Perceptual insensitivity to the modulation of interoceptive signals in depression, anxiety, and substance use disorders

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. Participants performed 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 substance use 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.

A Bayesian computational model reveals a failure to adapt interoceptive precision estimates across depression, anxiety, eating, and substance use disorders

“…As part of the T1000 project, participants completed a large number of assessments, self-report measures, and behavioral tasks (detailed in [64]). Here we focus on data from a cardiac perception task on which we have previously reported (i.e., on a subset of the participants reported here, with analyses unrelated to computational modeling [71,72]), wherein participants were asked to behaviorally indicate the times at which they felt their heartbeat. The utilization of the heartbeat tapping measure as an index of perception was based on a previously developed heartbeat tapping task [40]; for a more recent example, see [73]).…”

Simulating homeostatic, allostatic and goal-directed forms of interoceptive control using Active Inference

“…In this case, interoceptive changes are not sufficiently sensed and the model fails to generate appropriate corrective responses. This is a form of interoceptive insensitivity that can be observed in various psychopathologies [49]. In keeping, previous theoretical and computational studies have highlighted that aberrant precision settings can cause various perceptual problems, such as hallucinations [23,61] and the reporting of false symptoms [58], which are often associated to psychopathological conditions.…”

“…The precision of sensory (exteroceptive and interoceptive) channels is normally assumed to be proportional to signal-to-noise ratio, meaning that more (less) informative signals should be weighted more (less) during the inference. However, it has been proposed that some psychopathological conditions are characterized by interoceptive insensitivity, or the failure to sense salient interoceptive changes, which may be caused by aberrant precision weighting during interoceptive inference [49].…”

“…Furthermore, and most critically, in virtue of suboptimal precision weighting, the model fails to generate appropriate corrective responses. There is an increasing consensus that the aberrant precision weighting of exteroceptive, proprioceptive and/or interoceptive streams may be an important factor in the explanation of various psychopathological conditions, such as psychosis, chronic fatigue, depression, eating disorders and panic disorders [23,24,[26][27][28][29][30]49]. While some theoretical and computational models have explored these implications by examining the effects of low precision on beliefs and perception (using predictive coding), only few of them explicitly incorporated control (using Active Inference).…”

What If the Heartbeat Counting Task Required No Measure of Cardiac Activity?

“…We believe that, because the task is too difficult to complete at rest, participants cannot reach the target (i.e., sense their heartbeats), which makes the target (i.e., objective heartbeats) useless. It would be interesting to examine in future research how the correlation is affected when using modified instructions under conditions of physiological activation (see Smith et al, 2020). The validity of the task may increase under such conditions.…”