The impact of traumatic childhood experiences on interoception: disregarding one’s own body

in Borderline Personality Disorder and Emotion Dysregulation (2023), 10(1), 5

Background Deficient interoception, the processing and perception of internal bodily signals, has been discussed as a mechanism underlying various mental disorders. First results indicate a mediating role ... [more ▼]

Background Deficient interoception, the processing and perception of internal bodily signals, has been discussed as a mechanism underlying various mental disorders. First results indicate a mediating role of interoception in the interplay of traumatic childhood experiences and adult mental disorders. Traumatic childhood experiences may hinder the adequate processing, integration, and trust in bodily signals that are important in order to understand and regulate own needs and emotions, thereby increasing the vulnerability for mental disorders. However, an overarching study investigating alterations in different interoceptive measures and trauma-related disorders as well as their mediating role between early trauma and emotion dysregulation is still missing. Methods One hundred thirty-six individuals with varying levels of traumatic childhood experiences who either had a current diagnosis of major depression, posttraumatic stress disorder, or somatic symptom disorder, or no mental disorder, took part in a multidimensional assessment of interoceptive processes, including interoceptive accuracy, sensibility, and awareness. Kruskal–Wallis tests were used to compare groups regarding interoceptive processes and associations with traumatic childhood experiences and emotion dysregulation were analyzed with Spearman correlations. Furthermore, mediation analyses were computed to examine and compare interoceptive processes as potential mediators between traumatic childhood experiences and emotion dysregulation. Results Only body dissociation, a measure for interoceptive sensibility, was significantly reduced in individuals with a current mental disorder. Body dissociation was also the only interoceptive measure significantly associated with traumatic childhood experiences and emotion dysregulation and the only significant mediator in the relationship between traumatic childhood experiences and emotion dysregulation across groups. Conclusion Results suggest body dissociation, but not other interoceptive measures, as an important feature linking traumatic childhood experiences to current emotion dysregulation, an important transdiagnostic feature. As body dissociation refers to a habitual non-attendance or disregard of interoceptive signals, integrative therapeutic interventions could help affected individuals to overcome difficulties in emotion perception and regulation. [less ▲]

Less efficient cognitive pain modulation in healthy older adults – the impact of executive functions, chronic stress, and physical activity

in Heinrichs, Markus; Schönauer, Monika (Eds.) 47. Jahrestagung Psychologie und Gehirn (2022)

Demographic change and the associated increasing prevalence of chronic pain have contributed to increased research interest in the field of aging. Aging has been associated with less efficient pain ... [more ▼]

Demographic change and the associated increasing prevalence of chronic pain have contributed to increased research interest in the field of aging. Aging has been associated with less efficient pain inhibition through cognitive distraction. As pain modulation and executive functioning mainly involve the prefrontal cortical network, which shows age-related atrophy, we hypothesized an association between deteriorating cognitive modulation of pain in healthy older adults and reduced executive functions. As chronic stress can decrease executive functioning through prefrontal cortical impairment, we expected a negative impact on distraction from pain. In contrast, physical activity can have a stress-buffering effect and positively influences executive functions in older age. Therefore, increased physical activity should lead to better distraction from pain. Healthy young (18 -30 years) and older adults (65+ years) took part in a pain distraction paradigm (N-back) while receiving non-painful and moderately painful electric stimuli. Before, we examined executive functions, including response inhibition (Go/No-Go-task), inhibitory control (Stroop task), and working memory (Sternberg task). Additionally, chronic stress and physical activity were assessed using self-report questionnaires, supported by physiological measurements (heart rate variability). Preliminary results indicate a negative impact of chronic stress on distraction from pain particular in young participants, while physical fitness was related to more successful pain modulation in older adults. Our final results will contribute to a more differentiated view on executive functioning and pain modulation in aging, thereby leading to a better understanding of the impact of aging on non-pharmacological pain treatment and to better adapted pain therapies in this population. [less ▲]

From hands to heart: a trend for higher interoceptive accuracy in left-handed as compared to right-handed female participants

in Heinrichs, Markus; Schönauer, Monika (Eds.) 47. Jahrestagung Psychologie und Gehirn (2022)

There is a discrete anatomical organization of the neural substrates of mental processes. Right hemispheric dominance was repeatedly shown for interoception, the perception and processing of signals from ... [more ▼]

