Abstract
Meyerholz, Irzinger, Withöft, Gerlach, and Pohl (2019) reported on a comparably large effect (d = 1.21) of a contingent biofeedback procedure on cardiac accuracy as assessed by the heartbeat tracking task. However, this task has recently been criticized as a measure of interoceptive accuracy. We aimed to replicate this finding by using the well-validated heartbeat discrimination task and to compare the biofeedback with a deep breathing and a control condition (viewing a film clip). The trial was preregistered at open science framework (https://osf.io/9fxn6). Overall, 93 participants were randomized to one of the three conditions and the heartbeat discrimination task was presented prior and after the 20-minutes training sessions. The study had a power of .86 to detect a medium-sized effect in the biofeedback group and a power of .96 to detect a medium-sized interaction of intervention group and time. A general tendency for improvement in heartbeat detection accuracy was found across intervention groups (d = 0.19, p = .08); however, groups did not differ significantly. In particular, there was no significant interaction of intervention group and time (f = .00, p = .98) and no reliable effect for the biofeedback group (d = 0.15, p = .42). One limitation is that a different, but well-validated task was used to quantify interoceptive accuracy. This study suggests that biofeedback might not improve interoceptive accuracy in the cardiac domain, but effects seem to depend on the specific task applied.
Highlights
In a previously published report, Meyerholz, Irzinger, Withoft, Gerlach, and Pohl [1] found that a brief 20-minutes contingent biofeedback procedure resulted in a large-scaled improvement of interoceptive accuracy as assessed with the heartbeat tracking task, which measures interoceptive accuracy by means of comparing the perceived heartbeats with actual heartbeats of a predefined time period (e.g., 25 sec, 45sec, etc. [2, 3])
Based on recent findings of an optimization of blood flow in brain areas associated with interoception due to deep nasal breathing [17], we aimed to examine the efficacy of a coherent breathing intervention on cardiac interoceptive accuracy
Similar to Meyerholz et al [1], Bonferroni corrected pairwise comparisons indicated that the percentage of correct reactions improved significantly from block 1 (M = 55.37%, SD = 19.62) to block 3 (M = 65.90%, SD = 17.36; p = .027), which indicates the expected training effects
Summary
In a previously published report, Meyerholz, Irzinger, Withoft, Gerlach, and Pohl [1] found that a brief 20-minutes contingent biofeedback procedure resulted in a large-scaled improvement of interoceptive accuracy as assessed with the heartbeat tracking task, which measures interoceptive accuracy by means of comparing the perceived heartbeats with actual heartbeats of a predefined time period (e.g., 25 sec, 45sec, etc. [2, 3]). The authors conclude that cardiac biofeedback could improve interoceptive accuracy in the cardiac domain. As the authors discuss themselves, the heartbeat tracking task has been criticized, because (implicit) knowledge about the own heartbeat could lead to better task performance [4, 5] and participants might achieve high accuracy without heartbeat perception, but accurate knowledge of heart rate [6]. Discrimination tasks have been criticized, because they may not solely warrant allocation of attention on internal and organismic cues [11], the integration of external and internal signals is a part of interoception [6] and fundamental for selfconsciousness [12]. Some authors recommended the application of signal detection theory to study interoceptive accuracy [1, 7], which is implemented in discrimination tasks and allows to assess perceptual sensitivity separately from other non-perceptual factors [10]. Interoceptive accuracy has been differentiated from self-evaluated assessments of subjective interoception and metacognition–that is the ability to discriminate correct from incorrect perceptual decisions [15, 16]
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