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A developing area of research suggests that there may be a relationship between interoception and suicidal behavior. For example, it was recently reported that individuals who made a suicide attempt within the previous 5 years exhibit behavioral and neural abnormalities across multiple domains of interoception relative to nonattempters. This included increased tolerance for aversive sensations of pain and dyspnea, reduced heartbeat-perception accuracy, and blunted insula activity during attention to cardiac sensations. However, the degree to which interoceptive deficits persist following a suicidal attempt is unknown. In the current study, we examined differences between individuals with a remote history of suicide attempts (greater than 5 years ago; N = 56) versus those with no history of attempts (N = 240). We found that remote suicide attempters demonstrated greater pain tolerance and lower ratings of stress during a cold-pressor challenge and lower ratings of suffocation during a breath-hold challenge, as compared to nonattempters. In contrast, there were no group differences in breath-hold duration, interoceptive accuracy on a heartbeat-tapping task, or insula activation during cardiac attention. An exploratory resting-state functional connectivity analysis of individuals with suicide attempts in the past 5 years (N = 23), individuals with more remote histories of suicide attempts (N = 39), and nonattempters (N = 232) revealed preliminary and subtle evidence of differences in insula connectivity with areas of the temporal cortex in remote suicide attempters. Taken together, these findings suggest that blunted affective responses to aversive interoceptive sensations is an enduring characteristic of suicide attempters, even when assessed many years after a suicide attempt, whereas differences in the experience of nonaversive interoceptive sensations may be less persistent. [ABSTRACT FROM AUTHOR]

The present paper considers recent progress in our understanding of the afferent/ascending neural pathways and neural circuits of interoception. Of particular note is the extensive role of rostral neural systems, including cortical systems, in the recognition of internal body states, and the reciprocal role of efferent/descending systems in the regulation of those states. Together these reciprocal interacting networks entail interoceptive circuits that play an important role in a broad range of functions beyond the homeostatic maintenance of physiological steady-states. These include the regulation of behavioral, cognitive, and affective processes across conscious and nonconscious levels of processing. We highlight recent advances and knowledge gaps that are important for accelerating progress in the study of interoception. The nervous system receives ascending communication of interoceptive signals originating from the periphery via chemoreceptor, mechanoreceptor, and osmoreceptor pathways, several of which were discovered only recently. Visceral systems and associated interoceptive signals are regulated in part by descending central nervous system (CNS) control of the autonomic nervous system, yielding a reciprocal circuit that regulates bodily organs and a wide array of motor, cognitive, and affective processes. A gap in our understanding of how interoceptive signals are relayed through the CNS from the body centers on inputs to the nucleus tractus solitarius and higher relay pathways. The neural circuits of interoception are important for behavioral, cognitive, and emotional regulation across conscious and nonconscious levels of processing. [ABSTRACT FROM AUTHOR]

Background: Bilateral cardiac sympathetic denervation (BCSD) is an effective therapy for ventricular arrhythmias (VAs) in cardiomyopathies (CMPs). After BCSD, residual autonomic nervous system (ANS) function is unknown.Objective: The purpose of this study was to assess ANS responses in patients with CMP before and after BCSD as compared with demographically matched healthy controls.Methods: Patients with CMP undergoing BCSD and matched healthy controls were recruited. Noninvasive measures-finger cuff beat-to-beat blood pressure (BP), electrocardiography, palmar electrodermal activity (EDA), and finger pulse volume (FPV)-were obtained at rest and during autonomic stressors-posture change, handgrip, and mental stress. Maximal as well as specific responses to stressors were compared.Results: Eighteen patients with CMP (mean age 54 ± 14 years; 16 men, 89%; left ventricular ejection fraction 36% ± 14%) with refractory VAs and 8 matched healthy controls were studied; 9 patients with CMP underwent testing before and after (median 28 days) BCSD, with comparable ongoing medication. Before BCSD, patients with CMP (n = 13) had lower resting systolic BP and FPV than did healthy controls (P < .01). Maximal FPV and systolic BP reflex responses, expressed as percent change were similar, while diastolic BP, mean BP, and EDA responses were blunted. After BCSD, resting measurements were unchanged relative to presurgical baseline (n = 9). EDA responses to stressors were abolished, confirming BCSD, while maximal FPV and BP responses were preserved. Diastolic BP, mean BP, and FPV responses to orthostatic challenge pointed toward a better tolerance of active standing after BCSD as compared with before. Responses to other stressors remained unchanged.Conclusion: Patients with CMP and refractory VAs on optimal medical therapy have detectable but blunted adrenergic responses, which are not disrupted by BCSD. [ABSTRACT FROM AUTHOR]