There is a discrete anatomical organization of the neural substrates of mental processes. Right hemispheric dominance was repeatedly shown for interoception, the perception and processing of signals from inside the body. This right hemispheric dominance is supported, for example, by stronger heartbeat-evoked potentials (HEPs) over the right hemisphere, which represent neurophysiological indicators of cardiac interoception. These findings, however, are based on individuals with left hemispheric dominance, which manifests among other traits, predominantly in right-handedness. Left-handed individuals (presumably showing a right-hemispheric dominance) may show a facilitation of processes with a right-hemispheric relevance, such as interoception, which remains yet unclear. N = 42 healthy participants (21 left- and right-handed each) performed the heartbeat counting task (HCT) to assess cardiac interoceptive accuracy (“IAc”, i.e. the correspondence between actual and perceived bodily signals), as well as a time estimation task, as previous studies suggested that IAc in the HCT may be confounded by time estimation accuracy (TEAc). We found a trend-level difference among female participants, with left-handers presenting higher IAc scores than right-handers. There were no differences in TEAc or heart rate between groups. These preliminary findings suggest a potential facilitating effect of right hemispheric dominance on interoception, which seems to be specific for additional hemispheric specialization effects related to female sex. Future studies are warranted to replicate this trend and to reveal neurophysiological mechanisms of this effect (e.g., by investigating HEPs). [less ▲]

Interoception and the mentalization of bodily states

in Alsmith, Adrian J. T.; Longo, Matthew R. (Eds.) The Routledge Handbook of Bodily Awareness (2022)

More than 100 years ago, Sherrington coined the term interoception to denote sensations of endogenous origin arising from visceral organs. Starting from this physiological description of this unique ... [more ▼]

More than 100 years ago, Sherrington coined the term interoception to denote sensations of endogenous origin arising from visceral organs. Starting from this physiological description of this unique sensory system that concerns the internal body, we discuss how the definition of interoception has changed since then to include the role of both sensing and integrating all aspects of the body’s physiological state and motivational needs, with far-reaching effects on a range of cognitive processes. We highlight key developments in psychological sciences and neuroscience that underlie the central role of interoception for body awareness and eventually self-awareness. At the physiological level, interoceptive processes serve the homeostasis of the organism and in more modern predictive coding accounts are key for allostatic processes. At the psychological level interoception is central to our affective experiences and body awareness. Converging evidence from basic science as well as clinical and health psychology and neuropsychiatry suggest that the mentalization of our bodily states that is underpinned by interoception is at the core of our understanding of physical and mental health, self-awareness and social cognition. [less ▲]

Gastrische Interozeption und gastrische myoelektrische Aktivität bei chronisch-entzündlichen Darmerkrankungen und Reizdarmsyndrom

in Heinrichs, Markus; Schönauer, Monika (Eds.) 47. Jahrestagung Psychologie und Gehirn (2022)

Viszerale Hypersensitivität wird als zentraler Mechanismus bei chronisch-entzündlichen Darmerkrankungen (CED) und Reizdarmsyndrom (RDS) diskutiert, welche beide mit einer erheblichen Einschränkung der ... [more ▼]

Viszerale Hypersensitivität wird als zentraler Mechanismus bei chronisch-entzündlichen Darmerkrankungen (CED) und Reizdarmsyndrom (RDS) diskutiert, welche beide mit einer erheblichen Einschränkung der Lebensqualität einhergehen. Bisherige Studien verwenden zumeist invasive Verfahren, die jedoch typischerweise mit der Messung viszeraler Wahrnehmung interferieren. Diese Studie untersucht daher, ob CED und RDS mit einer veränderten Wahrnehmung „natürlicher“ (nicht-invasiver) gastrischer Dehnungen assoziiert sind („Interozeption“). Zwanzig CED-Patienten in Remission (13 Morbus Crohn, 7 Colitis Ulcerosa), 12 RDS-Patienten, sowie 20/12 parallelisierte gesunde Kontrollprobanden absolvierten den 2-stufigen Water-Load-Test, bei dem eine beliebige Menge Wasser getrunken wird, bis die subjektiven Schwelle der Sättigung (Stufe 1) und des Völlegefühls (Stufe 2) erreicht sind. Gastrische Motilität wurde mittels Elektrogastrographie untersucht. CED-Patienten tranken signifikant mehr Wasser bis zur Sättigungsschwelle als RDS-Patienten, während es keine Unterschiede zu den Kontrollgruppen gab. Die getrunkene Wassermenge bis zur Schwelle des Völlegefühls unterschied sich nicht zwischen den Gruppen. Die elektrogastrographischen Muster zeigten ebenfalls keine Gruppenunterschiede, was impliziert, dass es keine Pathologien in der gastrischen Motilität gab. Die getrunkene Wassermenge bis zur Sättigung korrelierte negativ mit darmbezogener Lebensqualität bei CED-Patienten, aber positiv mit emotionalem Wohlbefinden bei RDS-Patienten. Diese Ergebnisse legen eine relative gastrische Hypersensitivität bei RDS und eine relative gastrische Hyposensitivität bei CED nahe, was jeweils mit spezifischen Facetten der wahrgenommenen Lebensqualität assoziiert ist. [less ▲]

