Publications by authors named "Olga Pollatos"

82 Publications

Discrepancies Between Explicit Feelings of Power and Implicit Power Motives Are Related to Anxiety in Women With Anorexia Nervosa.

Front Psychol 2020 9;11:618650. Epub 2021 Feb 9.

Department of Clinical and Health Psychology, Ulm University, Ulm, Germany.

Background: Several studies identified low subjective feelings of power in women with anorexia nervosa (AN). However, little is known about implicit power motives and the discrepancy between explicit feelings of power and implicit power motives in AN.

Aim: The study investigated the discrepancy between explicit feelings of power and implicit power motives and its relationship to anxiety in patients with AN.

Method: Fifty-three outpatients and inpatients with AN and 48 participants without AN were compared regarding subjective feelings of power and anxiety. Explicit power [investigated with the Personal Sense of Power Scale (trait focus) and a visual analog scale (state focus)], implicit power motives [investigated with the Multi-Motive Grid (MMG)] and trait anxiety [measured with the State-Trait Anxiety Inventory (STAI)], were assessed.

Results: Explicit feelings of power (state and trait level) were lower in patients with AN compared to non-AN participants. No differences in implicit power motives were found when comparing the groups against each other. However, looking at the groups separately, women with AN had similar levels of implicit fear of losing power and hope for power, whereas woman without AN had significantly lower fear of losing power than hope for power. Focusing on discrepancies between powerful feelings and power motives, results were mixed, depending on the subscale of the MMG. Lastly, discrepancies between implicit power motives and explicit feelings of power were positively correlated with trait anxiety in AN patients.

Conclusion: These findings underline that individuals with AN display significantly lower explicit feelings of power, however, they show similar implicit power motives compared to individuals without AN. The discrepancy between explicit feelings of power and implicit power motives is related to anxiety in AN and may represent a vulnerability factor to illness maintenance.
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http://dx.doi.org/10.3389/fpsyg.2020.618650DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7901641PMC
February 2021

Interaction Between Sex and Cardiac Interoceptive Accuracy in Measures of Induced Pain.

Front Psychol 2020 9;11:577961. Epub 2021 Feb 9.

Department of Clinical and Health Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany.

Pain perception is influenced by several factors, and among them, affect, sex, and perception of bodily signals are assumed to play a prominent role. The aim of the present study is to explore how sex, cardiac interoceptive accuracy, and the interaction of the latter two influence the perception of experimentally induced pain. We investigated a large sample of young adults ( = 159, 50.9% female, age: 23.45, SD = 3.767), assessing current positive and negative affective state with the Positive and Negative Affect Schedule (both involved as control variables), cardiac interoceptive accuracy with the mental heartbeat tracking task, and pain sensitivity with electrical stimulation on the back of the dominant hand, applying a repeated-measures staircase protocol. Males showed a significantly higher pain threshold and tolerance level than females, whereas cardiac interoceptive accuracy was not associated with pain sensitivity. The impact of sex × cardiac interoceptive accuracy interaction was significant for pain threshold only, while pain tolerance was predicted only by sex. According to these findings, the associations between pain sensitivity, cardiac IAc, and sex might be more complicated than it was supposed in previous studies. Interactions between factors impacting pain perception appear worthy of further investigation.
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http://dx.doi.org/10.3389/fpsyg.2020.577961DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7900538PMC
February 2021

On the Relationship of Interoceptive Accuracy and Attention: A Controlled Study With Depressed Inpatients and a Healthy Cohort.

Front Psychol 2020 1;11:597488. Epub 2021 Feb 1.

Clinical and Health Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany.

Objective: Previous research has shown reduced interoceptive accuracy (IAcc) in depression. Attention deficit represents a key symptom of depression. Moreover, IAcc is positively correlated with attention. There is no study that investigates the effect of depression on IAcc and attention. The aim of this study is to examine the mediating effect of IAcc on depression and attention.

Methods: Thirty-six depressed patients from the Psychosomatic Clinic in Windach were matched with 36 healthy controls according to age and sex and were assessed at Ulm University. All participants completed the Beck Depression Inventory-II, the heartbeat perception task to examine IAcc, and the d2 test assessing selective attention.

Results: Depressed patients showed attention deficits-both for general visual attention and IAcc-compared to healthy controls. The mediation analyses revealed that the relationship between depression and attention is not mediated via IAcc. Furthermore, depression predicts IAcc and attention, but these effects are direct and largely unaffected by the respective other variable.

Discussion: The results of the present study highlight both interoceptive as well as attention deficits in depressed patients. No clear mediation between these variables could be shown in this study. More elaborative research is needed to clarify whether different approaches to improve IAcc are effective for these deficits in depressed patients and could therefore be of importance as an additional aspect of therapy in depression.
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http://dx.doi.org/10.3389/fpsyg.2020.597488DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7882488PMC
February 2021

Using bodily postures to reduce anxiety and improve interoception: A comparison between powerful and neutral poses.

PLoS One 2020 9;15(12):e0242578. Epub 2020 Dec 9.

Department of Clinical and Health Psychology, Ulm University, Ulm, Germany.

Background: Previous research has shown that anxiety syndromes are highly prevalent among university students. Effective treatments are needed to reduce the burden of anxiety in this population. Powerful postures have been found to impact affective states, as well as interoception (i.e. the ability to perceive inner bodily signals). However, no previous study has compared the effects of powerful- and neutral postures in regards to anxiety and interoceptive ability.

Methods: The first part of the study measured the single-session effect of adopting powerful- vs. neutral postures on students' (n = 57) interoceptive ability and state anxiety. The second part of the study measured the effect of adopting powerful or neutral postures twice daily for two weeks, on individuals' interoceptive ability and trait anxiety.

Results: State anxiety decreased in both conditions whereas interoceptive accuracy only increased in the power posing condition after a single session. Interoceptive accuracy increased in both groups after two weeks of training.

