Self-reported interoceptive deficits in eating disorders: A meta-analysis of studies using the eating disorder inventory

This document is the Accepted Manuscript version of the following article: Paul M. Jenkinson, Lauren Taylor, Keith R. Laws, ‘Self-reported interoceptive deficits in eating disorders: A meta-analysis of studies using the eating disorder inventory’, Journal of Psychosomatic Research, Vol. 110: 38-45, July 2018, under embargo until 19 April 2019. The Version of Record is available online at DOI: https://doi.org/10.1016/j.jpsychores.2018.04.005Objective: An impairment of the ability to sense the physiological condition of the body – interoception – has long been proposed as central to the onset and maintenance of eating disorders. More recent attention to this topic has generally indicated the presence of interoceptive deficits in individuals with an eating disorder diagnosis; however, possible links with specific diagnosis, BMI, age, illness duration, depression, and alexithymia remain unclear from individual studies. This meta-analysis aimed to provide a necessary quantitative overview of self-reported interoceptive deficits in eating disorder populations, and the relationship between these deficits and the previously mentioned factors. Methods: Using a random effects model, our meta-analysis assessed the magnitude of differences in interoceptive abilities as measured using the Eating Disorder Inventory in 41 samples comparing people with eating disorders (n=4308) and healthy controls (n=3459). Follow-up and moderator analysis was conducted, using group comparisons and meta-regressions. Results: We report a large pooled effect size of 1.62 for eating disorders with some variation between diagnostic groups. Further moderator analysis showed that BMI, age and alexithymia were significant predictors of overall effect size. Conclusion: This meta-analysis is the first to confirm that large interoceptive deficits occur in a variety of eating disorders and crucially, in those who have recovered. These deficits may be useful in identifying and distinguishing eating disorders. Future research needs to consider both objective and subjective measures of interoception across different types of eating disorders and may fruitfully examine interoception as a possible endophenotype and target for treatment.Peer reviewe

An interoceptive predictive coding model of conscious presence

We describe a theoretical model of the neurocognitive mechanisms underlying conscious presence and its disturbances. The model is based on interoceptive prediction error and is informed by predictive models of agency, general models of hierarchical predictive coding and dopaminergic signaling in cortex, the role of the anterior insular cortex (AIC) in interoception and emotion, and cognitive neuroscience evidence from studies of virtual reality and of psychiatric disorders of presence, specifically depersonalization/derealization disorder. The model associates presence with successful suppression by top-down predictions of informative interoceptive signals evoked by autonomic control signals and, indirectly, by visceral responses to afferent sensory signals. The model connects presence to agency by allowing that predicted interoceptive signals will depend on whether afferent sensory signals are determined, by a parallel predictive-coding mechanism, to be self-generated or externally caused. Anatomically, we identify the AIC as the likely locus of key neural comparator mechanisms. Our model integrates a broad range of previously disparate evidence, makes predictions for conjoint manipulations of agency and presence, offers a new view of emotion as interoceptive inference, and represents a step toward a mechanistic account of a fundamental phenomenological property of consciousness

Neuroimaging and psychophysiological investigation of the link between anxiety, enhanced affective reactivity and interoception in people with joint hypermobility

Objective: Anxiety is associated with increased physiological reactivity and also increased “interoceptive” sensitivity to such changes in internal bodily arousal. Joint hypermobility, an expression of a common variation in the connective tissue protein collagen, is increasingly recognized as a risk factor to anxiety and related disorders. This study explored the link between anxiety, interoceptive sensitivity and hypermobility in a sub-clinical population using neuroimaging and psychophysiological evaluation. Methods: Thirty-six healthy volunteers undertook interoceptive sensitivity tests, a clinical examination for hypermobility and completed validated questionnaire measures of state anxiety and body awareness tendency. Nineteen participants also performed an emotional processing paradigm during functional neuroimaging. Results: We confirmed a significant relationship between state anxiety score and joint hypermobility. Interoceptive sensitivity mediated the relationship between state anxiety and hypermobility. Hypermobile, compared to non-hypermobile, participants displayed heightened neural reactivity to sad and angry scenes within brain regions implicated in anxious feeling states, notably insular cortex. Conclusions: Our findings highlight the dependence of anxiety state on bodily context, and increase our understanding of the mechanisms through which vulnerability to anxiety disorders arises in people bearing a common variant of collagen

