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The concept of the self is complex and there is no consensus on what the self is. However, there are emerging patterns in the literature that point to two different selves, the narrative and experiential self. The narrative self refers to a conceptual or representational knowledge of the self that extends across time and manifests in self-reflection and personality assessments. The experiential self refers to first-person perception, moment-to-moment awareness, embodiment, and a sense of agency. These two selves are reliably linked to two distinct neural circuits, the default mode network (DMN) and the insula and salience network (SN). One of the consistent themes in the meditative and mindfulness literature is a change in the perspective of the self. In this paper, I will review how meditation alters those neural circuits providing a plausible mechanism that can explain the changes in the self. I also propose a rudimentary conceptual framework to account for some of the mixed results found throughout meditation literature., Competing Interests: The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Gibson.)

Breast cancer impairs physical and psychological well-being, even some years after treatments. Oncological treatments can strongly affect the body due to scars and breast(s) removal, for example, increasing symptoms of anxiety and depression. Psychological studies are effective in improving breast cancer survivors' emotions and behaviors through several approaches to interventions. Over years, the Mindfulness-Based Stress Reduction (MBSR) has been evaluated as an effective intervention to promote well-being in breast cancer survivors. The present study protocol aims to evaluate the effectiveness of a MBSR intervention in regulating interoceptive sensations, as the ability to be aware of inner sensations. Second, it seeks to identify changes in interoceptive feelings, mood, and body perception following the intervention. These changes will be evaluated across three data collection times to assess differences about emotions and body perception over time, focusing on their relevance for breast cancer survivors' well-being. Finally, the present study protocol aims to detect improvements in anxiety, depression, and body awareness, considering the potential positive impact of the MBSR approach on emotional well-being. Direction for future psychological intervention are given., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Sebri, Pizzoli, Marzorati, Mazzocco and Pravettoni.)

The evidence base for the effectiveness of art therapy continues to grow, even as a mechanistic understanding of how art therapy works remains limited. One promising avenue for increasing our understanding of how and why art therapy works is through the lens of neuroscience. A neuroscience-based approach to art therapy provides opportunities for improving understanding of the neural processes that underlie the complex interaction between perception, cognition, emotion and behavior that play out in the art therapy process. Understanding how therapeutic change occurs can result in improved treatment and better outcomes for clients. However, it can be tricky to connect art therapy and psychological theory directly to neural responses. The purposes of this perspective are to provide an overview of the current evidence and limits of neurobiological concepts of neuroplasticity, mirror systems, and interoception as applied to art therapy practice, and to provide updated information about outdated concepts that are still actively used in clinical practice. Critical analysis and understanding of the current scientific knowledge base can then be used to guide art therapy practice and support the development of hypothesis-based research to determine the primary mechanisms that drive the observed effects of art therapy interventions., Competing Interests: The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Strang.)

Background: Schizophrenia (SZ) is characterized by abnormalities in self-representation, including a disturbed sense of agency (SoA). The continuous processing of sensory information concerning the internal state of the body (interoception) is argued to be fundamental to neural representations of the self. We, therefore, tested if aberrant interoception underpins disturbances in SoA in SZ, focusing on cardiac interoceptive signaling., Methods: Forty-two SZ and 29 non-clinical participants (healthy controls; HC) performed an intentional binding task to measure SoA during concurrent heartbeat recording. The effect of cardiac interoceptive signals on SoA was measured by the difference in intentional binding effect during systole and diastole. This measure was standardized based on the overall intentional binding effect to control for non-cardiac factors, and then compared between SZ and HC., Results: Our study revealed a significant difference between SZ and HC groups, with opposite effects of cardiac systole on SoA. Specifically, cardiac systole disrupted SoA in SZ, contrasting with the enhanced SoA in HC. Across the SZ group, the extent to which SoA was disrupted by cardiac systole correlated significantly with a clinical proxy for symptom instability, namely the number of hospital admissions for hallucinations and delusions. Furthermore, the disruption was particularly observed in patients with severe hallucinations., Conclusions: This study revealed a disturbance in the impact of cardiac interoceptive signals on an implicit index of SoA in schizophrenia. This supports the notion that pathophysiological disruption of the central integration of interoceptive information increases vulnerability to disturbances in self-representation and the associated expression of schizophrenic symptoms., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Koreki, Terasawa, Nuruki, Oi, Critchley, Yogarajah and Onaya.)

Background: Awareness of one's own states is a particularly important part of cognition and emotion regulation. Recently, the concept of alexisomia has been used to refer to lack of awareness and expression of somatic sensations. Developing self-reported questionnaires to evaluate alexisomia represents a challenge for clinical psychology and medicine. In this context, we suggested to adapt the Body Awareness Questionnaire in French to measure alexisomia and its relation to alexithymia. In fact, we carried out a backtranslation and studied the validity of the construct in relation to proximal constructs around emotional awareness., Methods: For this study, 610 university students completed questionnaires measuring a three dimensions alexithymia concept [with The Toronto Alexithymia Scale (TAS-20)] or the five dimensions alexithymia concept [with The Bermond-Vorts Alexithymia Questionnaire (BVAQ-B)] and alexisomia (with the BAQ)., Results: Confirmatory factor analyses showed that the BAQ can be envisaged through 4 factors as well as a unidimensional model to refer to alexisomia. We also found that body awareness was negatively related to scores of alexithymia., Conclusion: Results are discussed in light of the construct of alexisomia and its clinical implications in somatic as well as mental disorders. We suggest that the BAQ, which assesses interoception, can contribute, in part, to the assessment of alexisomia. Like alexithymia, this is a key concept to take into consideration when designing treatment and prevention programs., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Carre, Shankland, Guillaume, Duclos, El-Jor, Pellissier and Flaudias.)

Interoception, the representation of our bodily state derived from physiological signals, is fundamental to our sense of self. Previous studies using cardiac feedback paradigms demonstrated interoceptive effects on self-perception. However, it remains unclear whether interoceptive information can extend self-attribution to non-bodily objects. This study aimed to elucidate whether cardiac signals can induce self-attribution to non-bodily objects and how interoceptive accuracy modulates this effect. A total of 44 male volunteers participated in an emotion assignment task where they viewed images of palms (bodily targets) and spheres (non-bodily targets) flashing in or out of sync with their heartbeat and assigned emotional images (positive/negative) to these targets. A heartbeat discrimination task was used to measure the interoceptive accuracy. The results showed no significant effect of synchronisation on emotion assignment for either the target type or the valence of the emotional images. However, participants with high interoceptive accuracy attributed both positive and negative images more to synchronised targets than those with low interoceptive accuracy. These findings suggest that although cardiac synchronisation may not uniformly facilitate the self-attribution of external objects, interoceptive accuracy may mediate attention to synchrony. Future studies should explore the conditions under which cardiac signals influence self-attribution., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Shibata, Harada and Ohira.)