Limitations: The study included no comparison to a condition where individuals adopted their natural (i.e. usual) bodily posture.

Conclusions: Embodiment interventions that include elements of adopting an open or expansive bodily posture whilst maintaining a self-focus, can help to reduce state anxiety and improve interoceptive accuracy in student populations. Power posing does not seem to be superior to holding a neutral posture to improve interoceptive accuracy or anxiety. One reason therefore could be that both conditions include the manipulation of self-focus and a postural change that diverges from individuals' normal posture.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0242578PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7725306PMC
January 2021

Using bodily postures in the treatment of anorexia nervosa: Effects of power posing on interoception and affective states.

Eur Eat Disord Rev 2021 Mar 30;29(2):216-231. Epub 2020 Nov 30.

Department of Clinical and Health Psychology, Ulm University, Ulm, Germany.

Objective: Power posing involves the adoption of an expansive bodily posture. This study examined whether power posing could benefit individuals with anorexia nervosa (AN) and women with normal weight in regards to interoceptive ability and affective states.

Method: Participants included 50 inpatients and outpatients with AN as well as 51 normal-weight women. Interoceptive accuracy (IAcc), measured by the heartbeat tracking task and interoceptive sensibility (IS), measured by confidence ratings, were assessed at baseline, after a single power posing session and after 1 week of daily training. Also, the short-term effects of power posing on subjective feelings of dominance, pleasantness, and arousal were investigated.

Results: Both groups increased in their IAcc after one power posing session. Also, there was a significant main effect of time on feelings of dominance and pleasantness in the short-term. Women with AN displayed lower levels of IS, dominance, and pleasantness as well as higher levels of arousal than women without AN.

Discussion: These findings suggest that power posing has the potential to increase IAcc, subjective feelings of power and pleasant affect in the short-term. Further research should investigate which mechanisms foster the effectiveness of this intervention to tailor it to the needs of women with AN.
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http://dx.doi.org/10.1002/erv.2813DOI Listing
March 2021

StudiCare mindfulness-study protocol of a randomized controlled trial evaluating an internet- and mobile-based intervention for college students with no and "on demand" guidance.

Trials 2020 Nov 26;21(1):975. Epub 2020 Nov 26.

Department of Clinical Psychology and Psychotherapy, Institute for Psychology and Education, Ulm University, Albert-Einstein-Allee 47, 89081, Ulm, Germany.

Background: College is an exciting but also challenging time with an increased risk for mental health issues. Only a minority of the college students concerned get professional help, a problem that might be improvable by internet- and mobile-based interventions (IMIs). However, adherence of IMIs is a concern. While guidance might be a solution, it is resource-intensive, derailing potential implementation on population level. The first aim of this trial is to evaluate the efficacy of the IMI StudiCare Mindfulness (StudiCare-M) for college students with "on demand" and no guidance. The second aim is to examine potential moderators and mediators, contributing to the questions of "how" and "for whom" such interventions work.

Methods: In this three-armed randomized controlled trial, both an unguided and "guidance on demand" (GoD) condition of StudiCare-M are compared to a waitlist control group. StudiCare-M is based on principles of acceptance and commitment therapy and stress management and consists of 7 modules plus two booster sessions. Participants in the GoD condition may ask their e-coach for support whenever needed. A total of 387 college students with moderate to low mindfulness are recruited at 15+ cooperating universities in Germany, Austria, and Switzerland via circular emails. Assessments take place before as well as 1, 2, and 6 months after randomization. The primary outcome is mindfulness. Secondary outcomes include stress, depression, anxiety, interoception, presenteeism, wellbeing, intervention satisfaction, adherence, and potential side effects. Among examined moderators and mediators are sociodemographic variables, pre-treatment symptomatology, treatment expectancy, self-efficacy, cognitive fusion, emotion regulation, and alexithymia. All data will be analyzed according to intention-to-treat (ITT) principles.

Discussion: Providing effective interventions to help college students become more resilient can make a valuable contribution to the health and functionality of future society. If effective under the condition of minimal or no guidance, StudiCare-M offers a low-threshold potentially resource-efficient possibility to enhance college student mental health on a population level. Moderation- and mediation analyses will deliver further insights for optimization of target groups and intervention content.

Trial Registration: WHO International Clinical Trials Registry Platform via the German Clinical Studies Trial Register DRKS00014774 . Registered on 18 May 2018.
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http://dx.doi.org/10.1186/s13063-020-04868-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7691111PMC
November 2020

Effectiveness of a guided online mindfulness-focused intervention in a student population: Study protocol for a randomised control trial.

BMJ Open 2020 03 24;10(3):e032775. Epub 2020 Mar 24.

Department of Clinical & Health Psychology, Ulm University, Ulm, Baden-Württemberg, Germany.

Background: Previous studies show that university students experience higher psychological stress than the general population, resulting in increased vulnerability for mental disorders for the student population. Online mindfulness interventions will be delivered to students as a potentially promising and more flexible approach compared to face-to-face interventions with the aim of improving their mental health. This study purposes to investigate the effectiveness of a guided online mindfulness-focused intervention for university students by using both self-reported and psychobiological measures.

Methods And Analyses: In this multicentre, two-armed randomised controlled trial with a parallel design, a guided version of the online mindfulness-focused intervention 'StudiCare Mindfulness' will be compared with a waitlist control group. In total, 120 participants will be recruited at different universities (of Applied Sciences) in (Neu-) Ulm. Data will be assessed prior to randomisation, after eight weeks (post-intervention) and six months after randomisation (follow-up). The primary outcome measure is mindfulness. The secondary outcome measures include depression, anxiety and stress levels, well-being, interoceptive sensibility, emotion regulation and alexithymia. Psychobiological parameters comprise interoceptive accuracy, hair cortisol and FKBP5 genotype. Sociodemographic variables, treatment expectations, side and adverse side effects, as well as intervention satisfaction and adherence will be assessed. All data analyses will be conducted according to the intention-to-treat principle.