Bilateral cardiac sympathetic denervation (BCSD) is a surgical treatment for refractory ventricular arrhythmias. Although the procedure has shown efficacy at reducing cardiac arrhythmias, its impact on mental health is unknown. In the current study we examined associations between the BCSD procedure and mental health. 10 ventricular arrhythmia patients undergoing BCSD completed assessments of anxiety, depression, and posttraumatic stress symptoms at pre- and post-BCSD time points. Wilcoxon signed rank and Mann-Whitney U tests were used to examine differences in mental health symptoms in the pre- and post-BSCD states. Point biserial correlations were used to explore associations between BCSD response and mental health symptoms. A significant reduction of anxiety symptoms was observed from pre- to post-BCSD. At the post-BCSD assessment, participants who successfully responded to the BCSD procedure exhibited lower anxiety symptoms compared to non-responders. However, no significant relationships were identified for depressive or PTSD symptoms. The BCSD procedure is associated with reduced anxiety shortly after successful treatment for refractory ventricular arrhythmias in a small sample. Longitudinal surveillance of mental health symptoms after BCSD may be warranted to monitor the impact of this procedure on mental health. • Stellate ganglia removal was associated with lower anxiety in cardiac arrhythmias. • Successful arrhythmia response to denervation was associated with lower anxiety. • Stellate ganglia removal was not associated with lower depression or PTSD symptoms. [ABSTRACT FROM AUTHOR]

• Evaluation of two paradigms measuring anticipation and experience as well as the detection of discrepancies between anticipated and experienced interoceptive states. • 52 participants (of which 10 took part in a retest) conducted both paradigms on two modalities: respiroception and nociception. • Results show both paradigms to be valid and reliable tools for assessing the anticipation of future interoceptive states across different interoceptive domains. • Paradigms offer the possibility for implementation in further studies using imaging techniques. As the sense of the body's internal state, interoception represents the afferent component of the brain-body feedback loop essential for linking internal sensation with body regulation, thereby minimizing erroneous feedback and maintaining homeostasis. The anticipation of potential future interoceptive states enables organisms to take regulatory actions to meet demands before they arise, and alterations of anticipation have been implicated in the pathophysiology of medical and psychiatric conditions. However, laboratory approaches operationalizing the anticipation of interoceptive states are missing. Therefore, we developed two interoceptive awareness paradigms, the Accuracy of Interoceptive Anticipation paradigm, and the Interoceptive Discrepancy paradigm, which we tested in 52 healthy participants on two sensory modalities: nociception and respiroception. Ten participants took part in a retest. The Accuracy of Interoceptive Anticipation paradigm focused on assessing how individuals anticipate and experience interoceptive stimuli of varying strengths. The Interoceptive Discrepancy paradigm extended this measure by manipulating previously learned expectations to induce discrepancies between anticipated and experienced stimuli. We found that anticipation and experience ratings successfully related to stimulus strength in both paradigms and modalities and were stable between test-retest. Furthermore, the Interoceptive Discrepancy paradigm successfully induced the expected discrepancies between anticipation and experience conditions, and discrepancy values were correlated across sensory modalities. Thus, both paradigms are valid and reliable tools for assessing the anticipation of future interoceptive states, and the Interoceptive Discrepancy paradigm is additionally suited to evaluate discrepancy awareness. [ABSTRACT FROM AUTHOR]