A game based approach to improve traders' decision-making

Purpose: The development of a game based approach to improving the decision-making capabilities of financial traders through attention to improving the regulation of emotions during trading. Design/methodology/approach: The project used a design-based research approach to integrate the contributions of a highly inter-disciplinary team. The approach was underpinned by considerable stakeholder engagement to understand the ‘ecology of practices’ in which this learning approach should be embedded. Findings: Taken together, our 35 laboratory, field and evaluation studies provide much support for the validity of our game based learning approach, the learning elements which make it up, and the value of designing game-based learning to fit within an ecology of existing practices. Originality/value: The novelty of the work described in the paper comes from the focus in this research project of combining knowledge and skills from multiple disciplines informed by a deep understanding of the context of application to achieve the successful development of a Learning Pathway, which addresses the transfer of learning to the practice environment Key words: Design-based research, emotion-regulation, disposition–effect, financial traders, serious games, sensor-based game

Evolution as Connecting First-Person and Third-Person Perspectives of Consciousness

First-person and third-person perspectives are different items of human consciousness.\ud Feeling the taste of a fruit or being consciously part of a group eating fruits call for different perspectives of\ud consciousness. The latter is about objective reality (third-person data). The former is about subjective\ud experience (first-person data) and cannot be described entirely by objective reality.\ud We propose to look at how these two perspectives could be rooted in an evolutionary origin of human\ud consciousness, and somehow be connected.\ud Our starting point is a scenario describing how evolution could have transformed a non self-conscious\ud auto-representation into a conscious self-representation (Menant 2006). The scenario is based on the\ud performance of inter-subjectivity existing among non human primates (Gardenfors 2006). A key item of the\ud scenario is the identification of the auto-representation of a subject with the representations that the subject\ud has of her conspecifics, the latter feeding the former with the meaning: “existing in the environment”.\ud So during evolution, pre-human primates were brought to perceive their auto-representation as existing in\ud the environment. Such process could have generated the initial elements of a conscious self-representation.\ud We take this scenario as providing a possible rooting of human consciousness in evolution.\ud We develop here a part of this scenario by expliciting the inward and outward components of the non\ud self-conscious auto-representation.\ud Inward components are about proprioception and interoception (thirst, pain, …). Outward components cover\ud the sensory information relative to the perception of the body (seen feet, … ) and of its effects on the\ud environment.\ud We consider that the initial elements of a conscious self-representation have been applied to both inward and\ud outward components of the auto-representation. We propose that the application to inward components made\ud possible some first-person information, and that the application to outward components brought up third-person\ud information. Relations between the two perspectives are highlighted.\ud Such approach can root first-person and third-person perspectives in the same slot of human evolution.\ud We conclude by a summary of the above and introduce a possible application of this approach to the concepts\ud of bodily self and of pre-reflexive self-consciousness (Legrand, 2006)

深層学習を用いた感情モデルの構築：感情メカニズムの理解へ向けた構成的アプローチ

電気通信大学201

Primary interoceptive cortex activity during simulated experiences of the body

Studies of the classic exteroceptive sensory systems (e.g., vision, touch) consistently demonstrate that vividly imagining a sensory experience of the world – simulating it – is associated with increased activity in the corresponding primary sensory cortex. We hypothesized, analogously, that simulating internal bodily sensations would be associated with increased neural activity in primary interoceptive cortex. An immersive, language-based mental imagery paradigm was used to test this hypothesis (e.g., imagine your heart pounding during a roller coaster ride, your face drenched in sweat during a workout). During two neuroimaging experiments, participants listened to vividly described situations and imagined “being there” in each scenario. In Study 1, we observed significantly heightened activity in primary interoceptive cortex (of dorsal posterior insula) during imagined experiences involving vivid internal sensations. This effect was specific to interoceptive simulation: it was not observed during a separate affect focus condition in Study 1, nor during an independent Study 2 that did not involve detailed simulation of internal sensations (instead involving simulation of other sensory experiences). These findings underscore the large-scale predictive architecture of the brain and reveal that words can be powerful drivers of bodily experiences