Ethics And Dissemination: All study procedures have been approved by the Ethics Committee of Ulm University (application No. 48/18). The findings will be disseminated widely through peer-reviewed publications and conference presentations.

Trial Registration Number: DRKS00014701.
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http://dx.doi.org/10.1136/bmjopen-2019-032775DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202707PMC
March 2020

Are interoceptive accuracy scores from the heartbeat counting task problematic? A comment on Zamariola et al. (2018).

Biol Psychol 2020 04 22;152:107868. Epub 2020 Feb 22.

Developmental Psychology, Institute of Psychology and Education, Ulm University, Albert-Einstein-Allee 47, 89081 Ulm, Germany.

In a recently published article, Zamariola et al. (2018) listed four problems of interoceptive accuracy (IAcc) scores as measured with Schandry's heartbeat counting task. In this comment, we clarify that IAcc scores are ratio variables, the analyses of which can result in misleading interpretations and incorrect conclusions. We examine the findings of Zamariola et al. (2018) by reanalyzing their data using statistical methods more adequate than the bivariate correlational analyses conducted by Zamariola et al. (2018) and by reinterpreting the results taking into account the fact that IAcc scores are ratio variables. Our findings indicate that the problems enlisted by Zamariola et al. (2018) can mainly be attributed to the statistical nature of IAcc scores and to the analysis approach of using bivariate correlations. We infer that the problems of IAcc scores mentioned by Zamariola et al. (2018) are not as serious as they might appear at first glance. In turn, we briefly mention some other problems of IAcc scores researchers may face based on the fact that ratio variables are bounded.
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http://dx.doi.org/10.1016/j.biopsycho.2020.107868DOI Listing
April 2020

Comment on "Zamariola et al. (2018), Interoceptive Accuracy Scores are Problematic: Evidence from Simple Bivariate Correlations"-The empirical data base, the conceptual reasoning and the analysis behind this statement are misconceived and do not support the authors' conclusions.

Biol Psychol 2020 04 21;152:107870. Epub 2020 Feb 21.

Department of Clinical Psychology & Psychotherapy, Eberhard-Karls-University of Tuebingen, Germany; Fresenius University of Applied Sciences, Munich, Germany. Electronic address:

A recent paper by Zamariola and colleagues is widely cited as an authority on the invalidity of the Heartbeat Counting Task as a measure of interoceptive accuracy. Given the widespread interest in this field, it is essential that papers about methods are conceptually sound. However, only one of the authors' four criticisms appears substantiated - that people count too few heartbeats. Their arguments about "simple bivariate correlations" and their finding that interoceptive accuracy and heart rate correlate, depend on 'spurious correlations' arising from the overlooked point that interoceptive accuracy is a ratio. Moreover, scrutiny of the authors' data shows that their fourth criticism (that interoceptive accuracy is lower on longer trials) is confounded by differences in mean heart rate between trials. We present data from our own labs to refute it. We draw the authors' and editors' attention to these issues and trust that they will reconsider these erroneous conclusions.
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http://dx.doi.org/10.1016/j.biopsycho.2020.107870DOI Listing
April 2020

Trait-Based Emotional Intelligence, Body Image Dissatisfaction, and HRQoL in Children.

Front Psychiatry 2019 23;10:973. Epub 2020 Jan 23.

Division Sports and Rehabilitation Medicine, Research Group "Join the Healthy Boat-Primary School", Ulm University, Ulm, Germany.

Background: Body image dissatisfaction (BID) is related to an increased risk for various health issues including descreased health-related quality of life (HRQoL), the development of problematic eating behaviors and obesity. Previous research indicates that emotional intelligence is one important factor related to BID in adults. Whether this is the case in children, remains yet unknown. Taking this into consideration, the aim of this study was to explore the relationship between BID and trait-based emotion intelligence (TEI) as well as HRQoL in female and male primary school children.

Materials And Methods: TEI and BID were assessed via self-reports as well as HRQoL via parental reports in a large sample of 991 primary school children (429 girls) within the "Baden Württemberg Study", which evaluated the effectiveness of the health prevention programm "Join the Healthy Boat" in Southwestern Germany.

Results: Our findings demonstrated the interrelation between higher levels of TEI and lower levels of BID among girls and boys. Positive associations were found between better HRQoL, better intrapersonal and stress management abilites (subscales of TEI) and lower BID, as reflected by parental and self-reports.

Conclusions: Our results reveal an interconnectivity between TEI, BID, and better HRQoL in female and male primary school children. Although the observed correlations were rather small, they nervertheless support the idea that TEI consists a key-factor for the self-regulation of health-related behavior. Prevention programs could benefit from including processes, that sough to improve aspects of emotional intelligence such as intrapersonal, interpersonal abilities, and adaptability, as an effort of preventing problematic habits or lifestyles that could lead to disordered eating behaviors as well as to obesity in middle childhood.
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http://dx.doi.org/10.3389/fpsyt.2019.00973DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6990369PMC
January 2020

Emotional responses to illness imagery in young adults: Effects of attention to somatic sensations and levels of illness anxiety.

Biol Psychol 2020 01 10;149:107812. Epub 2019 Nov 10.

Department of Psychology, University of Cyprus, Cyprus; Center of Applied Neuroscience, University of Cyprus, Cyprus.

