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

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

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

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

Interoceptive Approaches to Embodiment Research

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

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

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

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

in Development and Psychopathology (2021)

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

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

Quality of life among adult patients living with diabetes in Rwanda: a cross-sectional study in outpatient clinics

in BMJ Open (2021), 11

Objectives To report on the disease-related quality of life of patients living with diabetes mellitus in Rwanda and identify its predictors. Design Cross-sectional study, part of the baseline assessment ... [more ▼]

Objectives To report on the disease-related quality of life of patients living with diabetes mellitus in Rwanda and identify its predictors. Design Cross-sectional study, part of the baseline assessment of a cluster-randomised controlled trial. Setting Outpatient clinics for non-communicable diseases of nine hospitals across Rwanda. Participants Between January and August 2019, 206 patients were recruited as part of the clinical trial. Eligible participants were those aged 21–80 years and with a diagnosis of diabetes mellitus for at least 6 months. Illiterate patients, those with severe hearing or visual impairments, those with severe mental health conditions, terminally ill, and those pregnant or in the postpartum period were excluded Primary and secondary outcome measures Disease-specific quality of life was measured with the Kinyarwanda version of the Diabetes-39 (D-39) questionnaire. A glycated haemoglobin (HbA1c) test was performed on all patients. Sociodemographic and clinical data were collected, including medical history, disease-related complications and comorbidities. Results The worst affected dimensions of the D-39 were ‘anxiety and worry’ (mean=51.63, SD=25.51), ‘sexual functioning’ (mean=44.58, SD=37.02), and ‘energy and mobility’ (mean=42.71, SD=20.69). Duration of the disease and HbA1c values were not correlated with any of the D-39 dimensions. A moderating effect was identified between use of insulin and achieving a target HbA1c of 7% in the ‘diabetes control’ scale. The most frequent comorbidity was hypertension (49.0% of participants), which had a greater negative effect on the ‘diabetes control’ and ‘social burden’ scales in women. Higher education was a predictor of less impact on the ‘social burden’ and ‘energy and mobility’ scales. Conclusions Several variables were identified as predictors for the five dimensions of quality of life that were studied, providing opportunities for tailored preventive programmes. Further prospective studies are needed to determine causal relationships. [less ▲]

Disorganized attachment in adolescence: Emotional and physiological dysregulation during the Friends and Family Interview and a conflict interaction

in Development and Psychopathology (2020), 34(1), 431-445

The current study examined the effects of attachment on autonomy, relatedness and emotion regulation during an attachment interview (Friends and Family Interview; FFI) and a parent-child conflict ... [more ▼]

The current study examined the effects of attachment on autonomy, relatedness and emotion regulation during an attachment interview (Friends and Family Interview; FFI) and a parent-child conflict interaction (Family Interaction Task; FIT) in 49 adolescents (11 to 17 years old). Disorganized adolescents showed a steeper decrease in heart rate variability (HRV) than organized ones, during both the FFI and the FITs. Dismissing adolescents showed a more pronounced decrease in HRV during the FFI than secure and preoccupied individuals; no differences were found between these groups in HRV during the FITs. The results suggest that disorganized adolescents had more difficulties in regulating their emotions during both the FFI and the FITs, whereas dismissing individuals seemed effectively challenged only during the interview. [less ▲]

Interoception, stress and physical symptoms in stress-associated diseases

in European Journal of Health Psychology (2020), 27(1), 132-153

The brain and peripheral bodily organs continuously exchange information. Exemplary, interoception refers to the processing and perception of ascending information from the body to the brain. Stress ... [more ▼]

The brain and peripheral bodily organs continuously exchange information. Exemplary, interoception refers to the processing and perception of ascending information from the body to the brain. Stress responses involve a neurobehavioral cascade, which includes the activation of peripheral organs via neural and endocrine pathways and can thus be seen as an example for descending information on the brain-body axis. Hence, the interaction of interoception and stress represents bi-directional communication on the brain-body axis. The main hypothesis underlying this review is that the dysregulation of brain-body communication represents an important mechanism for the generation of physical symptoms in stress-related disorders. The aims of this review are, therefore, (1.) to summarize current knowledge on acute stress effects on different stages of interoceptive signal processing, (2.) to discuss possible patterns of abnormal brainbody communication (i.e., alterations in interoception and physiological stress axes activation) in mental disorders and chronic physical conditions, and (3.) to consider possible approaches to modify interoception. Due to the regulatory feedback loops underlying brain-body communication, the modification of interoceptive processes (ascending signals) may, in turn, affect physiological stress axes activity (descending signals), and, ultimately, also physical symptoms. [less ▲]

The Measurement of Resilience

in Journal of Economic Theory (2020), 189

Resilience has become an important topic in many social sciences. Numerous individual choices and economic and demographic outcomes are likely to be influenced by people’s resilience. School performance ... [more ▼]

