A Systematic Review of Associations Between Interoception, Vagal Tone, and Emotional Regulation: Potential Applications for Mental Health, Wellbeing, Psychological Flexibility, and Chronic Conditions

Abstract

Background: Interoception and heart rate variability have been found to predict outcomes of mental health and well-being. However, these have usually been investigated independently of one another. Objectives: This systematic review aimed to explore a key gap in the current literature, that being, identifying whether HRV and interoception predict emotional regulation outcomes and strategies. Methods: The process of article retrieval and selection followed the PRISMA guidelines. Databases PsychINFO, Web of Science, PubMed, CINAHL, and MEDLINE were scanned for papers published. Preliminary inclusion and exclusion criteria were specified following the PICO framework, whilst the CHARMS framework was used to help formulate the research question, and critically assess for bias. Results: Two hundred and thirty-seven studies were identified after initial database searches. Of these, eight studies were included in the final selection. Six studies explored the associations between HRV and ER, whilst three investigated the associations between interoception and ER (one study included both). Results show that greater HRV and interoception are associated with better ER. Specifically, high parasympathetic activity largely predicted the use of adaptive ER strategies such as reappraisal, and better acceptance of emotions. High interoception, instead, was predictive of effective downregulation of negative emotions and handling of social uncertainty, there was no association with any specific ER strategy. Conclusions: Awareness of one's own bodily feelings and vagal activation seem to be of central importance for the effective regulation of emotional responses. However, one limitation is the small sample of studies found, thus more studies in this area are needed in the future.

Associations Between Mental Health, Interoception, Psychological Flexibility, and Self-as-Context, as Predictors for Alexithymia: A Deep Artificial Neural Network Approach

“…Psychological flexibility (AAQII) only partially mediated the relation between attention regulation IAw and alexithymia total, and did not mediate the relation between emotional awareness IAw and alexithymia total. This suggests further that SAC may play an important role the condition of alexithymia and in the interoceptive system, particularly in relation to emotional awareness, which is a key component to well-being (Pinna and Edwards, 2020 ). As such, this has implications for the types of interventions employed in treating alexithymia, whereby a process-based therapy (PBT) which target core mediators (Hofmann and Hayes, 2019 ) for both the diagnostic and treatment phases could be introduced.…”

“…At this integration phase, the signals are then organized into primary emotional and motivational centers of the limbic system, the anterior insula, and cingulate cortices of the homeostatic sensorimotor cortex. This integrative system is activated during all emotion and motivational behavior (Murphy et al, 2003;Craig, 2014), so have an important role to play in terms of behavioral and emotional regulation (Pinna and Edwards, 2020). At this stage, it has been proposed that these centers then develop and define a meta-representation of the "self " which allow for finely-tuned regulatory responses to be formulated (Damasio and Carvalho, 2013).…”

Interoception and the origin of feelings: A new synthesis

“…First, the axons of a large number of interoceptive neurons are either entirely unmyelinated or lightly myelinated. [4,9,39,40] The lack of myelin insulation greatly increases the exposure of these fibers to the direct influence of molecules present in the extracellular space. [6] Second, the signaling taking place within this particular apparatus is disproportionately nonsynaptic-that is, signaling molecules are released for extracellular diffusion unconstrained by synaptic gaps.…”

Enhanced cardiac vagal tone in mental fatigue: Analysis of heart rate variability in Time-on-Task, recovery, and reactivity

“…vagal tone) and, therefore, have a clear functional interpretation. Cardiac vagal tone as an index of the parasympathetic nervous system activity predicts a broad range of cognitive functions [ 16 ] that are vulnerable to Time-on-Task such as executive [ 17 ], and attentional functions [ 18 ], working memory [ 19 ], and emotion regulation [ 20 ]. Importantly, it has been suggested that increased parasympathetic activation (i.e.…”