This study investigated the effect of interoceptive attention on emotional responses during illness imagery, and the moderating role of illness anxiety. 101 students (81 female; 18-35 years old) with low, moderate and high levels of illness anxiety had to imagine personally relevant illness scenarios and standardized fearful, joyful and neutral scenarios, after undergoing an attention manipulation to direct their attention towards interoceptive or exteroceptive stimuli. Emotional responses assessed included self-reports of arousal, valence and somatic sensations, and psychophysiological measures of heart rate reactivity and variability, skin conductance level, and facial electromyography. Findings showed increased reports of emotional arousal, negative affect and somatic symptoms, accompanied by negative emotion expressions, but a hypo-arousal physiological response pattern (i.e. low heart rate reactivity) during illness imagery after interoceptive attention, irrespective of illness anxiety levels. Under directed attention, the observed emotional response to illness imagery may increase the risk for developing and perpetuating illness anxiety.
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http://dx.doi.org/10.1016/j.biopsycho.2019.107812DOI Listing
January 2020

[The impact of religiousness on the attitude towards aggression and on aggressive behavior in a forensic-psychiatric inpatient sample].

Fortschr Neurol Psychiatr 2021 Mar 1;89(3):91-96. Epub 2019 Jul 1.

Universität Ulm, Klinik für Forensische Psychiatrie und Psychotherapie am BKH Günzburg.

Aim Of Study: According to previous research, religiousness might have a positive effect on the risk of delinquent behavior. This study aims to examine this correlation in a forensic-psychiatric inpatient sample. Furthermore, it compares self-reported aggression with the individuals' criminal history of violent offending.

Method: The study sample consisted of 84 forensic patients in mandatory drug treatment according to section 64 of the German Penal Code. Religiousness and attitude towards aggressive behavior were assessed by self-report. The participants' criminal history was screened for violent offences.

Results: In the male forensic-psychiatric inpatient sample, higher levels of religiousness correlated negatively with the attitude towards appetitive aggression, but not with aggressive behavior. In the female sample, no significant correlation was found.

Conclusion: We found a gender difference regarding the correlation of religiousness with the attitude towards aggression. Additionally, our results indicated a discrepancy between self-report of aggression and actual behavior in the sample of forensic-psychiatric inpatients. This might be explained by cognitive distortions, poor self-perception, or planning deficits.
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http://dx.doi.org/10.1055/a-0897-3877DOI Listing
March 2021

Interoceptive accuracy is related to long-term stress via self-regulation.

Psychophysiology 2019 10 23;56(10):e13429. Epub 2019 Jun 23.

Clinical and Health Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany.

Interoception describes the ability to perceive internal bodily signals. Previous research found a relationship between interoceptive accuracy (IAcc) and cardiovascular outcomes during or after acute stress. So far, the association between IAcc and long-term stress has not been investigated, although this would be important to identify a starting point to prevent long-term stress. To address this idea in the current study, we examined the relationship between IAcc and long-term stress, which was assessed with different questionnaires and biological markers, including cortisol and dehydroepiandrosterone (DHEA). Furthermore, we investigated self-regulation as a mechanism linking IAcc to long-term stress. The sample consisted of 98 participants. To measure IAcc, participants completed the heartbeat perception task. Perceived long-term stress and self-regulation were assessed via an online questionnaire. Moreover, hair samples were taken from 65 participants to determine long-term stress with cortisol and DHEA as well as the ratio of both. Results showed that IAcc was positively related to DHEA and weakly negatively related to the other indicators of long-term stress, except for the nonsignificant relationships to the indicators cortisol and stress experiences due to negative events. Furthermore, these relationships were mediated by participants' enhanced self-regulation. Thus, our results suggest that enhanced self-regulation could be a mechanism explaining why IAcc is associated with long-term stress.
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http://dx.doi.org/10.1111/psyp.13429DOI Listing
October 2019

Interoceptive deficits in patients with obsessive-compulsive disorder in the time course of cognitive-behavioral therapy.

PLoS One 2019 24;14(5):e0217237. Epub 2019 May 24.

Department of Clinical and Health Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany.

Interoception is impaired in different psychiatric disorders and is also associated with emotions. Only one study could show a higher interoceptive accuracy (IAcc) in patients with obsessive-compulsive disorder (OCD). Based on the predictive coding system we assume contrary results, indicating a decreased IAcc in patients with OCD. So far, there is no study investigating the effect of cognitive-behavioral therapy on IAcc in patients with OCD. Therefore, we hypothesize that patients with OCD improve their IAcc during the time course of therapy compared to healthy controls. Twenty-six patients with OCD from the Psychosomatic Clinic in Windach were examined in the time course of cognitive-behavioral therapy. They were compared to 26 matched healthy controls. IAcc via the heartbeat perception task as well as questionnaire data (OCD-, depression- and anxiety symptoms) were assessed. Results showed that IAcc, OCD-, depression- and anxiety symptoms were attenuated in patients with OCD. Patients recovered in the time course of therapy regarding OCD-, depression- and anxiety symptoms. Interoceptive deficits did not change in the time course of cognitive-behavioral therapy. We demonstrated that IAcc is affected in patients with OCD and this deficit does not change during the time course of a standardized therapy. Future studies should investigate, whether an inaccuracy in perceiving one's bodily signals constitutes a risk factor for relapse. Further, it could be examined if IAcc can be increased via self- and body focus interventions in patients with OCD.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0217237PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6534313PMC
January 2020

Changes in emotional processing following interoceptive network stimulation with rTMS.

Neuroscience 2019 05 14;406:405-419. Epub 2019 Mar 14.