Repetitive negative thinking (RNT) is a symptom that can negatively impact the treatment and course of common psychiatric disorders such as depression and anxiety. We aimed to characterize behavioral and genetic correlates of RNT to infer potential contributors to its genesis and maintenance. We applied a machine learning (ML) ensemble method to define the contribution of fear, interoceptive, reward, and cognitive variables to RNT, along with polygenic risk scores (PRS) for neuroticism, obsessive compulsive disorder (OCD), worry, insomnia, and headaches. We used the PRS and 20 principal components of the behavioral and cognitive variables to predict intensity of RNT. We employed the Tulsa-1000 study, a large database of deeply phenotyped individuals recruited between 2015 and 2018. PRS for neuroticism was the main predictor of RNT intensity (R 2 = 0.027 , p < 0.001). Behavioral variables indicative of faulty fear learning and processing, as well as aberrant interoceptive aversiveness, were significant contributors to RNT severity. Unexpectedly, we observed no contribution of reward behavior and diverse cognitive function variables. This study is an exploratory approach that must be validated with a second, independent cohort. Furthermore, this is an association study, limiting causal inference. RNT is highly determined by genetic risk for neuroticism, a behavioral construct that confers risk to a variety of internalizing disorders, and by emotional processing and learning features, including interoceptive aversiveness. These results suggest that targeting emotional and interoceptive processing areas, which involve central autonomic network structures, could be useful in the modulation of RNT intensity. • A machine learning ensemble method identified behavioral and genetic predictors of repetitive negative thinking (RNT). • Heightened response to aversive and fear inducing stimuli are associated with RNT. • The only genetic trait associated with RNT was polygenic risk score for neuroticism. • Our results warrant the exploration of interventions that target fear learning and interoceptive aversiveness. • Our results indicate that RNT is either a component of neuroticism or a contributor to the development and stability of it. [ABSTRACT FROM AUTHOR]

The neurovisceral integration (NVI) model was originally proposed to account for observed relationships between peripheral physiology, cognitive performance, and emotional/physical health. This model has also garnered a considerable amount of empirical support, largely from studies examining cardiac vagal control. However, recent advances in functional neuroanatomy, and in computational neuroscience, have yet to be incorporated into the NVI model. Here we present an updated/expanded version of the NVI model that incorporates these advances. Based on a review of studies of structural/functional anatomy, we first describe an eight - level hierarchy of nervous system structures, and the contribution that each level plausibly makes to vagal control. Second, we review recent work on a class of computational models of brain function known as “predictive coding” models. We illustrate how the computational dynamics of these models, when implemented within our proposed vagal control hierarchy, can increas e understanding of the relationship between vagal control and both cognitive performance and emotional/physical health. We conclude by discussing novel implications of this updated NVI model for future research. [ABSTRACT FROM AUTHOR]

Repetitive negative thinking (RNT) is a transdiagnostic symptom associated with poor outcomes in major depressive disorder (MDD). MDD is characterized by altered interoception, which has also been associated with poor outcomes. The present study investigated whether RNT is directly associated with altered interoceptive processing. Interoceptive awareness toward the heart and stomach was probed on the Visceral Interoceptive Attention (VIA) task with fMRI in MDD individuals who were propensity-matched on the severity of depression and anxiety symptoms and relevant demographics but different in RNT intensity (High RNT [H-RNT, n = 48] & Low RNT [L-RNT, n = 49]), and in matched healthy volunteers (HC, n = 27). Both H-RNT and L-RNT MDD individuals revealed reduced stomach interoceptive processing compared to HC in the left medial frontal region and insular cortex (H-RNT: β = −1.04, L-RNT: β = −0.97), perirhinal cortex (H-RNT: β = −0.99, L-RNT: β = −1.03), and caudate nucleus (H-RNT: β = −1.06, L-RNT: β = −0.89). However, H-RNT was associated with decreased right medial temporal lobe activity including the hippocampus and amygdala during stomach interoceptive trials (β = −0.61) compared to L-RNT. Insular interoceptive processing was similar in H-RNT and L-RNT participants (β = −0.07, p = 0.92). MDD individuals with high RNT exhibited altered gastric interoceptive responses in brain areas that are important for associating the information with specific contexts and emotions. Attenuated interoceptive processing may contribute to RNT generation, non-adaptive information processing, action selection, and thus poor treatment outcome. [ABSTRACT FROM AUTHOR]

