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The Heartbeat Counting Task (HCT) was designed and is intended to measure the objective ability to detect cardiac signals (also called cardiac interoceptive accuracy). Because interoceptive accuracy is thought to play a key role in biological (e.g., body mass index) and psychological (e.g., trait anxiety) risk factors and indicators of mental health, HCT scores should be associated with these outcomes. In order to examine this question, we performed a meta-analysis on these associations among adult participants. The final data set comprised 133 studies with 11,524 participants. We focused here on the seven most studied outcomes (i.e., outcomes that were studied in at least ten published studies). HCT performance was not significantly associated with trait anxiety, depression, and alexithymia. It was weakly and negatively associated with age after correction for publication bias, sex (male > female), heart rate, and body mass index. In addition, the quality assessment indicates that only a few studies reported sample size justification (6%), pre-registration (0.8%), and data in free access (6.8%). Theoretically expected associations between HCT performance and psychological indicators of mental health were not meta-analytically found. We discuss the implications of these findings for practice and theory.

Interoception, the processing of internal bodily states, is essential for constantly informing our brain about our physiological needs and maintaining homeostasis. Interoception contributes to our attitudes, decisions, health behaviors, and emotions. Many empirical studies have thus tested whether interoceptive deficits are associated with risk factors and indicators of mental (e.g., depression) and physical health (e.g., obesity). We argue, however, that the domain of interoception is characterized by significant conceptual and measurement limitations. The objective of this thesis was to explain and provide evidence for these limitations. At the conceptual level, we argued that the definition of interoception and the conceptualization of its dimensions are discrepant with empirical evidence and existing measures. At the measurement level, we showed the low concurrent and discriminant validity of the most frequently used measure of interoceptive accuracy (the Heartbeat Counting Task) even when more optimal instructions are used., (PSYE - Sciences psychologiques et de l'éducation) -- UCL, 2022

Interoception, defined as the sense of the internal bodily state, plays a critical role in physical, cognitive, emotional and social well-being. Regarding physical well-being, contemporary models of exercise regulation incorporate interoceptive processes in the regulation of physical exertion. Top-down processes continuously monitor the physiological condition of the body to ensure allostasis is maintained, however, flagged perturbations also appear to influence these higher order processes in return. More specifically, enhancing one's physiological arousal by means of physical activity is a viable way of manipulating the afferent input entering the interoceptive system, appearing to optimise the integration of early sensory stimulation with later affective responses. Despite this, the relationship between physical activity and top-down regulation is underrepresented in interoceptive research. We here address this gap by integrating findings from different disciplines to support the overlapping mechanisms, with the hope of stimulating further research in this field. Developing our understanding of how interoceptive processes are shaped by physical activity could hold significant clinical implications considering the impact of interoceptive deficits to mental health and well-being., Unión Europea. FP7, Ministerio de Ciencia e Innovación (MICINN), Depto. de Psicología Social, del Trabajo y Diferencial, Fac. de Psicología, TRUE, pub

According to traditional and recent literature, one of the core features of obsessive–compulsive disorder (OCD) is pathological doubt, defined as a lack of certitude or confidence in one's memory, attention, intuition, and perceptions. Recent studies have shown that uncertainty, amongst other cognitive and emotional processes, might be linked to an impairment in interoceptive abilities. Here we aimed to assess Interoceptive Accuracy (IA) in a population of OCD patients, and to determine whether alexithymia and symptoms of depression and anxiety would be associated with IA. We recruited 18 patients with OCD and 18 healthy controls (HC). Interoceptive accuracy was tested with the Heartbeat Counting Task. Participants also underwent a psychometric assessment for Obsessions and Compulsions (Y-BOCS), Alexithymia (TAS-20), Impulsivity (BIS-11), Anxiety and Depression (HAM-A and HAM-D). OCD patients had lower Interoceptive Accuracy than HC (p = 0.016) and presented more anxiety and depressive symptoms, along with more alexithymic features than HC. However, these psychological elements were not associated with the reduced IA. This study replicates previous findings and fits with the current literature investigating interoceptive abilities in patients with OCD, which might be used to design specific therapeutic interventions focused on internal bodily signals.