Clinical and Health Psychology, Institute of Psychology and Education, Ulm University, Germany. Electronic address:

Theories of emotion suggest a close relation of interoception and emotion. However, knowledge of underlying neuronal networks is still sparse. Repetitive transcranial magnetic stimulation (rTMS) is one neurostimulation method allowing causal conclusions between functions and brain regions via stimulation or inhibition of underlying brain structures. In this study, rTMS with a continuous theta burst stimulation (cTBS) protocol was used aiming for inhibition of important interoceptive network structures (frontotemporal insular network and right somatosensory cortices). Stimulation effects were investigated on interoceptive accuracy (IAc), emotional evaluation and neuronal correlates of emotional picture processing in 18 male participants. The main findings were an emotional flattening in subjective valences for affective stimuli after inhibition of the frontotemporal anterior insular network and of somatosensory cortices, being mirrored in visual evoked potentials as increased N2/decreased P3, indicating an initial orientation reaction followed by decreased attentional processing of positive stimuli. Moreover, cardiac and respiratory IAc were positively associated with P3 amplitudes and negatively related to positive valence ratings. Positive associations of decreases of cardiac/respiratory IAc with decreases of arousal ratings and decreases of P3 amplitudes for negative stimuli after inhibition of the frontotemporal insular network and after inhibition of somatosensory cortices allow the conclusion of a causal relationship between reduced activity in interoceptive network structures and blunted emotional processing of visual stimuli. Our results suggest that both arousal, and valence aspects of emotional processing are disturbed after inhibition of interoceptive network structures, confirming core assumptions of peripheral theories of emotions and models of interoceptive predictive coding.
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http://dx.doi.org/10.1016/j.neuroscience.2019.03.014DOI Listing
May 2019

Improving interoceptive ability through the practice of power posing: A pilot study.

PLoS One 2019 7;14(2):e0211453. Epub 2019 Feb 7.

Department of Clinical and Health Psychology, Ulm University, Ulm, Germany.

Interoception refers to the detection and perception of signals from the inner body. Deficits in this domain have been linked to psychopathologies, prompting the search for strategies to improve this ability. Preliminary studies have shown that interoception could be enhanced through the manipulation of subjective feelings of power. We tested the effects of adopting powerful postures on different facets of interoception. Firstly, we measured the impact of a single power posing session on interoceptive ability in 41 healthy females. Then, the same participants were randomly assigned to two conditions (daily power posing practice vs. no practice). After one week the conditions alternated. Interoceptive accuracy, measured by the heartbeat tracking task, interoceptive sensibility, measured by the Body Perception Questionnaire (BPQ) and confidence ratings, as well as subjective feelings of power were assessed at baseline, after a single power posing session and after one week of training. A single power posing session significantly increased individuals' interoceptive accuracy. Also, power posing reduced individuals' scores on the BPQ after one week of daily practice and increased subjective feelings of power after one session and one week of daily practice. These findings suggest that adopting powerful postures has the potential to increase interoceptive accuracy, as well as subjective feelings of power, and to reduce interoceptive sensibility, measured by questionnaire.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0211453PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6366763PMC
November 2019

Bidirectional relationship of stress and affect with physical activity and healthy eating.

Br J Health Psychol 2019 05 22;24(2):315-333. Epub 2019 Jan 22.

Department of Clinical and Health Psychology, Ulm University, Germany.

Objectives: Physical activity and healthy eating seem to be protective against experiencing stress and negative affect as well as increase positive affect. At the same time, previous studies showed that people reduce salutogenic behaviours such as physical activity and healthy eating in the face of stress and negative affect while increasing such behaviours in the context of positive affect. Due to daily fluctuations of these behaviours, the present study examined these relationships in daily life using ecological momentary assessment (EMA).

Design And Methods: Fifty-one university students responded to six daily prompts during 7 days via smartphone-based EMA. Items examined stress, emotional experience, physical activity duration, and healthy eating.

Results: Higher stress and negative affect, as well as lower positive affect, were related to a reduction in subsequent physical activity. Higher physical activity levels, in turn, were associated with less subsequent stress and negative affect, as well as more positive affect. No such effects for stress and affect on healthy eating or vice versa were found.

Conclusions: Engaging in physical activity is related to better mood and less stress/negative affect over the next several hours in daily life. Prevention efforts therefore may benefit by focusing on promoting physical activity, particularly when stress/negative affect is high to 'break the cycle' of inactivity, stress, and negative affect. Potential effects of healthy eating might be more subtle and characterized by interindividual differences or state effects. Statement of contribution What is already known on this subject? Physical activity can reduce stress as well as negative emotions and can enhance positive emotions. People tend to eat less healthy food during stressful times, and healthy eating can increase general health. Physical activity and healthy eating have been mostly assessed separately and through retrospective methods. What does this study add? This is an EMA study investigating bidirectional effects of stress, emotions, and salutogenic behaviour. After physical activity, people felt less stressed/negative and more positive; feeling better and less stressed resulted in more physical activity. Healthy eating was not associated with stress or emotion level and vice versa.
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http://dx.doi.org/10.1111/bjhp.12355DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6767465PMC
May 2019

Disconnected - Impaired Interoceptive Accuracy and Its Association With Self-Perception and Cardiac Vagal Tone in Patients With Dissociative Disorder.

Front Psychol 2018 27;9:897. Epub 2018 Jun 27.

Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.

Patients suffering from dissociative disorders are characterized by an avoidance of aversive stimuli. This includes the avoidance of emotions and, in particular, bodily perceptions. In the present pilot study, we explored the potential interoceptive accuracy deficit of patients suffering from dissociative disorders in a heartbeat detection task. Moreover, we investigated the impact of facial mirror-confrontation on interoceptive accuracy and the potential association between cardiac vagal tone derived from heart rate variability and interoceptive accuracy. Eighteen patients suffering from dissociative disorders and 18 healthy controls were assessed with the Mental Tracking Paradigm by Schandry for heartbeat detection at baseline and after confrontations exposing them to their own faces in a mirror (2 min each, accompanied by a negative or positive cognition). During the experiment, cardiac vagal tone was assessed. We used Pearson correlations to calculate potential associations between cardiac vagal tone and interoceptive accuracy. Patients performed significantly worse than the healthy controls in the heartbeat detection task at baseline. They displayed no significant increase in interoceptive accuracy following facial mirror-confrontation. In the patient group, higher cardiac vagal tone was associated with a more precise heartbeat detection performance. Dissociative disorder patients showed a considerable deficit in interoceptive accuracy. Our results fit with the assumption that highly dissociative patients tend to tune out the perceiving of bodily signals. To the extent that bodily signal perception may play a causal role in these disorders, therapeutic approaches enhancing interoceptive accuracy and cardiac vagal tone may be considered important and practicable steps to improve the therapy outcome of this patient group.
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http://dx.doi.org/10.3389/fpsyg.2018.00897DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6031288PMC
June 2018

It's craving time: time of day effects on momentary hunger and food craving in daily life.