Introduction: This study evaluated changes in the white matter of the brain and psychological health variables, resulting from a neuroscience-based mindfulness intervention, the Training for Awareness, Resilience, and Action (TARA), in a population of healthy adolescents., Methods: A total of 100 healthy adolescents (57 female, age ranges 14-18 years) were randomized into the 12-week TARA intervention or a waitlist-control group. All participants were imaged with diffusion MRI to quantify white matter connectivity between brain regions. Imaging occurred at baseline/randomization and after 12 weeks of baseline (pre- and post-intervention in the TARA group). We hypothesized that structural connectivity in the striatum and interoceptive networks would increase following the TARA intervention, and that, this increased connectivity would relate to psychological health metrics from the Strengths and Difficulties Questionnaire (SDQ) and the Insomnia Severity Index (ISI). The TARA intervention and all assessments, except for the MRIs, were fully remotely delivered using secure telehealth platforms and online electronic data capture systems., Results: The TARA intervention showed high consistency, tolerability, safety, recruitment, fidelity, adherence, and retention. After 12 weeks, the TARA group, but not controls, also demonstrated significantly improved sleep quality ( p  = 0.02), and changes in the right putamen node strength were related to this improved sleep quality ( r  = -0.42, p  = 0.006). Similarly, the TARA group, but not controls, had significantly increased right insula node strength related to improved emotional well-being ( r  = -0.31, p  = 0.04). Finally, we used the network-based statistics to identify a white matter interoception network that strengthened following TARA ( p  = 0.009)., Discussion: These results suggest that the TARA mindfulness-based intervention in healthy adolescents is feasible and safe, and it may act to increase structural connectivity strength in interoceptive brain regions. Furthermore, these white matter changes are associated with improved adolescent sleep quality and emotional well-being. Our results suggest that TARA could be a promising fully remotely delivered intervention for improving psychological well-being in adolescents. As our findings suggest that TARA affects brain regions in healthy adolescents, which are also known to be altered during depression in adolescents, future studies will examine the effects of TARA on depressed adolescents., Clinical Trial Registration: https://clinicaltrials.gov/study/NCT04254796., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Tymofiyeva, Sipes, Luks, Hamlat, Samson, Hoffmann, Glidden, Jakary, Li, Ngan, Henje and Yang.)

The neuroscience-based concept of "embodied cognition" or "embodiment" highlights that body and psyche are closely intertwined, i.e., effects of body and psyche are bidirectional and reciprocal. This represents the view that cognitive processes are not possible without the direct participation of the body. Traditional Cognitive Behavioral Therapy (CBT) addresses emotional processes on a conceptual level (dysfunctional thoughts, beliefs, attributions, etc.). However recent findings suggest that these processes already start at the level of bodily sensations. This opens up a way of working in therapy that includes the level of bodily sensations, where the development of emotional meaning is supported by bottom-up processes. Bidirectionality of embodiment can be effectively exploited by using body postures and movements associated with certain emotions, which we refer to as embodiment techniques, to deepen the physical experience of poorly felt emotions and support the valid construction of emotional meaning. This embodied approach offers several advantages: Prelinguistic or hard-to-grasp aspects can be identified more easily before being processed verbally. It is also easier to work with clients who have limited access to their emotions. Thus, in this paper we describe a new embodied CBT approach to working on the dysfunctional schema, which is based on three modules: body focus, emotional field, and interaction focus. In addition, using specific zones in the space of the therapy-room allows the embodiment of problematic interactions, as well as of power and powerlessness, closeness and distance, etc. Directly experiencing these processes on one's own body in the protected space of therapy allows faster and deeper insights than would be possible with conversations alone. Finally, the vitalizing power of emotions is used to create coherent action plans and successful interactions. This working method is illustrated by means of a case from practice., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Hauke, Lohr-Berger and Shafir.)

Introduction: Current evidence indicates a modulating role of respiratory processes in cardiac interoception, yet whether altered breathing patterns influence heartbeat-evoked potentials (HEP) remains inconclusive., Methods: Here, we examined the effects of voluntary hyperventilation (VH) as part of a clinical routine examination on scalp-recorded HEPs in epilepsy patients ( N = 80)., Results: Using cluster-based permutation analyses, HEP amplitudes were compared across pre-VH and post-VH conditions within young and elderly subgroups, as well as for the total sample. No differences in the HEP were detected for younger participants or across the full sample, while an increased late HEP during pre-VH compared to post-VH was fond in the senior group, denoting decreased cardiac interoceptive processing after hyperventilation., Discussion: The present study, thus, provides initial evidence of breathing-related HEP modulations in elderly epilepsy patients, emphasizing the potential of HEP as an interoceptive neural marker that could partially extend to the representation of pulmonary signaling. We speculate that aberrant CO 2 -chemosensing, coupled with disturbances in autonomic regulation, might constitute the underlying pathophysiological mechanism behind the obtained effect. Available databases involving patient records of routine VH assessment may constitute a valuable asset in disentangling the interplay of cardiac and ventilatory interoceptive information in various patient groups, providing thorough clinical data to parse, as well as increased statistical power and estimates of effects with higher precision through large-scale studies., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Stoupi, Weijs, Imbach and Lenggenhager.)

Background: Body image disorders are well documented in anorexia nervosa (AN); however, knowledge of interoceptive awareness (IA) in this population remains poor. This descriptive study investigated whether and how the representation of the interior of the body may have an impact on IA., Methods: The representations and knowledge of the body interior were evaluated with a drawing task in 34 women with AN and 34 healthy controls (HCs). A lexicometric analysis was performed on the vocabulary used to describe the drawn body parts in a structured interview. It was assumed that the conceptual representation of the body interior could be affected by or influence IA. Thus, the relationship between IA, measured with the heartbeat task and the ischemia-induction test, and the drawings was explored. Other scales, such as those of body shape, awareness or satisfaction, were used to assess affective representations of the body., Results: The drawing, lexicometric and IA results were similar in the two groups. No correlations were found among IA, body representation scores and representation level of body interior. Only the representation of bones by the AN group was significantly different., Discussion: Increased visual attention to the skeleton or greater awareness of bone health could explain the stronger representation of bones in the AN group. The psychophysical therapy received by some AN participants (73%) did not seem to have influenced IA. Our results do not support a relationship between IA and the representation of the body interior. Clinical trial registration: https://clinicaltrials.gov/, identifier NCT03988218., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Paquet, Girard, Passerieux, Boule, Lacroix, Sazerat, Olliac and Nubukpo.)

Objective: Health can be described as the state of homeostasis and optimal functioning across various bio-psycho-social dimensions and processes, allowing an individual to adapt and respond effectively to extrinsic and intrinsic challenges. Our thoughts, choices, behaviors, experiences, and feelings shape our existence. By transitioning from unconscious reactions to conscious responses, we can establish novel habits and behaviors, actively embracing positive shifts in our lifestyle., Subjects and Methods: The presented examination focuses on the smartwatch (SW), analyzing the incorporation of potentially progressive attributes that could enrich our lifestyle pursuits. The objective is not the health disorders themselves but the employment of wearable devices to create a strong sense of coherence in the Straussian grounded theory approach. The study had no subjects., Results: The potential of the SW has been partially explored in lifestyle intervention, modification, research, and practice., Conclusion: Based on our examination, creating an innovative SW capable of aiding individuals in better comprehending their behaviors and motivating them toward comprehensive changes in their lifestyle is a challenging yet attainable endeavor. Our ambition is to bring into existence SW capable of comprehensively measuring and evaluating interoception, circadian rhythm (CR), selected lifestyle pillars, and their associated components, and seamlessly integrating them into current SW features. It focuses on boosting motivation, maintenance, and amelioration regarding one's lifestyle. The novel approach strives to boost both immediate and underlying factors that actively contribute to improving one's metacognition., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Uher, Vašková, Poráčová, Cimbolákova, Küchelová, Buková and Bernasovská.)

Interoceptive awareness (IA) is crucial to understanding mental health. The Multidimensional Assessment of Interoceptive Awareness (MAIA) scale, available in approximately 30 languages, has gained global recognition for its research applicability. This review highlights the critical importance of integrating IA evaluation in clinical settings, advocating for the MAIA scale's potential as a screening tool. Through an examination of academic databases, including Scopus, PubMed, Google Scholar, and J-STOR, our analysis spans seven mental health domains: eating disorders (ED), depression, stress, anxiety, autism spectrum disorder (ASD), chronic pain, and suicide ideation (SI). Thirty-eight studies showed links between several dimensions of IA with different disorders. That is, ED was related to Body Trust and Self-Regulation; anxiety to Body Listening, Emotional Awareness, and Self-Regulation; depression to Noticing and Emotional Awareness; ASD to Trusting, Emotional Awareness, and Noticing; chronic pain to Not-Worrying and Self-Regulation; and SI with Trusting. These insights hold profound implications for both clinical practice and mental health research. Integrating IA assessments into standard clinical protocols has the potential to improve our understanding of pathology, enrich patient care, and enhance therapeutic strategies., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Solano Durán, Morales and Huepe.)

