Abstract
This study employed a series of heartbeat perception tasks to assess the hypothesis that cardiac interoceptive processing in individuals with depression/anxiety (N = 221), and substance use disorders (N = 136) is less flexible than that of healthy individuals (N = 53) in the context of physiological perturbation. Cardiac interoception was assessed via heartbeat tapping when: (1) guessing was allowed; (2) guessing was not allowed; and (3) experiencing an interoceptive perturbation (inspiratory breath hold) expected to amplify cardiac sensation. Healthy participants showed performance improvements across the three conditions, whereas those with depression/anxiety and/or substance use disorder showed minimal improvement. Machine learning analyses suggested that individual differences in these improvements were negatively related to anxiety sensitivity, but explained relatively little variance in performance. These results reveal a perceptual insensitivity to the modulation of interoceptive signals that was evident across several common psychiatric disorders, suggesting that interoceptive deficits in the realm of psychopathology manifest most prominently during states of homeostatic perturbation.
Highlights
This study employed a series of heartbeat perception tasks to assess the hypothesis that cardiac interoceptive processing in individuals with depression/anxiety (N = 221), and substance use disorders (N = 136) is less flexible than that of healthy individuals (N = 53) in the context of physiological perturbation
A number of tasks have been developed to study this function. They involve the performance of different actions, including heartbeat counting, heartbeat tapping, and heartbeat d etection[12,13,14,15,16,17], the active components of these tasks all involve the shifting of goal-directed attention towards the heartbeat signal, and providing an explicit report of the perceptual experience of heartbeat sensations
Regardless of one’s position on the optimal measure of cardioception, a consistent finding is that cardiac interoceptive accuracy is quite limited in the majority of individuals during resting conditions—where only roughly 35% of individuals appear to accurately perceive their own h eartbeats[25]
Summary
Studies of panic disorder patients under resting conditions have not demonstrated clear evidence for greater interoceptive accuracy for heartbeat sensations[35,36,37], despite the fact that multiple studies have shown that panic disorder patients perceive interoceptive (cardiorespiratory) sensations more intensely during a range of different physiological perturbations that transiently amplify afferent signal strength[38,39,40,41,42,43,44] These results suggest that differences in interoceptive experience during non-resting physiological contexts may be especially relevant for understanding psychopathology, especially for disorders with a heightened expression of anxiety
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