Modulation of emotional appraisal by false physiological feedback during fMRI

BACKGROUND James and Lange proposed that emotions are the perception of physiological reactions. Two-level theories of emotion extend this model to suggest that cognitive interpretations of physiological changes shape self-reported emotions. Correspondingly false physiological feedback of evoked or tonic bodily responses can alter emotional attributions. Moreover, anxiety states are proposed to arise from detection of mismatch between actual and anticipated states of physiological arousal. However, the neural underpinnings of these phenomena previously have not been examined. METHODOLOGY/PRINCIPAL FINDINGS We undertook a functional brain imaging (fMRI) experiment to investigate how both primary and second-order levels of physiological (viscerosensory) representation impact on the processing of external emotional cues. 12 participants were scanned while judging face stimuli during both exercise and non-exercise conditions in the context of true and false auditory feedback of tonic heart rate. We observed that the perceived emotional intensity/salience of neutral faces was enhanced by false feedback of increased heart rate. Regional changes in neural activity corresponding to this behavioural interaction were observed within included right anterior insula, bilateral mid insula, and amygdala. In addition, right anterior insula activity was enhanced during by asynchronous relative to synchronous cardiac feedback even with no change in perceived or actual heart rate suggesting this region serves as a comparator to detect physiological mismatches. Finally, BOLD activity within right anterior insula and amygdala predicted the corresponding changes in perceived intensity ratings at both a group and an individual level. CONCLUSIONS/SIGNIFICANCE Our findings identify the neural substrates supporting behavioural effects of false physiological feedback, and highlight mechanisms that underlie subjective anxiety states, including the importance of the right anterior insula in guiding second-order "cognitive" representations of bodily arousal state

Towards multiple interactions of inner and outer sensations in corporeal awareness

Under normal circumstances, different inner- and outer-body sources are integrated to form coherent and accurate mental experiences of the state of the body, leading to the phenomenon of corporeal awareness. How these processes are affected by changes in inner and outer inputs to the body, remains unclear. Here, we aim to present empirical evidence in which people experiencing a massive sensory disconnect may continue to experience feelings of their body state, suggesting that misperceptions of body awareness are determined by incomplete inner and outer signals. In these clinical populations, despite a long period of massive deafferentation, the activity of the neural structures subserving inner and outer body processing can be manipulated and tuned by means of body illusions that are usually based on multisensory stimulation. We suggest that a multisensory therapeutic approach could be adopted in the context of therapies for patients suffering from deafferentation. In this way, these individuals could regain a more complete feeling of their body state and the sensations they experience, which vary widely depending on their neurological condition

Neuroanatomical substrates for the volitional regulation of heart rate

The control of physiological arousal can assist in the regulation of emotional state. A subset cortical and subcortical brain regions are implicated in autonomic control of bodily arousal during emotional behaviors. Here, we combined human functional neuroimaging with autonomic monitoring to identify neural mechanisms that support the volitional regulation of heart rate, a process that may be assisted by visual feedback. During functional magnetic resonance imaging (fMRI), 15 healthy adults performed an experimental task in which they were prompted voluntarily to increase or decrease cardiovascular arousal (heart rate) during true, false, or absent visual feedback. Participants achieved appropriate changes in heart rate, without significant modulation of respiratory rate, and were overall not influenced by the presence of visual feedback. Increased activity in right amygdala, striatum and brainstem occurred when participants attempted to increase heart rate. In contrast, activation of ventrolateral prefrontal and parietal cortices occurred when attempting to decrease heart rate. Biofeedback enhanced activity within occipito-temporal cortices, but there was no significant interaction with task conditions. Activity in regions including pregenual anterior cingulate and ventral striatum reflected the magnitude of successful task performance, which was negatively related to subclinical anxiety symptoms. Measured changes in respiration correlated with posterior insula activation and heart rate, at a more lenient threshold, change correlated with insula, caudate, and midbrain activity. Our findings highlight a set of brain regions, notably ventrolateral prefrontal cortex, supporting volitional control of cardiovascular arousal. These data are relevant to understanding neural substrates supporting interaction between intentional and interoceptive states related to anxiety, with implications for biofeedback interventions, e.g., real-time fMRI, that target emotional regulation