Introduction: Anxiety is one of the most prevalent mental health conditions worldwide, and psychotherapeutic techniques can be employed to help manage and mitigate symptoms. While the available therapies are numerous, key strategies often involve cognitive and/or embodiment techniques. Within body-centered methods, breathing-oriented approaches are particularly prevalent, using either attention towards or active control of breathing. As the perception of body states (i.e., interoception) is thought to be an integral component of emotion generation, these embodiment and breathing techniques may be key in addressing the miscommunication between the brain and body that is thought to exist with anxiety. Therefore, we conducted a systematic review and meta-analysis to assess the effects of acute administration of psychological interventions for state anxiety., Results: This systematic review was conducted in accordance with the PRISMA statement and registered prospectively in PROSPERO. A literature search for randomized controlled trials was conducted in PubMed, PsycINFO, and Scopus. We considered interventions that focused on cognitive, embodiment or breathing strategies, or a combination of these techniques. Twelve studies met our inclusion criteria, and study characteristics, quality and effect sizes were assessed. A single cognitive study was found to produce a moderate reduction in state anxiety, while moderate to large effects were found across studies assessing embodiment practices. In contrast, studies which utilized breathing-based interventions alone produced inconsistent results, with both attention towards and active control of breathing producing large to no effects depending on the technique employed. Finally, consistent moderate effects were found with combination techniques that involved passive attention (e.g., towards cognitions, body and/or breathing), with active combination techniques producing inconsistent results., Discussion: While study numbers are limited regarding brief interventions, cognitive and embodiment techniques are consistently helpful for reducing state anxiety, while breathing-based exercises need to consider the specific technique employed, and how successful this may be for each individual. Furthermore, combined practices such as mindfulness can also be successful, although care must be taken when introducing an active change to one or more elements., Prospero Systematic Review Registration Number: CRD42024507585 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024507585., Competing Interests: Author FB is the Founder & Creative Director of Optimal Health Model Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Chin, Gorman, Beck, Russell, Stephan and Harrison.)

Developing a sense of internal safety and security depends mainly on others: numerous neuromodulators play a significant role in the homeostatic process, regulating the importance of proximity to a caregiver and experiencing feelings that enable us to regulate our interdependence with our conspecifics since birth. This array of neurofunctional structures have been called the SEPARATION DISTRESS system (now more commonly known as the PANIC/ GRIEF system). This emotional system is mainly involved in the production of depressive symptoms. The disruption of this essential emotional balance leads to the onset of feelings of panic followed by depression. We will focus on the neuropeptides that play a crucial role in social approach behavior in mammals, which enhance prosocial behavior and facilitate the consolidation of social bonds. We propose that most prosocial behaviors are regulated through the specific neuromodulators acting on salient intersubjective stimuli, reflecting an increased sense of inner confidence (safety) in social relationships. This review considers the neurofunctional link between the feelings that may ultimately be at the base of a sense of inner safety and the central neuromodulatory systems. This link may shed light on the clinical implications for the development of early mother-infant bonding and the depressive clinical consequences when this bond is disrupted, such as in post-partum depression, depressive feelings connected to, addiction, neurofunctional disorders, and psychological trauma., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Clarici, Bulfon, Radin and Panksepp.)

Interpersonal touch represents the primal sensory experience between humans, fostering social bonding from the cradle to the death bed. In recent decades "affective touch" has been intensely studied, stimulated by the discovery of a population of mechanosensitive unmyelinated C-tactile afferents in mammalian skin. A lack of touch in childhood is associated with negative consequences for psychosocial and physical health and the benefits of professional touch techniques in the prevention and treatment of various diseases have been shown over and over again in clinical studies. However, its application in mainstream clinical applications remains limited. To bridge the gap between recent discoveries in touch research and clinical medicine, we propose the establishment of a new discipline: 'Touch Medicine'. Here, we unfold the potential of Touch Medicine by focusing on the treatment of depression, which in our view is primarily a disorder of the lived body. Controlled studies and systematic reviews have demonstrated the antidepressant, anxiolytic and analgesic effects of specific massage techniques. Underlying mechanisms of action are currently under investigation, ranging from interoceptive, endocrinological, to stress-related or psychological underpinnings. Touch Medicine represents a novel interdisciplinary field connected to various medical specialities such as neonatology, pediatrics, pain medicine, neurology, psychiatry, and geriatrics - but also clinical psychology and psychosomatic medicine might benefit from the integration of these findings into their daily practice., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 McGlone, Uvnäs Moberg, Norholt, Eggart and Müller-Oerlinghausen.)

Introduction: Interoception, the perception of the internal state of the body, has been shown to be closely linked to emotions and mental health. Of particular interest are interoceptive learning processes that capture associations between environmental cues and body signals as a basis for making homeostatically relevant predictions about the future. One method of measuring respiratory interoceptive learning that has shown promising results is the Breathing Learning Task (BLT). While the original BLT required binary predictions regarding the presence or absence of an upcoming inspiratory resistance, here we extended this paradigm to capture continuous measures of prediction (un)certainty., Methods: Sixteen healthy participants completed the continuous version of the BLT, where they were asked to predict the likelihood of breathing resistances on a continuous scale from 0.0 to 10.0. In order to explain participants' responses, a Rescorla-Wagner model of associative learning was combined with suitable observation models for continuous or binary predictions, respectively. For validation, we compared both models against corresponding null models and examined the correlation between observed and modeled predictions. The model was additionally extended to test whether learning rates differed according to stimuli valence. Finally, summary measures of prediction certainty as well as model estimates for learning rates were considered against interoceptive and mental health questionnaire measures., Results: Our results demonstrated that the continuous model fits closely captured participant behavior using empirical data, and the binarised predictions showed excellent replicability compared to previously collected data. However, the model extension indicated that there were no significant differences between learning rates for negative (i.e. breathing resistance) and positive (i.e. no breathing resistance) stimuli. Finally, significant correlations were found between fatigue severity and both prediction certainty and learning rate, as well as between anxiety sensitivity and prediction certainty., Discussion: These results demonstrate the utility of gathering enriched continuous prediction data in interoceptive learning tasks, and suggest that the updated BLT is a promising paradigm for future investigations into interoceptive learning and potential links to mental health., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Brand, Wise, Hess, Russell, Stephan and Harrison.)

Interoception, sometimes referred to as the 'hidden sense,' communicates the state of internal conditions for autonomic energy regulation and is important for human motor control as well as self-awareness. The insula, the cortex of interoception, integrates internal senses such as hunger, thirst and emotions. With input from the cerebellum and proprioceptive inputs, it creates a vast sensorimotor network essential for static posture and dynamic movement. With humans being bipedal to allow for improved mobility and energy utilization, greater neuromotor control is required to effectively stabilize and control the four postural zones of mass (i.e., head, torso, pelvis, and lower extremities) over the base of support. In a dynamic state, this neuromotor control that maintains verticality is critical, challenging energy management for somatic motor control as well as visceral and autonomic functions. In this perspective article, the authors promote a simple series of posture photographs to allow one to integrate more accurate alignment of their postural zones of mass with respect to the gravity line by correlating cortical interoception with cognitive feedback. Doing this focuses one on their body perception in space compared to the objective images. Strengthening interoceptive postural awareness can shift the net result of each zone of postural mass during day-to-day movement towards stronger posture biomechanics and can serve as an individualized strategy to optimize function, longevity, and rehabilitation., Competing Interests: SW is CEO of BodyZone.com, a company that promotes healthy posture and other self-care habits that owns CEsoup.com, PostureMonth.org, PosturePractice.com, PostureZone.com, StandTallerLiveLonger.com, and StrongPosture.com. The remaining author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Weiniger and Schilaty.)

