is altered in overweight and obese participants. DESIGN AND METHODS We therefore examined interoceptive sensitivity among 75 overweight and obese women and men using a heartbeat detection task and compared them to normal weight controls. We hypothesized that overweight and obesity would be related to attenuated interoceptive sensitivity. RESULTS Interoceptive sensitivity was higher in normal weight participants as compared to overweight and obese participants. Additionally, we found a negative correlation coefficient between the BMI and interoceptive sensitivity in the overweight and obese group only. CONCLUSIONS In accordance with our hypotheses, we found evidence for reduced interoceptive sensitivity in overweight and obese individuals. Interoceptive sensitivity presumably interacts with the regulation of food intake in everyday life in part by facilitating the detection of bodily changes accompanying satiety. Overweight and obese individuals might experience greater difficulties in accurately detecting such signals due to reduced interoceptive sensitivity.