Interoceptive accuracy (IAc), the ability to perceive signals from within the body, has been linked to many beneficial health outcomes but also to psychopathologies such as anxiety disorders. Therefore, its relation to a person's subjective well-being (SWB) is unclear. Here, we predicted that individuals who are prone to interpreting interoceptive signals positively benefit from IAc and exhibit higher SWB. In contrast, individuals with predispositions towards negative interpretations suffer from it, resulting in lower SWB. Participants completed a measure of cardiac IAc, measures of extraversion, neuroticism, optimism and pessimism as personality traits that have been related to positive and negative attributional styles, and various measures of well-being. Psychiatric and physical well-being were predicted by the interaction between optimism/pessimism and IAc. While for optimistic participants, IAc did not predict higher well-being, for pessimistic individuals, it predicted lower well-being. These findings shed light on the role of interoception for SWB and its adaptiveness for individuals with different personalities.

Interoception refers to the sensation of internal bodily signals. When studying sensory perception, one needs measurements for assessing individual abilities. Individual interoceptive abilities have mostly been measured by a heartbeat counting task, however recent criticism towards the validity of the task has surfaced. A limiting factor remaining for interoceptive research is the lack of standardized valid measurements for individual abilities. In this context, new measurements have been proposed, such as a thermal matching task. In the present study, I examine the reliability of the new thermal matching task, as well as the relationship between skin-mediated interoceptive sensations and cardiac interoception. The thermal matching task was found to be temporally stable on the dorsal forearm, but not on the dorsal hand or palm. Furthermore, participants were significantly better at the task on the dorsal forearm compared to dorsal hand and palm. There were also differences in the task between genders, however whether this is due to gender effects or associated confounding variables remains unclear. The thermal matching task shows potential to be included as a measure for thermal perception in an interoceptive context. Future research should address the relationship between the thermal matching task and other measurements of thermal perception.

Interoception refers to the sensation of internal bodily signals. When studying sensory perception, one needs measurements for assessing individual abilities. Individual interoceptive abilities have mostly been measured by a heartbeat counting task, however recent criticism towards the validity of the task has surfaced. A limiting factor remaining for interoceptive research is the lack of standardized valid measurements for individual abilities. In this context, new measurements have been proposed, such as a thermal matching task. In the present study, I examine the reliability of the new thermal matching task, as well as the relationship between skin-mediated interoceptive sensations and cardiac interoception. The thermal matching task was found to be temporally stable on the dorsal forearm, but not on the dorsal hand or palm. Furthermore, participants were significantly better at the task on the dorsal forearm compared to dorsal hand and palm. There were also differences in the task between genders, however whether this is due to gender effects or associated confounding variables remains unclear. The thermal matching task shows potential to be included as a measure for thermal perception in an interoceptive context. Future research should address the relationship between the thermal matching task and other measurements of thermal perception.

In four studies (total N = 534), we examined the moderating impact of Interoceptive Accuracy (i.e. IAcc, as measured with the heartbeat counting task) and Interoceptive Sensibility (IS, assessed via questionnaire) on negative affect, following social exclusion or after receiving negative feedback. Results from an integrative data analysis combining the four studies confirmed that the manipulations were successful at inducing negative affect. However, no significant interaction between mood induction (control versus negative affect induction) and interoception on mood measures was observed, and this was true both for objective (i.e. IAcc) and subjective (i.e. IS) measures of interoception. Hence, previous conclusions on the moderating impact of interoception in the relationship between mood induction and self-reported mood were neither replicated nor generalised to this larger sample. We discuss these findings in light of theories of emotion regulation as well as recent concerns raised about the validity of the heartbeat counting task.

The heartbeat counting task (HCT) is among the most frequently used measures of interoceptive accuracy (i.e., IAcc). Growing concerns, however, have been raised regarding the validity of this task, as well as the validity of the IAcc scores that are derived from it. In the present study, healthy participants (N=123) performed both the original task and an adapted version of it that stressed the importance of reporting only their perceptually felt heartbeats. In the original task, we found that participants report relying on three different strategies (i.e., detection of heartbeats in a specific body location, detection of heartbeats in a diffuse way and heart rate estimation) to complete the task. In the adapted task, we found that IAcc scores are drastically reduced (about 50%) when asking participants to avoid relying on non-interoceptive signals and to only report the heartbeats they perceive. These findings confirm that the HCT task is largely contaminated by the influence of non-interoceptive processes. Implications of these findings for research on interoception are discussed.