The conventional dichotomy between human health and disease has historically been approached through reductionist models that emphasize the exclusive causal relevance of physiological and pathological processes. Consequently, self-awareness and affective dimensions, integral to a phenomenological perspective, are often relegated to secondary traits, affording little consideration for the causal role of embodied living organization. Our interest lies in exploring the potential relevance of the phenomenology of embodied self-awareness in relation to interoceptive processes within therapeutic settings. As we illustrate, when the unfolding processes of interoceptive awareness and its affective capacity take precedence, the agent assumes an active, rather than passive, role in their own experience of health or illness. Departing from an enactive, phenomenological, and ecological standpoint, we propose a distinctive perspective on interoceptive processes, relying on an affective conceptualization of a spectrum of experiences of bodily being-in-the-world. Our primary argument posits that considering interoceptive processes from an embodied and ecological viewpoint of the self, interacting with the material and social environment, enables an approach to the gradient of affective experiences of embodied self-awareness-where pleasure or suffering is perceived and felt-in a naturalized, non-reductive, and relational manner. We discern two ways in which interoceptive processes interrelate with the experience of embodied self-awareness: sensitivity (self-affective) and affective-laden perception. Drawing on this distinction, we provide a nuanced description of these experiences within communities of cis-women, exemplified through the contexts of menstruation and endometriosis. This exploration seeks to enhance our understanding of the phenomenology of embodied, ecological, and affective self-experience from within diverse and situated bodies. The goal is to contribute to their autonomy and ability to adapt and self-regulate within therapeutic contexts., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 González-Grandón, Cadena-Alvear and Gastelum-Vargas.)

Past research that distinguishes between affective and neutral words has predominantly relied on two-dimensional models of emotion focused on valence and arousal. However, these two dimensions cannot differentiate between emotion-label words (e.g., fear) and emotion-laden words (e.g., death). In the current study, we aimed to determine the unique affective characteristics that differentiate emotion-label, emotion-laden, and neutral words. Therefore, apart from valence and arousal, we considered different affective features of multi-componential models of emotion: action, assessment, expression, feeling, and interoception. The study materials included 800 Spanish words (104 emotion-label words, 340 emotion-laden words, and 356 neutral words). To examine the differences between each word type, we carried out a Principal Component Analysis and a Random Forest Classifier technique. Our results indicate that these words are characterized more precisely when the two-dimensional approach is combined with multi-componential models. Specifically, our analyses revealed that feeling, interoception and valence are key features in accurately differentiating between emotion-label, emotion-laden, and neutral words., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Betancourt, Guasch and Ferré.)

Active inference (AIF) is a theory of the behavior of information-processing open dynamic systems. It describes them as generative models (GM) generating inferences on the causes of sensory input they receive from their environment. Based on these inferences, GMs generate predictions about sensory input. The discrepancy between a prediction and the actual input results in prediction error. GMs then execute action policies predicted to minimize the prediction error. The free-energy principle provides a rationale for AIF by stipulating that information-processing open systems must constantly minimize their free energy (through suppressing the cumulative prediction error) to avoid decay. The theory of homeostasis and allostasis has a similar logic. Homeostatic set points are expectations of living organisms. Discrepancies between set points and actual states generate stress. For optimal functioning, organisms avoid stress by preserving homeostasis. Theories of AIF and homeostasis have recently converged, with AIF providing a formal account for homeo- and allostasis. In this paper, we present bacterial chemotaxis as molecular AIF, where mutual constraints by extero- and interoception play an essential role in controlling bacterial behavior supporting homeostasis. Extending this insight to the brain, we propose a conceptual model of the brain homeostatic GM, in which we suggest partition of the brain GM into cognitive and physiological homeostatic GMs. We outline their mutual regulation as well as their integration based on the free-energy principle. From this analysis, affect and self-efficacy emerge as the main regulators of the cognitive homeostatic GM. We suggest fatigue and depression as target neurocognitive phenomena for studying the neural mechanisms of such regulation., Competing Interests: The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Krupnik.)

Introduction: Interoceptive deficits are associated with difficulties in identifying and regulating emotions. However, research on interoception after acquired brain injury (ABI) is scarce, and its relationship with emotional difficulties in this population is unknown. This study aimed to (1) examine differences in self-reported alexithymia, performance-based emotional awareness, emotion regulation, depression, and interoceptive sensibility between ABI and control individuals; and (2) analyze the role of adaptive interoceptive dimensions in these emotional processes after ABI., Methods: Forty-three individuals with ABI and 42 matched control individuals completed the Multidimensional Assessment of Interoceptive Awareness-2, the Toronto Alexithymia Scale, the Levels of Emotional Awareness Scale, the Difficulties in Emotion Regulation Scale, and the Hospital Anxiety and Depression Scale., Results: Compared to the control group, individuals with ABI showed reduced tendency to ignore unpleasant sensations increased severity of depressive symptoms, as well as tendencies to have greater difficulties in emotion regulation and lower emotional awareness. Additionally, interoceptive dimensions such as trusting, as well as not-distracting from and not-worrying about bodily sensations, played a relevant role in explaining lower alexithymia and difficulties in emotion regulation. Moreover, lower alexithymia and emotion dysregulation were related to less depressive symptoms. These relationships were invariant across ABI and control individuals., Discussion: Although individuals with ABI may have different levels of emotional abilities compared to non-ABI individuals, the relationship patterns between interoceptive and emotional processes appear to be similar between the two groups. This study suggests the potential benefit of addressing both interoceptive and emotional difficulties in treatments targeting such prevalent sequelae of ABI as depressive symptoms., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer RET declared shared affiliation with the authors to the handling editor at the time of review. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2023 Desdentado, Miragall, Llorens, Navarro and Baños.)

The concept of minimal self-consciousness or "minimal self" is equivalent to a very basic form of first-person, pre-reflective self-awareness, which includes bodily self-awareness, and is related to phenomenal experience (qualia) and sentience. This phenomenological concept plays a role in characterizations of the senses of ownership and agency; in recent debates about Buddhist conceptions of the no-self; in explanations of illusions such as the Rubber Hand Illusion; as well as in characterizations of schizophrenia as a self-disorder. Despite its relevance to these complex investigations, a number of theorists have recently pointed out that the concept is not well defined. In order to provide some clarification about the notion of minimal self and how it relates to bodily and sensory processes this paper reaches back to the ideas expressed in a famous medieval thought experiment proposed in the 11th century: Avicenna's Flying Man argument. The paper then provides a review of some of the contemporary debates about the minimal self, pointing especially to questions about the role of bodily and social processes., Competing Interests: The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2023 Gallagher.)

Interoception plays a crucial role in maintaining bodily homeostasis and promoting survival, and is considered the basis of human emotion, cognition, and self-formation. A malfunction of interoception is increasingly suggested to be a fundamental component of different mental health conditions, and depressive disorders have been especially closely associated. Interoceptive signaling and processing depends on a system called the "interoceptive pathway," with the insula, located in the deep part of the lateral fissure, being the most important brain structure in this pathway. Neuroimaging studies have revealed alterations in the structure and function of the insula in a large number of individuals with depression, yet the precise relationship between these alterations and interoceptive dysfunction remains unclear. The goal of this review is to examine the evidence that exists for dysfunction of interoception in people with Major Depressive Disorder (MDD), and to determine the associated specific alterations in the structure and function of the insula revealed by neuroimaging. Overall, three aspects of the potential relationship between interoceptive dysfunction and alterations in insular function in people with depression have been assessed, namely clinical symptoms, quantitative measures of interoceptive function and ability, and interoceptive modulation. To conclude, several specific limitations of the published studies and important lines of enquiry for future research are offered., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Hu, He, Roberts, Chen, Yan, Pu, Song and Luo.)