A Theory-Informed, Personalized mHealth Intervention for Adolescents (Mobile App for Physical Activity): Development and Pilot Study

in JMIR Formative Research (2022), 6(6), 35118

Background: Evidence suggests that physical activity (PA) during childhood and adolescence is crucial as it usually results in adequate PA levels in adulthood. Given the ubiquitous use of smartphones by ... [more ▼]

Background: Evidence suggests that physical activity (PA) during childhood and adolescence is crucial as it usually results in adequate PA levels in adulthood. Given the ubiquitous use of smartphones by adolescents, these devices may offer feasible means to reach young populations and deliver interventions aiming to increase PA participation and decrease sedentary time. To date, very few studies have reported smartphone-based interventions promoting PA for adolescents. In addition, most available fitness apps do not include the latest evidence-based content. Objective: This paper described the systematic development of a behavior change, theory-informed Mobile App for Physical Activity intervention with personalized prompts for adolescents aged 16 to 18 years. The within-subject trial results provided the first evidence of the general effectiveness of the intervention based on the outcomes step count, sedentary time, and moderate to vigorous PA (MVPA) minutes. The effectiveness of the intervention component personalized PA prompt was also assessed. Methods: A 4-week within-subject trial with 18 healthy adolescents aged 16 to 18 years was conducted (mean age 16.33, SD 0.57 years). After the baseline week, the participants used the Mobile App for Physical Activity intervention (Fitbit fitness tracker+app), which included a daily personalized PA prompt delivered via a pop-up notification. A paired 1-tailed t test was performed to assess the effectiveness of the intervention. Change-point analysis was performed to assess the effectiveness of a personalized PA prompt 30 and 60 minutes after prompt delivery. Results: The results showed that the intervention significantly reduced sedentary time in adolescents during the first week of the trial (t17=−1.79; P=.04; bootstrapped P=.02). This trend, although remaining positive, diminished over time. Our findings indicate that the intervention had no effect on metabolic equivalent of task–based MVPA minutes, although the descriptive increase may give reason for further investigation. Although the results suggested no overall change in heart rate–based MVPA minutes, the results from the change-point analyses suggest that the personalized PA prompts significantly increased heart rate per minute during the second week of the study (t16=1.84; P=.04; bootstrapped P=.04). There were no significant increases in participants’ overall step count; however, the personalized PA prompts resulted in a marginally significant increase in step counts per minute in the second week of the study (t17=1.35; P=.09; bootstrapped P=.05). Conclusions: The results of the trial provide preliminary evidence of the benefit of the Mobile App for Physical Activity intervention for modest yet significant reductions in participants’ sedentary time and the beneficial role of personalized PAprompts. These results also provide further evidence of the benefits and relative efficacy of personalized activity suggestions for inclusion in smartphone-based PA interventions. This study provides an example of how to guide the development of smartphone-based mobile health PA interventions for adolescents. [less ▲]

Distraction from Pain in Aging – the Impact of Acute Stress

in Heinrichs, Markus; Schönauer, Monika (Eds.) 47. Jahrestagung Psychologie und Gehirn (2022)

While older people report acute and chronic pain more often than younger people, and, therefore, would benefit significantly from non-pharmacological pain treatment, little is known about how age affects ... [more ▼]

While older people report acute and chronic pain more often than younger people, and, therefore, would benefit significantly from non-pharmacological pain treatment, little is known about how age affects psychological strategies of pain modulation. Distraction from pain by cognitive engagement, an efficient pain modulation strategy, relies on the prefrontal cortex (PFC). The PFC, however, is an area affected by age-related cognitive decline, which might lead to reduced pain relief through distraction in older adults. Acute stress, a common concomitant phenomenon of pain, might additionally reduce the pain relief effect by its negative impact on PFC and PFC-based executive functions. Healthy young (18-30 years) and older participants (65+ years) performed a pain distraction task before and after acute stress induction using the Trier Social Stress Test, or a respective control condition. An n-Back working memory task with low and high cognitive load served as the distraction paradigm, during which participants received non-painful and moderately painful stimuli. These stimuli were individually adjusted transdermal electrical pulse trains to the inner forearm and participants rated them regarding their intensity and unpleasantness. Pain-related evoked potentials were recorded with a 64-channel EEG, and several saliva samples were collected to measure hormonal stress responses. First analyses on the currently small sample suggest a negative impact of acute stress on distraction from pain in both age groups. Our final results will contribute to a deeper understanding on the efficacy of pain modulation in aging and potential influencing factors, helping to optimize pain treatments in this population. [less ▲]

