Enhanced cardiac perception predicts impaired performance in the Iowa Gambling Task in patients with panic disorder

Objective: Somatic marker theory predicts that somatic cues serve intuitive decision- making; however, cardiovascular symptoms are threat cues for patients with panic disorder (PD). Therefore, enhanced cardiac perception may aid intuitive decision-making only in healthy individuals, but impair intuitive decision-making in PD patients.
Methods: PD patients and age- and sex-matched volunteers without a psychiatric diagnosis (n = 17, respectively) completed the Iowa Gambling Task (IGT) as a measure of intuitive decision-making. Inter-individual differences in cardiac perception were assessed with a common mental tracking task.
Results: In line with our hypothesis, we found a pattern of opposing associations (Fisher’s Z=1.78, p=.04) of high cardiac perception with improved IGT-performance in matched control-participants (r = .36, n = 14) but impaired IGT-performance in PD patients (r = -.38, n = 13).
Conclusion: Interoceptive skills, typically assumed to aid intuitive decision-making, can have the opposite effect in PD patients who experience interoceptive cues as threatening, and tend to avoid them. This may explain why PD patients frequently have problems with decision-making in everyday life. Screening of cardiac perception may help identifying patients who benefit from specifically tailored interventions.