Interoception, the capacity to perceive internal bodily states, is thought to influence cognitive, affective and interpersonal functioning. It is frequently assessed using the heartbeat counting task, introduced recently in interoceptive research. In this task participants are requested to count their heartbeats without relying on external cues. Interoceptive Accuracy (i.e., IAcc) scores are then computed based on absolute comparisons between actual and reported heartbeats. In a large sample of participants (N = 572), we observed that, whereas IAcc scores are meant to be theoretically agnostic to error type (i.e., over- or underestimation of heartbeats), these scores massively (i.e., > 95%) reflect under-reports. Of concern too, the correlation between actual and reported heartbeats is low overall (r = .16), varies non-linearly across IAcc score percentiles, and suggests undistinguishable interoceptive capacities within the top 60% IAcc scorers. We also found that IAcc scores, which are conceptually independent from actual heart rates, are structurally bound to them. Finally, we show that IAcc scores vary across the time intervals used in the task. We encourage researchers using this score for studying cognitive and emotional processes to reconsider its meaning.

The heartbeat counting task (HCT) is among the most frequently used measure of interoceptive accuracy (i.e., IAcc). Growing concerns, however, have been raised regarding the validity of this task, as well as the validity of the IAcc scores that are derived from it. In the present study, healthy participants (N = 123) performed both the original task and an adapted version of it that stressed the importance of reporting only their perceptually felt heartbeats. In the original task, we found that participants report relying on three different strategies (i.e., detection of heartbeats in a specific body location, detection of heartbeats in a diffuse way and heart rate estimation) to complete the task. In the adapted task, we found that IAcc scores are drastically reduced (about 50%) when asking participants to avoid relying on non-interoceptive signals and to only report the heartbeats they perceive. These findings confirm that the HCT task is largely contaminated by the influence of non-interoceptive processes. Implications of these findings for research on interoception are discussed.

Interoception is the sense of the physiological condition of the body. Modern definitions differentiated three separated sub-constructs: accuracy (IAc), i.e., the ability to detect physiological states, sensibility (IAs), i.e., a self-evaluated measure of interoception, and awareness (IAw) i.e., a metacognitive awareness of the accuracy. Preliminary researches correlated pain with alterations in the interoceptive matrix albeit, to the best of our knowledge, interoceptive alterations in chronic pain conditions have never been studied systematically. We searched for studies that assessed interoception in subjects with chronic pain and compared it to healthy population. Eleven studies were included among different chronic pain conditions. Results suggested that chronic pain subjects might present low IAc and, allegedly, that IAc negatively correlates with symptoms severity in specific disorders. Data were inconclusive for IAs and IAw. The high risk of bias across multiple dimensions suggests to consider these conclusions with cautions. Nonetheless, deficits in interoceptive processes indicate a promising path for new form of therapies, and they require further attention and a more defined line of research.

Interoception is the sense of the physiological condition of the body. Modern definitions differentiated three separated sub-constructs: accuracy (IAc), i.e., the ability to detect physiological states, sensibility (IAs), i.e., a self-evaluated measure of interoception, and awareness (IAw) i.e., a metacognitive awareness of the accuracy. Preliminary researches correlated pain with alterations in the interoceptive matrix albeit, to the best of our knowledge, interoceptive alterations in chronic pain conditions have never been studied systematically. We searched for studies that assessed interoception in subjects with chronic pain and compared it to healthy population. Eleven studies were included among different chronic pain conditions. Results suggested that chronic pain subjects might present low IAc and, allegedly, that IAc negatively correlates with symptoms severity in specific disorders. Data were inconclusive for IAs and IAw. The high risk of bias across multiple dimensions suggests to consider these conclusions with cautions. Nonetheless, deficits in interoceptive processes indicate a promising path for new form of therapies, and they require further attention and a more defined line of research.

Interoception, the sense of the physiological condition of the body, provides a basis for subjective feelings and emotions. Anterior insular cortex activity represents the state of the body and varies according to personality traits, such as emotional susceptibility (ES)-the tendency to experience feelings of discomfort and vulnerability when facing emotionally-laden stimuli. The accuracy of perceiving one's own bodily signals, or interoceptive accuracy (IAc), can be assessed with the heartbeat perception task (HPT), which is the experimental measure used by most of the existing research on interoception. However, IAc is only one facet of interoception. Interoceptive awareness (IAw) is the conscious perception of sensations from inside the body, such as heart beat, respiration, satiety, and the autonomic nervous system sensations related to emotions, which create the sense of the physiological condition of the body. We developed an Italian version of the recent self-report Multidimensional Assessment of Interoceptive Awareness (MAIA), tested its psychometric properties (reliability, dimensionality, and construct validity), and examined its relationship to ES, as assessed using the Emotional Susceptibility Scale, in a sample (n = 321) of healthy Italian psychology students (293 females, mean age: 20.5 years). In a subgroup of females (n = 135), we measured IAc with the HPT. We used a series of correlation/regression analyses to examine the complex interplay between the three constructs. We provide further evidence for a substantial independence of the IAc and IAw measures, confirming previous reports and current theoretical models that differentiate between IAc and IAw. Our analyses elucidate the complex relationship between distinct dimensions of IAw and ES, highlighting the need for continued efforts to shed more light on this topic.