Background: Interoception (i.e., the ability to recognize bodily signals), alexithymia (i.e., the inability to recognize emotional states) and negative affect (i.e., unpleasant feelings such as anxiety) have been associated with alcohol use disorder (AUD). Previous research suggests that interoception may underlie alexithymia, which in turn may be associated with negative affectivity. However, this remains to be empirically tested. This study investigates whether alexithymia mediates the association between interoception and anxiety and whether this association differs across individuals with AUD and a healthy control (HC) comparison group., Methods: The AUD group consisted of 99 participants enrolled in an 8-week abstinence-based inpatient treatment program. The HC group included 103 healthy individuals. The heartbeat counting task (HCT) was used to assess interoception (cardiac interoceptive accuracy). The Toronto Alexithymia Scale (TAS-20) was used to assess alexithymia. The Brief Symptom Inventory (BSI) was used to assess anxiety., Results: The moderated mediation model with interoception as the predictor, alexithymia as the mediator, and negative affect (i.e., state anxiety) as the dependent variable was tested. The analysis showed that the conditional indirect effect of interoception on anxiety via alexithymia was significant for individuals with AUD [ ab = -0.300, bootstrap 95% CI = (-0.618, -0.088)], as well as for HCs [ ab = -0.088, bootstrap 95% CI = (-0.195, -0.014)]; however, the conditional indirect effect significantly differed across HCs and individuals with AUD. Namely, the mediated effect was greater among individuals with AUD compared to the HC group., Conclusion: The results suggests that interoceptive impairment contributes to greater negative affect (i.e., state anxiety) via alexithymia especially for individuals with AUD. Improving emotion recognition via therapeutic methods focused on strengthening interoceptive abilities could improve outcomes for individuals receiving treatment for AUD., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Wiśniewski, Jakubczyk, Trucco, Kobyliński, Suszek, Zaorska, Rydzewska and Kopera.)

An interoceptive homeostatic system monitors levels of CO 2 /H + and provides a proportionate drive to respiratory control networks that adjust lung ventilation to maintain physiologically appropriate levels of CO 2 and rapidly regulate tissue acid-base balance. It has long been suspected that the sensory cells responsible for the major CNS contribution to this so-called respiratory CO 2 /H + chemoreception are located in the brainstem-but there is still substantial debate in the field as to which specific cells subserve the sensory function. Indeed, at the present time, several cell types have been championed as potential respiratory chemoreceptors, including neurons and astrocytes. In this review, we advance a set of criteria that are necessary and sufficient for definitive acceptance of any cell type as a respiratory chemoreceptor. We examine the extant evidence supporting consideration of the different putative chemoreceptor candidate cell types in the context of these criteria and also note for each where the criteria have not yet been fulfilled. By enumerating these specific criteria we hope to provide a useful heuristic that can be employed both to evaluate the various existing respiratory chemoreceptor candidates, and also to focus effort on specific experimental tests that can satisfy the remaining requirements for definitive acceptance., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Gonye and Bayliss.)

This study aimed to establish perceptual strength norms for 1,000 words in the languages of Korean, English, and L2 English, in order to investigate the similarity and difference across languages as well as the influence of the environment on semantic processing. The perceptual strength norms, which are a collection of word profiles that summarize how a word is experienced through different sensory modalities including the five common senses and interoception, provide a valuable tool for testing embodiment cognition theory. The results of this study demonstrated that language users had parallel sensory experiences with concepts, and that L2 learners were also able to associate their sensory experiences with linguistic concepts. Additionally, the results highlighted the importance of incorporating interoception as a sensory modality in the development of perceptual strength norms, as it had a negative correlation with both vision and concreteness. This study was the first to establish norms for Korean and L2 English and directly compare languages using the identical and translation-equivalent word list., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Lee and Shin.)

Installation art, with its immersive and participatory character, has been argued to require the use and awareness of the body, which potentially constitute key parts of the artwork's experience and appreciation. Heightened body awareness is even argued to be a key to particularly profound emotional or even transformative states, which have been frequently ascribed to this genre. However, the body in the experience of installation art has rarely been empirically considered. To address this gap, we investigated the body's role in the experience of Tomás Saraceno's in orbit installation. Based on a list of self-report items created from a review of the theoretical literature, we-for the first time-captured (quantitatively and qualitatively): what kind of subjective bodily experiences visitors ( N = 230) reported, how these items grouped into clusters (using network science), and how these relate to emotion, art appraisal, and transformative outcomes. Network analysis of the items determined four communities related to "interoception," "presence," "disturbance," and "proprioception." Proprioception (e.g., awareness of balance/movement/weight) turned out to be a significant determinant of art appreciation in our study, and, together with "disturbing" body experiences (feeling awkward/watched/chills), coincided with transformation. We also assessed individual differences in body awareness yet did not find that these moderate those relationships. We suggest future research on installation art based on a more unified assessment of the role of the body in embodied-enactive aesthetics and its relation to the intensity and impact of art experience in general., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Kühnapfel, Fingerhut and Pelowski.)

Objectives: Migraine is a complex neurological disorder that typically presents with unilateral cephalgia associated with cognitive impairment and reduced interoception. These symptoms result in socio-economic repercussions due to reduced productivity, efficiency, and work performance. Therefore, along with headache management, improving cognition and interoception should also be significant therapeutic targets to effectively manage migraine. To achieve this, we propose to explore the role of a yoga-based visual respiratory biofeedback (VRB) as a possible therapeutic strategy., Methods and Analysis: At least 64 participants will be recruited for the trial after screening for eligibility criteria, using the migraine screening questionnaire and Montreal cognitive assessment test. They will be randomly allocated (1:1) to either the experimental group receiving a 20-min session of yoga-based VRB or the control group who will be asked to watch a documentary film for the same duration. Visuospatial cognition will be assessed by the Corsi block-tapping task, and cardiac interoceptive accuracy will be assessed by the heartbeat counting task at baseline and immediately after the intervention. Based on the distribution and variance of the data obtained, analysis will be conducted based on linear mixed models using SPSS version 28.0.1.0, with a two-sided p -value of < 0.05 considered to be statistically significant., Discussion: To the best of our knowledge, this is the first study to design and assess the effects of yoga-based biofeedback therapy on cognition and cardiac interoception in migraineurs. Furthermore, we postulated that pranayama's therapeutic effects might be enhanced by using visual yogic respiratory biofeedback. Considering the socio-economic burden of migraine, if found effective, VRB investigated in the trial could be considered as a therapeutic strategy., Clinical Trial Registration: ClinicalTrials.gov CTRI, CTRI/2023/03/050430., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Ramaswamy, Shetty and Shetty.)

This study examined the associations between psychopathy dimensions (triarchic phenotypes and classical factors), empathy domains (cognitive and affective), and interoception (interoceptive attention and accuracy) while accounting for the putative role of alexithymia. A community sample ( n  = 515) completed an online survey encompassing: Triarchic Psychopathy Measure (boldness, meanness, disinhibition); Levenson Self-Report Psychopathy Scale (primary and secondary psychopathy); Body Perception Questionnaire (interoceptive attention); Interoceptive Accuracy Scale; Toronto Alexithymia Scale. Hierarchical linear regression models were implemented for hypothesis-driven analyses examining the associations between psychopathy, empathy, and interoception while controlling for sex, age, and alexithymia. Exploratory path models were employed to investigate alexithymia and/or cognitive empathy as mediators between interoception and psychopathy. Our results largely confirmed the postulated empathy profiles across psychopathy dimensions, as meanness and primary psychopathy displayed a broad empathy impairment, while disinhibition and secondary psychopathy were only associated with diminished cognitive empathy. Importantly, boldness displayed a unique pattern (enhanced cognitive empathy and reduced affective empathy), further reinforcing its importance within the constellation of psychopathy traits. Contrary to our hypotheses, self-perceived interoceptive attention and accuracy were not associated with either psychopathy dimension after controlling for alexithymia. However, interoceptive accuracy and alexithymia were associated with cognitive empathy, while alexithymia was also positively related to all psychopathy dimensions (as expected), despite the unexpected strong and negative association with boldness. Exploratory analyses suggested significant indirect effects (mediation) between interoceptive accuracy and psychopathy via alexithymia and/or cognitive empathy. These mediating effects must be interpreted with caution and future studies should be designed to formally test this model., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Campos, Rocha and Barbosa.)

