Comparison of methods for cardiac interoception self-assessment
https://doi.org/10.15829/1728-8800-2023-3797
EDN: GYZHEK
Abstract
Aim. Interoception reflects the perception, integration and modulation of visceral signals. Currently, there is no established universal approach to cardiac interoception assessment allowing its inclusion in the diagnostic protocol for various diseases. The aim was to compare three tests of interoception self-assessment based on heart palpitations within one day in healthy subjects.
Material and methods. Eighty healthy volunteers took part in the study. To assess cardiac interoception, a test with button pushes at the moment of palpitations, a feedback test in the form of synchronous and asynchronous sound signals, a heartbeat counting task at specified time intervals were conducted with simultaneous electrocardiographic recording. The obtained data were compared with each other (Wilcoxon test). Its pairwise dependence (Spearman coefficient) and dependence on body parameters (sex, age, body mass index, fat mass, anxiety) were assessed (univariate linear regression).
Results. The accuracy of the heartbeat counting task turned out to be significantly higher than in the button- pressing test (p=0,005). However, both estimates correlate with each other (r=0,66, p=0,003). A positive dependence of test accuracy on sex was found for the heartbeat counting task (p=0,021) and a negative dependence on fat mass for button- pressing task (p=0,032).
Conclusion. The study found that volunteers' estimates of heartbeat accuracy varied across tests and were also associated with sex and body composition. The heart rate counting task and the button- pressing task are the most suitable for interoception assessment.
Keywords
About the Authors
I. A. MinenkoRussian Federation
Moscow
K. N. Germanova
Russian Federation
Moscow
A. S. Limonova
Russian Federation
Moscow
A. A. Sukmanova
Russian Federation
Moscow
N. Iashvili
Finland
Department of Psychology
Jyväskylä
V. V. Nikulin
Germany
Department of Neurology
Leipzig
V. A. Kutsenko
Russian Federation
Moscow
Е. E. Egorenkova
Russian Federation
Moscow
M. A. Nazarova
United States
Boston
A. I. Ershova
Russian Federation
Moscow
O. M. Drapkina
Russian Federation
Moscow
References
1. Ferentzi E, Wilhelm O, Köteles F. What counts when heartbeats are counted. Trends in Cognitive Sciences. 2022;26(10):832-5. doi:10.1016/j.tics.2022.07.009.
2. Vig L, Ferentzi E, Köteles F. Sustained attention is related to heartbeat counting task performance but not to self-reported aspects of interoception and mindfulness. Conscious Cogn. 2021;95(6):103209. doi:10.1016/j.concog.2021.103209.
3. Park HD, Blanke O. Heartbeat- evoked cortical responses: Underlying mechanisms, functional roles, and methodological considerations. Neuroimage. 2019;197:502-11. doi:10.1016/j.neuroimage.2019.04.081.
4. Couto B, Adolfi F, Velasquez M, et al. Heart evoked potential triggers brain responses to natural affective scenes: a preliminary study. Auton Neurosci. 2015;193:132-7. doi:10.1016/j.autneu.2015.06.006.
5. Limonova AS, Germanova KN, Gantman MV, et al. Neurovisceral interactions within the brain- heart axis as the basis of neurocardiology. Cardiovascular Therapy and Prevention. 2022; 21(10):3435. (In Russ.) doi:10.15829/1728-8800-2022-3435.
6. Wolters C, Gerlach AL, Pohl A. Interoceptive accuracy and bias in somatic symptom disorder, illness anxiety disorder, and functional syndromes: A systematic review and metaanalysis. Plos one. 2022;17(8):e0271717. doi:10.1371/journal.pone.0271717.
7. Bonaz B, Lane RD, Oshinsky ML. Diseases, disorders, and comorbidities of interoception. Trends Neurosci. 2021;44(1):39-51. doi:10.1016/j.tins.2020.09.009.
8. Smulevich AB. Depression as a general medical problem: clinical and therapy issues. Psychiatry and psychopharmacotherapy. 2006;8(3):4-10. (In Russ.)
9. Kandiah JW, Blumberger DM, Rabkin SW. The fundamental basis of palpitations: a neurocardiology approach. Curr Cardiol Rev. 2022;18(3):e090921196306. doi:10.2174/1573403X17666210909123930.
10. Ehlers A, Mayou RA, Sprigings DC, et al. Psychological and perceptual factors associated with arrhythmias and benign palpitations. Psychosom Med. 2000;62(5):693-702. doi:10.1097/00006842-200009000-00014.
11. Barsky A, Cleary P, Brener J, et al. The perception of cardiac activity in medical outpatients. Cardiology. 1993;83(5-6):304-15. doi:10.1159/000175986.
12. Cameron OG, Minoshima S. Regional brain activation due to pharmacologically induced adrenergic interoceptive stimulation in humans. Psychosom Med. 2002;64(6):851-61. doi:10.1097/01.psy.0000038939.33335.32.