Interoception, the sense of the physiological condition of the body, provides a basis for subjective feelings and emotions. Anterior insular cortex activity represents the state of the body and varies according to personality traits, such as emotional susceptibility (ES)-the tendency to experience feelings of discomfort and vulnerability when facing emotionally-laden stimuli. The accuracy of perceiving one's own bodily signals, or interoceptive accuracy (IAc), can be assessed with the heartbeat perception task (HPT), which is the experimental measure used by most of the existing research on interoception. However, IAc is only one facet of interoception. Interoceptive awareness (IAw) is the conscious perception of sensations from inside the body, such as heart beat, respiration, satiety, and the autonomic nervous system sensations related to emotions, which create the sense of the physiological condition of the body. We developed an Italian version of the recent self-report Multidimensional Assessment of Interoceptive Awareness (MAIA), tested its psychometric properties (reliability, dimensionality, and construct validity), and examined its relationship to ES, as assessed using the Emotional Susceptibility Scale, in a sample (n = 321) of healthy Italian psychology students (293 females, mean age: 20.5 years). In a subgroup of females (n = 135), we measured IAc with the HPT. We used a series of correlation/regression analyses to examine the complex interplay between the three constructs. We provide further evidence for a substantial independence of the IAc and IAw measures, confirming previous reports and current theoretical models that differentiate between IAc and IAw. Our analyses elucidate the complex relationship between distinct dimensions of IAw and ES, highlighting the need for continued efforts to shed more light on this topic.

The present doctoral thesis involves three experimental studies on pain processing and its modulation by psychological mechanisms. The first investigation focused on the relationship between associative learning aspects and the endogenous pain control system referred to as diffuse noxious inhibitory controls (DNIC) or conditioned pain modulation (CPM). The aim of the study consisted in uncovering whether descending pain inhibition may depend on specific environmental or circumstantial cues that have been linked to a reduction of pain sensations through associative learning in pain treatment contexts. A heterotopic noxious counter-stimulation (HNCS) was used to trigger the endogenous pain control system in the experimental context. For the study of the potential impact of associative learning on the pain-inhibits-pain phenomenon, a respondent (Pavlovian) conditioning procedure was realized during the HNCS stimulation. It could be shown that the repeated pairing of a phone signal (conditioned stimulus, CS) with the unconditioned tonic pain stimulus (UCS, HNCS) enabled the CS in the post-conditioning phase to generate a DNIC-like effect similar to the one induced by the tonic pain stimulus. The results demonstrated that learning processes are able to influence endogenous pain modulation processes and decreases in pain perceptions and reflex activity. A thermal grill paradigm was used in the second and third study to examine the influence of psychological characteristics on the individual disposition to display the thermal grill illusion (TGI) of pain. First, the impact of pain-related personality traits like trait anxiety, pain catastrophizing, rumination, pessimism, expectancy of pain, suggestibility and interoceptive accuracy on inter-individual differences in paradoxical pain sensitivity was assessed. Second, the potential influence of dispositional self-regulation ability on illusive pain perceptions was measured. Vagally mediated heart rate variability (HRV) at re

The present doctoral thesis involves three experimental studies on pain processing and its modulation by psychological mechanisms. The first investigation focused on the relationship between associative learning aspects and the endogenous pain control system referred to as diffuse noxious inhibitory controls (DNIC) or conditioned pain modulation (CPM). The aim of the study consisted in uncovering whether descending pain inhibition may depend on specific environmental or circumstantial cues that have been linked to a reduction of pain sensations through associative learning in pain treatment contexts. A heterotopic noxious counter-stimulation (HNCS) was used to trigger the endogenous pain control system in the experimental context. For the study of the potential impact of associative learning on the pain-inhibits-pain phenomenon, a respondent (Pavlovian) conditioning procedure was realized during the HNCS stimulation. It could be shown that the repeated pairing of a phone signal (conditioned stimulus, CS) with the unconditioned tonic pain stimulus (UCS, HNCS) enabled the CS in the post-conditioning phase to generate a DNIC-like effect similar to the one induced by the tonic pain stimulus. The results demonstrated that learning processes are able to influence endogenous pain modulation processes and decreases in pain perceptions and reflex activity. A thermal grill paradigm was used in the second and third study to examine the influence of psychological characteristics on the individual disposition to display the thermal grill illusion (TGI) of pain. First, the impact of pain-related personality traits like trait anxiety, pain catastrophizing, rumination, pessimism, expectancy of pain, suggestibility and interoceptive accuracy on inter-individual differences in paradoxical pain sensitivity was assessed. Second, the potential influence of dispositional self-regulation ability on illusive pain perceptions was measured. Vagally mediated heart rate variability (HRV) at re