Women who received a diagnosis of breast cancer often report impairments in physical and psychological wellbeing, even some years after treatments. Individual awareness about physical changes, body image, and current sensations related to their body is important to maintain a psycho-emotional balance. Virtual reality, as an advanced human-computer interface, can be an effective tool to improve breast cancer survivors' abilities to know and manage their current sensations related to their bodies. The present study protocol proposes a virtual reality intervention aiming at promoting interoception and emotional wellbeing, fear of cancer recurrence, and body perception in breast cancer survivors, according to the three data collection times. Repeated-measure analysis of variance (ANOVA) with between-within interaction will be performed. Expected results include participants' awareness of their internal feelings, the reduction of negative emotions, and the management of symptoms related to the body, clarifying characteristics for the effective implementation of VR psychological intervention in the future., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Sebri, Durosini, Strika, Pizzoli, Mazzocco and Pravettoni.)

Interoceptive individual differences have garnered interest because of their relationship with mental health. One type of individual difference that has received little attention is variability in the sensation/s that are understood to mean a particular interoceptive state, something that may be especially relevant for hunger. We examined if interoceptive hunger is multidimensional and idiosyncratic, if it is reliable, and if it is linked to dysfunctional eating and beliefs about the causes of hunger. Participants completed a survey just before a main meal, with most retested around 1 month later. We found that interoceptive hunger has 11 dimensions, and while people differ considerably in their combinations of interoceptive hungers, these represent only 4% of all possible permutations. Hunger reports were reliable. We found relationships between variability in hunger interoception and dysfunctional eating, especially for uncontrolled eating. We also found that hunger beliefs were in some cases strongly related to aspects of hunger interoception. The implications of these findings are discussed., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Stevenson, Hill, Hughes, Wright, Bartlett, Saluja and Francis.)

The Bayesian approach of cognitive science largely takes the position that evolution drives perception to produce precepts that are veridical. However, some efforts utilizing evolutionary game theory simulations have shown that perception is more likely based on a fitness function, which promotes survival rather than promoting perceptual truth about the environment. Although these findings do not correspond well with the standard Bayesian approach to cognition, they may correspond with a behavioral functional contextual approach that is ontologically neutral (a-ontological). This approach, formalized through a post-Skinnerian account of behaviorism called relational frame theory (RFT), can, in fact, be shown to correspond well with an evolutionary fitness function, whereby contextual functions form that corresponds to a fitness function interface of the world. This fitness interface approach therefore may help provide a mathematical description for a functional contextual interface of phenomenological experience. Furthermore, this more broadly fits with a neurological active inference approach based on the free-energy principle (FEP) and more broadly with Lagrangian mechanics. These assumptions of how fitness beats truth (FBT) and FEP correspond to RFT are then discussed within a broader multidimensional and evolutionary framework called the extended evolutionary meta-model (EEMM) that has emerged out of the functional contextual behavioral science literature to incorporate principles of cognition, neurobiology, behaviorism, and evolution and are discussed in the context of a novel RFT framework called "Neurobiological and Natural Selection Relational Frame Theory" (N-frame). This framework mathematically connects RFT to FBT, FEP, and EEMM within a single framework that expands into dynamic graph networking. This is then discussed for its implications of empirical work at the non-ergodic process-based idiographic level as applied to individual and societal level dynamic modeling and clinical work. This discussion is framed within the context of individuals that are described as evolutionary adaptive and conscious (observer-self) agents that minimize entropy and can promote a prosocial society through group-level values and psychological flexibility., Competing Interests: The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Edwards.)

Worry is a form of repetitive negative thought. High worry-proneness is one risk factor leading to anxiety disorder. Several types of research indicated that anxiety disorder was highly associated with disrupted interoception. The insula is consistently considered to play a key role in interoception. However, the relationship between worry and the interoception network is poorly investigated in worry-prone individuals. Thus, it is essential to identify the neural characteristic of high worry-proneness subjects. A total of 32 high worry-proneness (HWP) subjects and 25 low worry-proneness (LWP) subjects were recruited and underwent magnetic resonance imaging scanning. Six subregions of insula were chosen as regions of interest. Then, seed-based static and dynamic functional connectivity were calculated. Increased static functional connectivity was observed between the ventral anterior insula and inferior parietal lobule in HWP compared to LWP. Decreased static functional connectivity was found between the left ventral anterior insula and the pregenual anterior cingulate cortex. Decreased dynamic functional connectivity was also shown between the right posterior insula and the inferior parietal lobule in HWP. Moreover, a post-hoc test exploring the effect of changed function within the insular region confirmed that a significant positive relationship between static functional connectivity (ventral anterior insula-inferior parietal lobule) and dynamic functional connectivity (posterior insula-inferior parietal lobule) in LWP but not in HWP. Our results might suggest that deficient insular function may be an essential factor related to high worry in healthy subjects., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Zhang, Cai, Duan and He.)

Interoception can be described as the ability to perceive inner body sensations and it is different between biological sex. However, no previous research correlated this ability with brain functional connectivity (FC) between males and females. In this study, we used resting-state functional magnetic resonance imaging to investigate FC of networks involved in interoception among males and females in a sample of healthy volunteers matched for age. In total, 67 participants (34 females, mean age 44.2; 33 males, mean age 37.2) underwent a functional MRI session and completed the Self-Awareness Questionnaire (SAQ) that tests the interoceptive awareness. To assess the effect of sex on scores obtained on the SAQ we performed a multivariate analysis of variance. A whole-brain seed-to-seed FC analysis was conducted to investigate the correlation between SAQ score and FC, and then to test differences in FC between males and females with SAQ score as a covariate. MANOVA revealed a significant difference in SAQ scores between males and females with higher values for the second ones. Also, significant correlations among interoception scores and FC in Salience network and fronto-temporo-parietal brain areas have been detected, with a sharp prevalence for the female. These results support the idea of a female advantage in the attention toward interoceptive sensations, suggesting common inter-network areas that concur to create the sense of self., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Alfano, Cavaliere, Di Cecca, Ciccarelli, Salvatore, Aiello and Federico.)

The role of emotional reactivity in the psychopathology of depression has been studied widely but not comprehensively. Inconsistencies in existing literature indicate the presence of other factors may affect this dynamic. An individual's method of processing their physiological sensations is a third variable because emotions are psychophysiological. This study identified the predictiveness of ease of activation, intensity, and duration of negative and positive emotions on depressive symptoms differentiated by interoceptive sensibility (IS). A total of 270 community participants filled-in questionnaires assessing their IS, habitual emotional reactivity, depressive severity, and response bias. A two-step clustering analysis identified the IS characteristics. Negative and positive reactivity models among each IS cluster were tested using bootstrapping regression, controlling for gender and response bias. IS can be clustered into "high IS," "low IS," and "worriers." Both positive and negative reactivity's predictiveness patterns on depression were different between IS clusters. Lower positive reactivity predicted depression among individuals with low IS (harder to activate positive emotions) and worriers (shorter duration of positive emotions) but not among individuals with high IS. Those with high IS also exhibited the highest positive reactivity. Ease of activating negative emotions predicted depression among high IS individuals, and a longer duration of negative emotions predicted depression among worriers. IS may affect the psychopathology of depression through subjective emotional reactivity. Thus, IS characteristics can be incorporated into intervention plans., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Huang, Huang and Yen.)