Interoceptive Approaches to Embodiment Research

in Robinson, Michael D.; Thomas, Laura E. (Eds.) Handbook of Embodied Psychology: Thinking, Feeling, and Acting. (2021)

Interoception refers to the processing and perception of signals arising from inside the body. Currently, there are two alternative conceptualizations of interoception: (1) an ‘inclusive’ view considering ... [more ▼]

Interoception refers to the processing and perception of signals arising from inside the body. Currently, there are two alternative conceptualizations of interoception: (1) an ‘inclusive’ view considering all bodily signals from inside the body as relevant for interoception, and (2) an ‘exclusive’ view, which is based on receptor types and neurophysiology, and, therefore, a focus on visceroception. These conceptualizations have different implications for the underlying neurophysiology and, therefore, the mechanisms behind embodiment. Thereafter, we discuss current models of interoception and provide definitions of the most common interoceptive terms, which include interoceptive accuracy, sensibility, sensitivity, awareness, and prediction error. We then present examples of interoceptive paradigms to assess different elements of interoception models. Typical interoceptive indicators include self-reports, behavioral measures, and neurophysiological indices. Finally, we discuss the link between interoceptive indicators and emotional experience and emotion regulation, consciousness, and decision-making. These findings illustrate the relevance of interoceptive indicators for embodiment. [less ▲]

Noradrenergic activation induced by yohimbine decreases interoceptive accuracy in healthy individuals with childhood adversity

in Development and Psychopathology (2021)

Acute stress affects interoception, but it remains unclear if this is due to activation of the sympatho-adreno-medullary (SAM) or hypothalamicpituitary-adrenocortical axis. This study aimed to investigate ... [more ▼]

Acute stress affects interoception, but it remains unclear if this is due to activation of the sympatho-adreno-medullary (SAM) or hypothalamicpituitary-adrenocortical axis. This study aimed to investigate the effect of SAM axis activation on interoceptive accuracy (IAcc). Central alpha2-adrenergic receptors represent a negative feedback mechanism of the SAM axis. Major depressive disorder and adverse childhood experiences (ACE) are associated with alterations in the biological stress systems, including central alpha2-adrenergic receptors. Here, healthy individuals with and without ACE as well as depressive patients with and without ACE (n=114; all without antidepressant medication) were tested after yohimbine (alpha2-adrenergic antagonist) and placebo. We assessed IAcc and sensibility in a heartbeat counting task. Increases in systolic and diastolic blood pressure after yohimbine confirmed successful SAM axis activation. IAcc decreased after yohimbine only in the healthy group with ACE, but remained unchanged in all other groups (‘group’ × ‘drug’ interaction). This effect may be due to selective up-regulation of alpha2-adrenergic receptors after childhood trauma, which reduces capacity for attention focus on heartbeats. The sympathetic neural pathway including alpha2-adrenergic circuitries may be essential for mediating interoceptive signal transmission. Suppressed processing of physical sensations in stressful situations may represent an adaptive response in healthy individuals who experienced ACE. [less ▲]

On the construct validity of interoceptive accuracy based on heartbeat counting: cardiovascular determinants of absolute and tilt-induced change scores

in Biological Psychology (2021), 164(1), 108168

Interoceptive accuracy (IAcc) as assessed with the heartbeat counting task (IAccHBCT) may be affected by a range of factors including (1.) the ability to adequately detect cardiac signals, indicated by ... [more ▼]

Interoceptive accuracy (IAcc) as assessed with the heartbeat counting task (IAccHBCT) may be affected by a range of factors including (1.) the ability to adequately detect cardiac signals, indicated by IAcc in a heartbeat discrimination task (IAccHBDT), (2.) cardiac signal properties, affected by sympathetic and parasympathetic tone, and (3.) non-interoceptive processes, including time estimation accuracy (TEAcc). In the current study we investigated the contribution of these factors to absolute and Δ IAccHBCT scores, induced by passive head-up and head-down tilt in 49 healthy individuals. A set of hierarchical regression models showed IAccHBDT scores as the strongest and, across different orthostatic (tilt) conditions, most stable (positive) predictor of absolute and Δ IAccHBCT scores. Neither indicators of cardiac signal properties (except for HR in head-down-tilt), nor TEAcc predicted absolute or Δ IAccHBCT scores. These findings support the convergent and discriminant validity of absolute and Δ IAccHBCT scores. [less ▲]