Attention to internal bodily sensations is a core feature of mindfulness meditation. Previous studies have not detected differences in interoceptive accuracy between meditators and nonmeditators on heartbeat detection and perception tasks. We compared differences in respiratory interoceptive accuracy between meditators and nonmeditators in the ability to detect and discriminate respiratory resistive loads and sustain accurate perception of respiratory tidal volume during nondistracted and distracted conditions. Groups did not differ in overall performance on the detection and discrimination tasks; however, meditators were more accurate in discriminating the resistive load with the lowest ceiling effect. Meditators were also more accurate during the nondistracted tracking task at a lag time of 1 s following the breath. Results provide initial support for the notion that meditators have greater respiratory interoceptive accuracy compared to nonmeditators.

Attention to internal bodily sensations is a core feature of mindfulness meditation. Previous studies have not detected differences in interoceptive accuracy between meditators and nonmeditators on heartbeat detection and perception tasks. We compared differences in respiratory interoceptive accuracy between meditators and nonmeditators in the ability to detect and discriminate respiratory resistive loads and sustain accurate perception of respiratory tidal volume during nondistracted and distracted conditions. Groups did not differ in overall performance on the detection and discrimination tasks; however, meditators were more accurate in discriminating the resistive load with the lowest ceiling effect. Meditators were also more accurate during the nondistracted tracking task at a lag time of 1 s following the breath. Results provide initial support for the notion that meditators have greater respiratory interoceptive accuracy compared to nonmeditators.

Attention to internal bodily sensations is a core feature of mindfulness meditation. Previous studies have not detected differences in interoceptive accuracy between meditators and nonmeditators on heartbeat detection and perception tasks. We compared differences in respiratory interoceptive accuracy between meditators and nonmeditators in the ability to detect and discriminate respiratory resistive loads and sustain accurate perception of respiratory tidal volume during nondistracted and distracted conditions. Groups did not differ in overall performance on the detection and discrimination tasks; however, meditators were more accurate in discriminating the resistive load with the lowest ceiling effect. Meditators were also more accurate during the nondistracted tracking task at a lag time of 1 s following the breath. Results provide initial support for the notion that meditators have greater respiratory interoceptive accuracy compared to nonmeditators.

Herbert and colleagues (2012) state that changes in autonomic activity following a specific type of interoceptive sensation, intensifies general interoceptive awareness. This conclusion is being critically examined and reformulated. A distinction is made between Interoceptive Awareness (IAw) and Interoceptive Accuracy (IAc); awareness not necessarily implying accuracy. Given the heterogeneity of interoceptive sensations, we emphasize to abstain from concluding that heartbeat perception tasks can be considered as a measure of OVERALL IAw or OVERALL IAc until this has been more elaborately investigated. Results are reinterpreted to indicate that homeostatic challenges which lead to an increase in ionotropic cardiac activity, lead to an increased cardioceptive accuracy, and perhaps increased cardioceptive awareness. However, the findings do not provide conclusive evidence that such challenges increase other types of IAc, nor that they increase OVERALL IAw. Furthermore, it remains unclear whether homeostatic challenges leading to negative inotropic cardiac activity, would similarly lead to changes in accuracy of heartbeat perception.

Herbert and colleagues (2012) state that changes in autonomic activity following a specific type of interoceptive sensation, intensifies general interoceptive awareness. This conclusion is being critically examined and reformulated. A distinction is made between Interoceptive Awareness (IAw) and Interoceptive Accuracy (IAc); awareness not necessarily implying accuracy. Given the heterogeneity of interoceptive sensations, we emphasize to abstain from concluding that heartbeat perception tasks can be considered as a measure of OVERALL IAw or OVERALL IAc until this has been more elaborately investigated. Results are reinterpreted to indicate that homeostatic challenges which lead to an increase in ionotropic cardiac activity, lead to an increased cardioceptive accuracy, and perhaps increased cardioceptive awareness. However, the findings do not provide conclusive evidence that such challenges increase other types of IAc, nor that they increase OVERALL IAw. Furthermore, it remains unclear whether homeostatic challenges leading to negative inotropic cardiac activity, would similarly lead to changes in accuracy of heartbeat perception.