Background: Movement is an essential element in maintaining overall well-being, producing both physical and mental health benefits. Yoga is a mindful movement practice, with traditional yogic texts providing a framework, called the Koshas, that delineates how an intentional movement practice may impact multidimensional aspects of an individual. To date, no self-report measure examines the multifaceted ways that movement affects the individual at a physical and psychological level. Therefore, we developed the Multidimensional Impacts of Movement Scale (MIMS) by aligning ancient yogic traditions with current neuroscientific concepts., Methods: MIMS was developed based on the five categories of the Koshas; 9 questions per Kosha resulted in 45 total questions. Participants ( n  = 103) self-identified as having yoga, running, or weightlifting as their primary movement practice, engaging in this practice at least 30 min per session, once a week, for the past 3 months. Participants engaged in their usual movement practice and then (within 2 h of their workout session) completed the MIMS along with a series of previously validated questionnaires. After a period of 2 weeks, participants completed their normal movement practice once again and took the MIMS a second time to assess test-retest reliability and Cronbach's alpha. Validity testing included convergent and divergent validity testing through Pearson's product-moment correlations and confirmatory factor analysis., Results: One-hundred and three participants completed all study measures. Test-retest reliability demonstrated stability over time ( r  = 0.737, p  < 0.001). Cronbach's alpha was between 0.775 and 0.840 for each of the factors, p  < 0.001. MIMS was sensitive to confirmatory and discriminatory validity testing. Validity was also demonstrated through confirmatory factor analysis (i.e., Chi Square, Comparative Fit Index, Root Mean Square Error of Approximation)., Conclusion: MIMS is a valid and reliable tool to measure the multidimensional impacts of movement. The tool provides information about the effects of movement on a range of physical and psychological elements including subscales representing the body, energy, mind, intuition, and contentment. Physical activities that include aspects of mindfulness may demonstrate the most robust effects on the MIMS., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Lynn and Basso.)

Macroscopic taste processing connectivity was investigated using functional magnetic resonance imaging during the presentation of sour, salty, and sweet tastants in anesthetized macaque monkeys. This examination of taste processing affords the opportunity to study the interactions between sensory regions, central integrators, and effector areas. Here, 58 brain regions associated with gustatory processing in primates were aggregated, collectively forming the gustatory connectome . Regional regression coefficients (or β-series) obtained during taste stimulation were correlated to infer functional connectivity. This connectivity was then evaluated by assessing its laterality, modularity and centrality. Our results indicate significant correlations between same region pairs across hemispheres in a bilaterally interconnected scheme for taste processing throughout the gustatory connectome. Using unbiased community detection, three bilateral sub-networks were detected within the graph of the connectome. This analysis revealed clustering of 16 medial cortical structures, 24 lateral structures, and 18 subcortical structures. Across the three sub-networks, a similar pattern was observed in the differential processing of taste qualities. In all cases, the amplitude of the response was greatest for sweet, but the network connectivity was strongest for sour and salty tastants. The importance of each region in taste processing was computed using node centrality measures within the connectome graph, showing centrality to be correlated across hemispheres and, to a smaller extent, region volume. Connectome hubs exhibited varying degrees of centrality with a prominent leftward increase in insular cortex centrality. Taken together, these criteria illustrate quantifiable characteristics of the macaque monkey gustatory connectome and its organization as a tri-modular network, which may reflect the general medial-lateral-subcortical organization of salience and interoception processing networks., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Hartig, Karimi and Evrard.)

Recent studies using a novel method for targeted ablation of afferent renal nerves have demonstrated their importance in the development and maintenance of some animal models of hypertension. However, relatively little is known about the anatomy of renal afferent nerves distal to the renal pelvis. Here, we investigated the anatomical relationship between renal glomeruli and afferent axons identified based on transient receptor potential vanilloid 1 channel (TRPV1) lineage or calcitonin gene related peptide (CGRP) immunolabeling. Analysis of over 6,000 (10,000 was accurate prior to the removal of the TH data during the review process) glomeruli from wildtype C57BL/6J mice and transgenic mice expressing tdTomato in TRPV1 lineage cells indicated that approximately half of all glomeruli sampled were closely apposed to tdTomato+ or CGRP+ afferent axons. Glomeruli were categorized as superficial, midcortical, or juxtamedullary based on their depth within the cortex. Juxtamedullary glomeruli were more likely to be closely apposed by afferent axon subtypes than more superficial glomeruli. High-resolution imaging of thick, cleared renal slices and subsequent distance transformations revealed that CGRP+ axons closely apposed to glomeruli were often found within 2 microns of nephrin+ labeling of glomerular podocytes. Furthermore, imaging of thick slices suggested that CGRP+ axon bundles can closely appose multiple glomeruli that share the same interlobular artery. Based on their expression of CGRP or tdTomato, prevalence near glomeruli, proximity to glomerular structures, and close apposition to multiple glomeruli within a module, we hypothesize that periglomerular afferent axons may function as mechanoreceptors monitoring glomerular pressure. These anatomical findings highlight the importance of further studies investigating the physiological role of periglomerular afferent axons in neural control of renal function in health and disease., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Tyshynsky, Sensarma, Riedl, Bukowy, Schramm, Vulchanova and Osborn.)

Anxiety and depression commonly co-occur, yet the underlying brain and behavioral processes are poorly understood. Here we examined the hypothesis that individuals with comorbid anxiety and depression would show increased fearful reactivity to an aversive interoceptive perturbation relative to depressed-only individuals. One-hundred and eighty anxious and/or depressed participants from the Tulsa 1000 study completed multi-level behavioral or functional magnetic resonance imaging assessments of interoception and nociception including breath-hold and cold-pressor challenges, and heartbeat perception and interoceptive attention tasks. One-hundred and four individuals with comorbid depression and anxiety disorders (Dep+Anx) were propensity matched with 52 individuals with depression-only (Dep). Data were analyzed using mixed-effects linear regression. The Dep+Anx group showed significantly greater self-reported fear of suffocation during breath holding (Wilcoxon r = 0.23) and reduced cold pain tolerance ( R 2 = 0.027) signified by hand removal during immersion. However, these groups did not differ with respect to neutrally-valenced behavioral indices of heartbeat perception or neural indices of interoceptive attention. Individuals with comorbid depression and anxiety, vs. those with only depression, show increased respiratory fearfulness and nociceptive reactivity during perturbations of these signals, whilst showing similar interoceptive awareness in the absence of perturbation. Our findings suggest that individuals with comorbid anxiety and depression process aversive interoceptive and nociceptive signals differently than those with depression alone, providing support for a process model of increased threat sensitivity and hyperarousal in anxious depression., Competing Interests: MP is an advisor to Spring Care, Inc., a behavioral health startup, he has received royalties for an article about methamphetamine in UpToDate. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Ironside, DeVille, Kuplicki, Burrows, Smith, Teed, Paulus and Khalsa.)

Introduction: Decision making results not only from logical analyses, but seems to be further guided by the ability to perceive somatic information (interoceptive accuracy). Relations between interoceptive accuracy and decision making have been exclusively studied in adults and with regard to complex, uncertain situations (as measured by the Iowa Gambling Task, IGT)., Methods: In the present study, 1454 children (6-11 years) were examined at two time points (approximately 1 year apart) using an IGT as well as a delay-of-gratification task for sweets-items and toy-items. Interoceptive accuracy was measured using a child-adapted version of the Heartbeat Perception Task., Results: The present results revealed that children with higher, as compared to lower, interoceptive accuracy showed more advantageous choices in the IGT and delayed more sweets-items, but not toy-items, in a delay-of-gratification task at time point 2 but not at time point 1. However, no longitudinal relation between interoceptive accuracy and decision making 1 year later could be shown., Discussion: Results indicate that interoceptive accuracy relates to decision-making abilities in situations of varying complexity already in middle childhood, and that this link might consolidate across the examined 1-year period. Furthermore, the association of interoceptive accuracy and the delay of sweets-items might have implications for the regulation of body weight at a later age., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Pollatos, Mönkemöller, Groppe and Elsner.)