Resilience has become an important topic in many social sciences. Numerous individual choices and economic and demographic outcomes are likely to be influenced by people’s resilience. School performance, work absenteeism and burnout, longevity, the quality of sleep and health-risk behaviors such as substance abuse are some examples. Similarly, it is of high policy relevance to understand the determinants of both individual resilience (such as educational, marital and occupational status) and ecological resilience (such as climate change). Empirical work designed to uncover such relationships suffers from the absence of a resilience measure applicable in the context of large data sets. We fill this gap by proposing a specific measure that is characterized by a set of natural properties. After an introduction to the notion of resilience and its attributes, we argue why these conditions have intuitive appeal. Finally, we provide illustrating examples and derive our main characterization result. [less ▲]

Modulation of startle and heart rate responses by fear of physical activity in patients with heart failure and in healthy adults

in Physiology and Behavior (2020), 225(1), 113044

Fear of physical activity (FoPA) is prevalent in patients with heart failure and associated with lower physical activity despite medical exercise prescriptions. The present study examined physiological ... [more ▼]

Fear of physical activity (FoPA) is prevalent in patients with heart failure and associated with lower physical activity despite medical exercise prescriptions. The present study examined physiological indicators of FoPA by assessing startle modulation and heart rate responses after affective priming with lexical stimuli of positive, neutral, and negative valence, as well as words related to physical activity as potentially phobic cues. After screening for FoPA in patients with heart failure and healthy adults, twenty participants each were assigned to one of three subsamples: a healthy control group and two cardiac patient groups scoring either low or high on FoPA. The high-FoPA group showed more pronounced startle potentiation and heart rate acceleration (i.e., mobilization of defensive behavior) in the phobic prime condition compared to controls. Differences in FoPA accounted for 30% of the startle potentiation by phobic priming, whereas general anxiety, depression, and disease severity were no significant predictors in patients with heart failure. These findings suggest that heart failure-associated FoPA elicits avoidance behavior at a largely automatic level, and might thereby contribute to low adherence to exercise regimen. Thus, FoPA should be addressed in the design of psychological interventions for cardiac patients to foster physical activity. [less ▲]

Cardiac cycle phases affect auditory-evoked potentials, startle eye blink and pre-motor reaction times in response to acoustic startle stimuli

in International Journal of Psychophysiology (2020), 157(1), 70-81

Startle stimuli evoke lower responses when presented during the early as compared to the late cardiac cycle phase, an effect that has been called ‘cardiac modulation of startle’ (CMS). The CMS effect may ... [more ▼]

Startle stimuli evoke lower responses when presented during the early as compared to the late cardiac cycle phase, an effect that has been called ‘cardiac modulation of startle’ (CMS). The CMS effect may be associated with visceral-afferent neural traffic, as it is reduced in individuals with degeneration of afferent autonomic nerves. The aim of this study was to investigate whether the CMS effect is due a modulation of only early, automatic stages of stimulus processing by baro-afferent neural traffic, or if late stages are also affected. We, therefore, investigated early and late components of auditory-evoked potentials (AEPs) to acoustic startle stimuli (105, 100, 95 dB), which were presented during the early (R-wave +230 ms) or the late cardiac cycle phase (R +530 ms) in two studies. In Study 1, participants were requested to ignore (n=25) or to respond to the stimuli with button-presses (n=24). In Study 2 (n=23), participants were asked to rate the intensity of the stimuli. We found lower EMG startle response magnitudes (both studies) and slower pre-motor reaction times in the early as compared to the late cardiac cycle phase (Study 1). We also observed lower N1 negativity (both studies), but higher P2 (Study 1) and P3 positivity (both studies) in response to stimuli presented in the early cardiac cycle phase. This AEP modulation pattern appears to be specific to the CMS effect, suggesting that early stages of startle stimulus processing are attenuated, whereas late stages are enhanced by baro-afferent neural traffic [less ▲]

Glucocorticoid receptor signaling in leukocytes after early life adversity.

in Development and Psychopathology (2020), 32(3), 853-863

Early life adversity (ELA) has been associated with inflammation and immunosenescence, as well as hyporeactivity of the HPA-axis. As the immune system and HPA-axis are tightly intertwined around the ... [more ▼]

Early life adversity (ELA) has been associated with inflammation and immunosenescence, as well as hyporeactivity of the HPA-axis. As the immune system and HPA-axis are tightly intertwined around the glucocorticoid receptor (GR) we examined peripheral GR functionality in the EpiPath cohort, where participants had either been exposed to ELA (separation from parents and/or institutionalization followed by adoption) (n=40) or had been reared by their biological parents (n=72). Expression of the strict GR target genes FKBP5 and GILZ as well as total and 1F and 1H GR transcripts were similar between groups. Furthermore, there were no differences in GR sensitivity, examined by the effects of dexamethasone on IL6 production in LPS-stimulated whole blood. Although we did not find differences in methylation at the GR 1F exon or promoter region, we identified a region of the GR 1H promoter (CpG 1-9) that showed lower methylation levels in ELA. Peripheral GR signaling was unperturbed in our cohort and the observed immune phenotype does not appear to be secondary to an altered glucocorticoid receptor response to glucocorticoids. To identify signaling pathways that may underlie the ELA immune phenotype, future research should focus on unbiased approaches, such as investigating whole genome methylation profiles. [less ▲]