13. Stern ER, Grimaldi SJ, Muratore A, et al. Neural correlates of interoception: Effects of interoceptive focus and relationship to dimensional measures of body awareness. Hum Brain Mapp. 2017;38(12):6068-82. doi:10.1002/hbm.23811.
14. Garfinkel SN, Seth AK, Barrett AB, et al. Knowing your own heart: distinguishing interoceptive accuracy from interoceptive awareness. Biol Psychol. 2015;104:65-74. doi:10.1016/j.biopsycho.2014.11.004.
15. Schandry R. Heart beat perception and emotional experience. Psychophysiology. 1981;18(4):483-8. doi:10.1111/j.1469-8986.1981.tb02486.x.
16. Körmendi J, Ferentzi E, Köteles F. Expectation predicts performance in the mental heartbeat tracking task. Biol Psychol. 2021;164:108170. doi:10.1016/j.biopsycho.2021.108170.
17. Körmendi J, Ferentzi E, Köteles, F. A heartbeat away from a valid tracking task. An empirical comparison of the mental and the motor tracking task. Biol Psychol. 2022;171:108328. doi:10.1016/j.biopsycho.2022.108328.
18. Desmedt O, Luminet O, Corneille O. The heartbeat counting task largely involves non-interoceptive processes: Evidence from both the original and an adapted counting task. Biol Psychol. 2018;138:185-8. doi:10.1016/j.biopsycho.2018.09.004.
19. Brener J, Ring C. Towards a psychophysics of interoceptive processes: the measurement of heartbeat detection. Philos Trans R Soc B: Biol Sci. 2016:371(1708):20160015. doi:10.1098/rstb.2016.0015.
20. Pennebaker JW, Hoover CW. Visceral perception versus visceral detection: Disentangling methods and assumptions. Biofeedback Self-regulation. 1984;9:339-52. doi:10.1007/BF00998977.
21. Spielberger CD. Anxiety, drive theory, and computer- assisted learning. Progr Exp Pers Res. 1970;6:109-48.
22. Fittipaldi S, Abrevaya S, de la Fuente A, et al. A multidimensional and multi- feature framework for cardiac interoception. Neuroimage. 2020;212:116677. doi:10.1016/j.neuroimage.2020.116677.
23. Wiens S, Palmer SN. Quadratic trend analysis and heartbeat detection. Biol Psychol. 2001;58(2):159-75. doi:10.1016/s03010511(01)00110-7.
24. Macmillan NA. Signal detection theory. Signal Detection Theory. In: Wixted J, ed. Stevens’ Handbook of Experimental Psychology. New York/John Wiley and Sons, 2002:43-90. ISBN: 9780471378884. doi:10.1002/0471214426.pas0402.
25. Körmendi J, Ferentzi E. Heart activity perception: narrative review on the measures of the cardiac perceptual ability. Biologia Futura. 2023;1-13. doi:10.1007/s42977-023-00181-4.
26. Hickman L, Seyedsalehi A, Cook JL, et al. The relationship between heartbeat counting and heartbeat discrimination: A meta-analysis. Biol Psychol. 2020;156:107949. doi:10.1016/j.biopsycho.2020.107949.
27. Ring C, Brener J. Heartbeat counting is unrelated to heartbeat detection: A comparison of methods to quantify interoception. Psychophysiology. 2018;55(9):e13084. doi:10.1111/psyp.13084.
28. Rouse CH, Jones GE, Jones KR. The effect of body composition and gender on cardiac awareness. Psychophysiology. 1988;25(4):400-7. doi:10.1111/j.1469-8986.1988.tb01876.x.
29. Whitehead WE, Drescher VM, Heiman P, et al. Relation of heart rate control to heartbeat perception. Biofeedback Selfregulation. 1977;2(4):371-92. doi:10.1007/BF00998623.
30. Grabauskaitė A, Baranauskas M, Griškova- Bulanova I. Interoception and gender: What aspects should we pay attention to? Conscious Cogn. 2017;48:129-37. doi:10.1016/j.concog.2016.11.002.
Supplementary files
What is already known about the subject?
- Interoception is the perception and integration by the central nervous system of afferent information about the body state. The study of interoception is of great practical importance, since it is known to change in a number of diseases.
What might this study add?
- Despite the available data on the significance of interoception impairment in a number of diseases, there is currently no reliable standardized approach to its assessment. In this study, the results of three test for assessing cardiac interoception were compared in one sample of healthy volunteers.
- Methodological issues of implementation and application of tests in clinical practice were discussed.
Review
For citations:
Minenko I.A., Germanova K.N., Limonova A.S., Sukmanova A.A., Iashvili N., Nikulin V.V., Kutsenko V.A., Egorenkova Е.E., Nazarova M.A., Ershova A.I., Drapkina O.M. Comparison of methods for cardiac interoception self-assessment. Cardiovascular Therapy and Prevention. 2023;22(10):3797. (In Russ.) https://doi.org/10.15829/1728-8800-2023-3797. EDN: GYZHEK