Introduction: Previous research has identified numerous physical, psychological, and spiritual benefits associated with the practice of yoga. Indeed, yoga has been linked with improved quality of life, reduced stress, and numerous markers of psychological well-being. In the current research, a cross-sectional design was used to examine whether the psychological benefits associated with yoga only apply to long-term practitioners or whether more "casual," intermittent yoga experience could produce positive outcomes., Methods: An American population of long-term practitioners ( n  = 129), intermittent practitioners ( n  = 161), and non-practitioners ( n  = 164) completed online self-report measures of emotional regulation, trait mindfulness, self-compassion, interoceptive awareness, and spiritual intelligence variables., Results: The results indicated that long-term (LT) practitioners scored higher than intermittent experience (IE) practitioners on measures of mindfulness ( M LT  = 137.3; M IE  = 127.6), interoceptive awareness ( M LT  = 3.4; M IE  = 3.1), self-compassion ( M LT  = 3.4; M IE  = 3.1), and spiritual intelligence ( M LT  = 63.5; M IE  = 55.5; all p -value < 0.05). Intermittent practitioners scored higher than no-experience (NE) group on interoceptive awareness ( M IE  = 3.1; M NE  = 2.7) and spiritual intelligence ( M IE  = 55.5; M NE  = 46.6; both p -value < 0.05). Contrary to our hypotheses, yoga experience had no effect on depression, anxiety, or stress levels. Separate mediation analyses demonstrated that interoceptive awareness, spiritual intelligence, mindfulness, and self-compassion each mediated the relationship between yoga experience and emotion dysregulation. Furthermore, emotion dysregulation mediated the relationship between yoga experience and depression, anxiety, and stress., Discussion: Taken together, the results of this study suggest that long-term practitioners experience more benefits compared to intermittent and non-practitioners, and that the mechanisms underlying these benefits are multi-faceted., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Parkinson and Smith.)

Humans often perform rhythmic synchronized movements. Professional musicians and dancers particularly perform such movement tasks well and have a higher interoceptive accuracy (IAcc) than non-musicians and non-dancers. We thus hypothesized that rhythmic synchronized movements might be enhanced by a higher IAcc. To investigate this hypothesis, this study conducted a heartbeat counting task and a rhythmic synchronization tapping task with normal (easier) and slow (harder) tempi metronomes. Inconsistent with our hypothesis, however, a higher IAcc was negatively correlated with timing control, but only in the slow tempo condition [ r (30) = 0.46, p < 0.05]. This suggests that a higher IAcc did not enhance timing control in rhythmic synchronized movements but rather weakened it, resting heart rate variability was not correlated with timing control., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Tomyta, Katahira and Ohira.)

The central nervous system (CNS) exerts a strong regulatory influence over the cardiovascular system in response to environmental demands. Floatation-REST (Reduced Environmental Stimulation Therapy) is an intervention that minimizes stimulation from the environment, yet little is known about the autonomic consequences of reducing external sensory input to the CNS. We recently found that Floatation-REST induces a strong anxiolytic effect in anxious patients while paradoxically enhancing their interoceptive awareness for cardiorespiratory sensations. To further investigate the physiologic nature of this anxiolytic effect, the present study measured acute cardiovascular changes during Floatation-REST using wireless and waterproof equipment that allowed for concurrent measurement of heart rate, heart rate variability (HRV), breathing rate, and blood pressure. Using a within-subjects crossover design, 37 clinically anxious participants with high levels of anxiety sensitivity and 20 non-anxious comparison participants were randomly assigned to undergo a 90-min session of either Floatation-REST or an exteroceptive comparison condition that entailed watching a relaxing nature film. Measures of state anxiety and serenity were collected before and after each session, while indices of autonomic activity were measured throughout each session. HRV was calculated using both time-series and frequency domain analyses. Linear mixed-effects modeling revealed a significant main effect of condition such that relative to the film condition, Floatation-REST elicited significant decreases ( p < 0.001) in diastolic blood pressure, systolic blood pressure, breathing rate, and certain metrics of HRV including the standard deviation of the interbeat interval (SDNN), low-frequency HRV, and very low-frequency HRV. Heart rate showed a non-significant trend ( p = 0.073) toward being lower in the float condition, especially toward the beginning of the session. The only metric that showed a significant increase during Floatation-REST was normalized high-frequency HRV ( p < 0.001). The observed physiological changes were consistent across both anxious and non-anxious participants, and there were no significant group by condition interactions. Blood pressure was the only cardiac metric significantly associated with float-related reductions in state anxiety and increases in serenity. These findings suggest that Floatation-REST lowers sympathetic arousal and alters the balance of the autonomic nervous system toward a more parasympathetic state., Clinical Trial Registration: [https://clinicaltrials.gov/show/NCT03051074], identifier [NCT03051074]., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Flux, Fine, Poplin, Al Zoubi, Schoenhals, Schettler, Refai, Naegele, Wohlrab, Yeh, Lowry, Levine, Smith, Khalsa and Feinstein.)

Introduction: Emotional prosody is defined as suprasegmental and segmental changes in the human voice and related acoustic parameters that can inform the listener about the emotional state of the speaker. While the processing of emotional prosody is well represented in the literature, the mechanism of embodied cognition in emotional voice perception is very little studied. This study aimed to investigate the influence of induced bodily vibrations-through a vibrator placed close to the vocal cords-in the perception of emotional vocalizations. The main hypothesis was that induced body vibrations would constitute a potential interoceptive feedback that can influence the auditory perception of emotions. It was also expected that these effects would be greater for stimuli that are more ambiguous., Methods: Participants were presented with emotional vocalizations expressing joy or anger which varied from low-intensity vocalizations, considered as ambiguous, to high-intensity ones, considered as non-ambiguous. Vibrations were induced simultaneously in half of the trials and expressed joy or anger congruently with the voice stimuli. Participants had to evaluate each voice stimulus using four visual analog scales (joy, anger, and surprise, sadness as control scales)., Results: A significant effect of the vibrations was observed on the three behavioral indexes-discrimination, confusion and accuracy-with vibrations confusing rather than facilitating vocal emotion processing., Conclusion: Over all, this study brings new light on a poorly documented topic, namely the potential use of vocal cords vibrations as an interoceptive feedback allowing humans to modulate voice production and perception during social interactions., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Selosse, Grandjean and Ceravolo.)

Panic disorder (PD) is unique among anxiety disorders in that the emotional symptoms (e.g., fear and anxiety) associated with panic are strongly linked to body sensations indicative of threats to physiological homeostasis. For example, panic attacks often present with feelings of suffocation that evoke hyperventilation, breathlessness, or air hunger. Due to the somatic underpinnings of PD, a major focus has been placed on interoceptive signaling and it is recognized that dysfunctional body-to-brain communication pathways promote the initiation and maintenance of PD symptomatology. While body-to-brain signaling can occur via several pathways, immune and humoral pathways play an important role in communicating bodily physiological state to the brain. Accumulating evidence suggests that neuroimmune mediators play a role in fear and panic-associated disorders, although this has not been systematically investigated. Currently, our understanding of the role of immune mechanisms in the etiology and maintenance of PD remains limited. In the current review, we attempt to summarize findings that support a role of immune dysregulation in PD symptomology. We compile evidence from human studies and panic-relevant rodent paradigms that indicate a role of systemic and brain immune signaling in the regulation of fear and panic-relevant behavior and physiology. Specifically, we discuss how immune signaling can contribute to maladaptive body-to-brain communication and conditioned fear that are relevant to spontaneous and conditioned symptoms of PD and identify putative avenues warranting future investigation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 McMurray and Sah.)