Nutrition 2018 11 6;55-56:15-20. Epub 2018 Apr 6.

Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria; Department of Psychology, University of Salzburg, Salzburg, Austria.

Objective: A key determinant of food intake besides hunger is food craving, which refers to an intense desire to consume a specific food. Although they commonly co-occur, they are conceptually different and their dissociation is thought to underlie unhealthy eating (e.g., eating in the absence of hunger). To date, we know almost nothing about their coherence (or dissociation) in daily life or about the role of time of day and different food types.

Methods: The present investigation assessed both hunger and food craving for several food categories in daily life using smartphone-based ecological momentary assessment. Across three independent studies (n = 50, n = 51, and n = 59), participants received five or six prompts a day and reported their momentary hunger and desire for tasty food (a subcomponent of food craving).

Results: Consistent across studies, hunger and desire for tasty food exhibited largely similar patterns throughout the day with two peaks (roughly corresponding to lunch and dinner). Examining more specific food categories, study 3 found that although desire for main meal-type foods had a two-peak pattern in coherence with hunger, this pattern was different for snack-type foods: Desire for fruits decreased, whereas desire for sweets and salty snacks increased throughout the day with less coherence with hunger.

Conclusions: These findings suggest that dissociations between hunger and craving are found only for snack-type foods, whereas hunger and general food cravings cohere strongly. Interventions addressing snacking may take these circadian patterns of food cravings into account.
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http://dx.doi.org/10.1016/j.nut.2018.03.048DOI Listing
November 2018

Interoception is associated with heartbeat-evoked brain potentials (HEPs) in adolescents.

Biol Psychol 2018 09 23;137:24-33. Epub 2018 Jun 23.

Clinical and Health Psychology, Institute of Psychology and Education, Ulm University, Germany. Electronic address:

Heartbeat-evoked brain potentials (HEPs) are an index of the cortical reflection of cardiac interoceptive signals. Studies which have examined interoception in adolescents with the use of HEPs are not known to the authors so far. This study investigated the function of the HEP as a marker of interoception in adolescents. EEG and ECG were recorded in 46 adolescents during a resting condition and during a heartbeat detection task. Participants were asked for confidence in their interoceptive accuracy during heartbeat perception. HEPs appeared during both conditions, showing maximal activity over frontocentral electrodes in the heartbeat condition, and highest activity over occipital locations in the resting condition. Interoceptive accuracy (IAc) was positively associated with the HEP at frontocentral locations only for the heartbeat condition. Interoceptive sensibility was not associated with the HEP. No significant association between IAc and interoceptive sensibility was revealed. Our results highlight the relevance of the HEP as a neural marker of interoception in adolescents. Its use as an indicator of vulnerability for affective, physical and mental dysfunctions during adolescence should be exploited in future studies.
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http://dx.doi.org/10.1016/j.biopsycho.2018.06.007DOI Listing
September 2018

Interoception and Mental Health: A Roadmap.

Biol Psychiatry Cogn Neurosci Neuroimaging 2018 06 28;3(6):501-513. Epub 2017 Dec 28.

Laureate Institute for Brain Research, University of Tulsa, Tulsa, Oklahoma.

Interoception refers to the process by which the nervous system senses, interprets, and integrates signals originating from within the body, providing a moment-by-moment mapping of the body's internal landscape across conscious and unconscious levels. Interoceptive signaling has been considered a component process of reflexes, urges, feelings, drives, adaptive responses, and cognitive and emotional experiences, highlighting its contributions to the maintenance of homeostatic functioning, body regulation, and survival. Dysfunction of interoception is increasingly recognized as an important component of different mental health conditions, including anxiety disorders, mood disorders, eating disorders, addictive disorders, and somatic symptom disorders. However, a number of conceptual and methodological challenges have made it difficult for interoceptive constructs to be broadly applied in mental health research and treatment settings. In November 2016, the Laureate Institute for Brain Research organized the first Interoception Summit, a gathering of interoception experts from around the world, with the goal of accelerating progress in understanding the role of interoception in mental health. The discussions at the meeting were organized around four themes: interoceptive assessment, interoceptive integration, interoceptive psychopathology, and the generation of a roadmap that could serve as a guide for future endeavors. This review article presents an overview of the emerging consensus generated by the meeting.
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http://dx.doi.org/10.1016/j.bpsc.2017.12.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6054486PMC
June 2018

I see neither your Fear, nor your Sadness - Interoception in adolescents.

Conscious Cogn 2018 04;60:52-61

Clinical and Health Psychology, Institute of Psychology and Education, Ulm University, Albert-Einstein-Allee 41, 89069 Ulm, Germany.

Interoception describes the mapping of the body's internal landscape and has been connected to greater intensity of emotional experience. The goal of the current study was to explore the relationship between interoception and emotion face recognition in healthy adolescents. The heartbeat perception task was used to assess interoceptive accuracy(IAC) and participants were asked to recognize different facial expressions. EEG activity was recorded, providing data for the P100, the N170 and the P300 ERP components. Results indicated high sensitivity to negative affect, as well as low accuracy in the recognition of fear and sadness among adolescents high in IAC, reflected by amplitude modulations in the N170 and the P300. The interpretation of these results focus on the intensity experienced in negative facial emotions, modified by IAC, as well as on emotional valence and arousal. These findings emphasize the dynamic integration of body and mind for shaping emotion recognition in adolescence.
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http://dx.doi.org/10.1016/j.concog.2018.02.011DOI Listing
April 2018

Feasibility and relative validity of a digital photo-based dietary assessment: results from the Nutris-Phone study.

