Post-learning cold pressor stress, after a heartbeat perception training, enhances interoceptive accuracy in high blood pressure responders

Interoceptive accuracy (IAc) plays an important role for generation of medically
unexplained symptoms (MUS) and trainings to enhance IAc reduces
the perceived symptom severity of MUS. Post-learning stress may facilitate
recognition learning. It is yet unknown, however, if acute stress, when evoked
during the memory consolidation phase, could enhance the visceral learning
in a heartbeat perception training (HBPT). The present study is the first
to investigate the effects of a socially evaluated cold pressor test (SECPT)
induced after a HBPT aimed at increasing IAc. The sample consisted of 48
healthy students (28 women). IAc was assessed at three different time points:
(1) once as a baseline measure, (2) 30 minutes after the SECPT, and (3) the
day after. Assessment of IAc was performed using the heartbeat perception
task developed by Schandry (1981). The HBPT followed the baseline IAc
assessment and was a replication of the paradigm developed by Schaefer et
al. (2014). The SECPT followed immediately after the HBPT. Results showed
that post-encoding stress significantly increased IAc between T1 and T3
for participants showing a high blood pressure (BP) response in the SECPT
compared to the control group, whereas low BP responders did not show such
an effect. This indicates that post-encoding stress enhances visceral memory
consolidation in high BP responders compared to low BP responder and
non-stressed control participants. Post-learning stress facilitation of visceral
learning and memory may represent a mechanism underlying symptom generation,
which should be addressed in studies on somatic symptom disorders
in the future.