Empathic communication between a patient and therapist is an essential component of psychotherapy. However, finding objective neural markers of the quality of the psychotherapeutic relationship have been elusive. Here we conceptualize how a neuroscience-informed approach involving real-time neurofeedback, facilitated via existing functional magnetic resonance imaging (fMRI) and electroencephalography (EEG) technologies, could provide objective information for facilitating therapeutic rapport. We propose several neurofeedback-assisted psychotherapy (NF-AP) approaches that could be studied as a way to optimize the experience of the individual patient and therapist across the spectrum of psychotherapeutic treatment. Finally, we consider how the possible strengths of these approaches are balanced by their current limitations and discuss the future prospects of NF-AP. • Biomarkers of empathy and rapport may be evaluated using neurofeedback. • Neurofeedback can be used to measure therapeutic alliance between patients and therapists. • The application of neurofeedback in psychotherapy is an innovative approach. [ABSTRACT FROM AUTHOR]

To survive, organisms must effectively respond to the challenge of maintaining their physiological integrity in the face of an ever-changing environment. Preserving this homeostasis critically relies on adaptive behavior. In this review, we consider recent frameworks that extend classical homeostatic control via reflex arcs to include more flexible forms of adaptive behavior that take interoceptive context, experiences, and expectations into account. Specifically, we define a landscape for computational models of interoception, body regulation, and forecasting, address these models' unique challenges in relation to translational research efforts, and discuss what they can teach us about cognition as well as physical and mental health. The sensory-control loop can be used as a guiding principle to align different computational models of interoception and body regulation. Recent computational frameworks focus on formulating body regulation via flexible, adaptive control mechanisms that extend classical reflex arcs. The perception and regulation of interoceptive signals pose tangible and unique challenges for computational modeling. Concrete computational frameworks of brain–body interactions hold great potential for translational research. Modeling approaches could be applied to develop testable 'computational biomarkers' to support diagnostic, prognostic, or treatment efforts, particularly in individuals with symptoms originating from maladaptive brain–body interactions. [ABSTRACT FROM AUTHOR]

Unmedicated individuals with major depressive disorder (MDD) show abnormal interoception, but it is unclear whether antidepressant treatment via serotonergic medication alters this relationship. The current cross-sectional study examined associations between neural and behavioral indices of interoceptive processing and chronic serotonergic medication administration in MDD. 47 selective serotonin reuptake inhibitor (SSRI)-medicated MDD (MDD-SSRI) individuals were propensity-matched with 48 unmedicated current MDD (MDD-UnMed) and 41 healthy comparison (HC) participants on demographics including age, sex, body mass index, education, as well as on dimensional scales of symptom severity including depression and anxiety. All participants completed an interoceptive attention task during functional magnetic resonance imaging, and a behavioral heartbeat tapping task under three conditions: Guessing, No Guessing, and Breath Hold. Relative to HC, both MDD groups: (1) exhibited lower mid-insula, amygdala, putamen, and caudate activation during interoceptive versus exteroceptive attention; and (2) showed poorer heartbeat tapping performance during the Breath Hold condition. However, the MDD-SSRI group reported higher intensity ratings of heartbeat and stomach sensations than MDD-UnMed and HC during the interoceptive attention task. These findings suggest that the attenuated patterns of neural activation observed in depressed individuals during interoceptive attention are not ameliorated by the chronic administration of serotonergic medications. However, amplified interoceptive sensation ratings suggest a potential impact of chronic serotonergic medication on conscious experiences of internal body states. Future investigations will need to determine the extent to which serotonergic medications acutely influence interoceptive processing, and whether such changes play a role in therapeutic responses during treatment initiation. • MDD patients exhibited lower self-reported interoceptive awareness than HC. • MDD patients showed lower insula, amygdala, and striatum activation than HC. • Insula activation did not differ between unmedicated and SSRI-medicated MDD. • MDD-SSRI displayed greater interoceptive sensation ratings than MDD-UnMed and HC. [ABSTRACT FROM AUTHOR]