Public Health Nutr 2019 05 6;22(7):1160-1167. Epub 2018 Mar 6.

1Institute of Epidemiology and Medical Biometry,Central Institute for Biomedical Technology(ZIBMT),University of Ulm,Albert-Einstein-Allee 41,89081 Ulm,Germany.

Objective: For dietary assessment, mobile devices with a camera can be used as an alternative to hand-written paper records. The Nutritional Tracking Information Smartphone (Nutris-Phone) study aimed to examine relative validity and feasibility of a photo-based dietary record in everyday life.

Design: Parallel to the photo-based technique, a weighed record was performed. Participant satisfaction was assessed by questionnaire. A trained nutrition scientist evaluated portion sizes and nutrient content was calculated (DGExpert). Spearman correlation and Bland-Altman analyses were applied.

Setting: Healthy, non-pregnant volunteers (≥18 years) without intent to lose weight recruited at Ulm University, Germany.

Subjects: Sixty-six participants (36 % males, median age 22·0 (interquartile range 20·0-25·0) years) took pictures of foods and beverages consumed with a commercially available mobile phone.

Results: Significant correlation between the photo-based and weighed record was observed: energy (r=0·991), carbohydrate (r=0·980), fat (r=0·972), protein (r=0·988), fibre (r=0·941). Bland-Altman analyses indicated comparable means and acceptable 95 % limits of agreement (energy: -345·2 to 302·9 kJ (-82·5 to 72·4 kcal); carbohydrate: -15·2 to 13·1 g; fat: -6·4 to 6·4 g; protein: -5·9 to 5·6 g; fibre: -2·7 to 2·5 g). However, with increasing intake level, underestimation by the digital method was present (except for fat, all P<0·01). Over 80 % of participants were satisfied with the photo-based record. In nearly 90 %, technical implementation was without major problems.

Conclusions: Compared with a weighed record, the photo-based dietary record seems to be valid, feasible and user-friendly to estimate energy, macronutrient and fibre intakes, although a systematic bias with increasing levels of intake should be kept in mind.
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http://dx.doi.org/10.1017/S1368980018000344DOI Listing
May 2019

Improvement of Interoceptive Processes after an 8-Week Body Scan Intervention.

Front Hum Neurosci 2017 12;11:452. Epub 2017 Sep 12.

Department of Clinical and Health Psychology, Institute of Psychology and Education, Ulm UniversityUlm, Germany.

Interoceptive processes are defined as ability to detect sensations arising within the body. There is a growing body of research investigating ways of improving interoceptive processes. One promising approach increasing the attention to bodily sensations is the body scan (BS), a method stemming from mindfulness-based stress reduction. Research so far revealed only heterogenous findings of meditational practice and mindfulness-based stress reduction on interoceptive processes. Even more importantly, there is no study considering the effect of an 8-week BS intervention on interoceptive processes and the distinguishable subdomains of interoception. Therefore, the main objective of this research is to examine the effects of a BS intervention on different interoceptive subdomains over 8 weeks of training in two different samples. In study 1, healthy participants executed a 20 min standardized audiotaped BS in the BS intervention group ( = 25) each day over 8 weeks. The control group ( = 24) listened to an audio book for the same amount of time. In study 2, the BS group ( = 18) was compared to an inactive control group ( = 18). In both studies, three measurement points were realized and interoceptive accuracy (IAc) - using a heartbeat perception task - as well as interoceptive sensibility (IS) - using confidence ratings for the heartbeat perception task and the subscale 'interoceptive awareness' of the Eating Disorder Inventory-2 (EDI-2) - were assessed. In study 1, we found, as a descriptive trend, IAc and confidence ratings to be increased irrespective of the condition. However, analysis revealed a significant improvement of IAc between T1 and T3 in the BS intervention only. IS revealed to be unaffected by the interventions. In study 2, we observed a significant positive effect of the BS intervention on IAc and confidence ratings compared to the inactive controls. As in study 1, IS (EDI-2) was unaffected by the intervention. The results highlight the fact that interoception can be improved by long-term interventions focusing on bodily signals. Further studies might focus on clinical samples showing deficits in interoceptive processes and could use other bodily systems for measurement (e.g., respiratory signals) as well methods manipulating body ownership.
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http://dx.doi.org/10.3389/fnhum.2017.00452DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5601051PMC
September 2017

Reply to Coll 'Important methodological issues regarding the use of transcranial magnetic stimulation to investigate interoceptive processing' (2017).

Philos Trans R Soc Lond B Biol Sci 2017 May;372(1721)

Section for Neurostimulation, Department of Psychiatry, Ulm University, 89075 Ulm, Germany.

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http://dx.doi.org/10.1098/rstb.2017.0046DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5394650PMC
May 2017

Changes in interoceptive processes following brain stimulation.

Philos Trans R Soc Lond B Biol Sci 2016 11 10;371(1708). Epub 2016 Oct 10.

Section for Neurostimulation, Department of Psychiatry, Ulm University, 89075 Ulm, Germany.

The processing and perception of individual internal bodily signals (interoception) has been differentiated to comprise different levels and processes involved. The so-called heartbeat-evoked potential (HEP) offers an additional possibility to examine automatic processing of cardiac signals. Knowledge on neural structures potentially supporting different facets of interoception is still sparse. One way to get insights into neuroanatomical function is to manipulate the activity of different brain structures. In this study, we used repetitive transcranial magnetic stimulation (rTMS) and a continuous theta-burst protocol to inhibit specific central locations of the interoceptive network including the right anterior insula and the right somatosensory cortices and assessed effects on interoceptive facets and the HEP in 18 male participants. Main results were that inhibiting anterior insula resulted in a significant decline in cardiac and respiratory interoceptive accuracy (IAc) and in a consistent decrease in perception confidence. Continuous theta-burst stimulation (cTBS) over somatosensory cortices reduced only cardiac IAc and affected perception confidence. Inhibiting right anterior insula and right somatosensory cortices increased interoceptive sensibility and reduced the HEP amplitude over frontocentral locations. Our findings strongly suggest that cTBS is an effective tool to investigate the neural network supporting interoceptive processes.This article is part of the themed issue 'Interoception beyond homeostasis: affect, cognition and mental health'.
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http://dx.doi.org/10.1098/rstb.2016.0016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5062104PMC
November 2016

Interoceptive Processes in Anorexia Nervosa in the Time Course of Cognitive-Behavioral Therapy: A Pilot Study.

Front Psychiatry 2016 15;7:199. Epub 2016 Dec 15.

Clinical and Health Psychology, Institute of Psychology and Education, Ulm University , Ulm , Germany.

Objective: Previous studies report reduced interoceptive abilities in anorexia nervosa (AN) using various methods. Recent research suggests that different levels of interoceptive processes aiming at different subdomains of interoceptive abilities must be further distinguished as these levels can be differentially affected. Two important levels refer to interoceptive accuracy (IA) derived from objective performance tasks such as the heartbeat detection task and interoceptive sensibility (IS) as assessed by self-report. There is a lack of studies investigating both IA and IS in AN and examining them in the time course of therapy. The aim of this pilot study was to evaluate the different interoceptive processes - especially IA and IS - in the time course of therapy.

Methods: Fifteen patients with AN (restricting type) from the Psychosomatic Clinic in Windach were investigated three times (T1, T2, T3) during a standardized cognitive-behavioral therapy and compared with 15 matched healthy controls assessed at Ulm University in a comparable design. All participants performed the heartbeat detection task examining IA and completed standard psychological assessments including an assessment of IS.

Results: Patients with AN showed a significantly decreased weight, higher levels of depression, and both reduced IA and IS compared to healthy controls at T1. Following therapy, patients recovered in terms of weight and depression symptomatology. A descriptive trend for recovering from IA and IS was observed.

Discussion: Our findings suggest that interoceptive deficits are present in recovered patients. Therefore, further investigations are needed with more patients, differentiating between relapsed and recovered patients, and more specific training methods to improve interoceptive processes.
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http://dx.doi.org/10.3389/fpsyt.2016.00199DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5156660PMC
December 2016

Describe Your Feelings: Body Illusion Related to Alexithymia in Adolescence.

Front Psychol 2016 28;7:1690. Epub 2016 Oct 28.

Clinical and Health Psychology, Institute of Psychology and Education, Ulm University Ulm, Germany.

Having access to bodily signals is known to be crucial for differentiating the self from others and coping with negative feelings. The interplay between bodily and emotional processes develops in adolescence, where vulnerability is high, as negative affect states often occur, that could hamper the integration of bodily input into the self. Aim of the present study in healthy adolescents was to examine, whether a disturbed emotional awareness, described by the alexithymic construct, could trigger a higher malleability in the sense of body-ownership. Fifty-four healthy adolescents aged between 12 to 17 years participated in this study. The Strength and Difficulties Questionnaire (SDQ) and the Screening psychischer Störungen im Jugendalter were used to assess emotional distress and conduct problems. Alexithymia was assessed by the TAS-20. The rubber hand illusion was implemented for examining the malleability of body-ownership. A higher body illusion was found to be connected with "difficulties in describing feelings". Moreover, a higher degree of self-reported conduct and emotional problems as assessed by the SDQ were associated with a more pronounced body illusion. Further findings revealed an association between emotional distress and the emotional alexithymia subscales "difficulties in identifying feelings" and "difficulties in describing feelings". Our findings emphasize a close link between the sense of body-ownership and emotional awareness as assessed by emotional facets of the alexithymic trait. We suggest that in adolescents with higher malleability of body-ownership, a vicious circle might occur where affect and integration of different proprioceptive signals regarding the body become more entangled.
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http://dx.doi.org/10.3389/fpsyg.2016.01690DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5083713PMC
October 2016

Atypical Self-Focus Effect on Interoceptive Accuracy in Anorexia Nervosa.

Front Hum Neurosci 2016 27;10:484. Epub 2016 Sep 27.

Laboratory of Action and Body, Department of Psychology, Royal Holloway, University of London Egham, UK.

: Interoceptive abilities are known to be affected in anorexia nervosa (AN). Previous studies could show that private self-focus can enhance interoceptive accuracy (IAcc) in healthy participants. As body dissatisfaction is high in AN, confrontation with bodily features such as the own face might have a directly opposed effect in AN. Whether patients with AN can benefit from self-focus in their IAcc and whether this pattern changes over the time-course of cognitive behavioral therapy was investigated in this study. : Fifteen patients with AN from the Psychosomatic Clinic in Windach were assessed three times in the time course of a standardized cognitive-behavioral therapy. They were compared to 15 controls, recruited from Ulm University and tested in a comparable setting. Both groups performed the heartbeat perception task assessing IAcc under two conditions either enhancing ("Self") or decreasing ("Other") self-focused attention. Furthermore, body dissatisfaction was assessed by a subscale of the Eating Disorder (ED) Inventory 2. : Patients with AN scored higher in IAcc when watching others' faces as compared to one's own face while performing the heartbeat perception task. The opposite pattern was observed in controls. IAcc remained reduced in AN as compared to controls in the time-course of cognitive-behavioral therapy, while body-dissatisfaction improved in AN. High body dissatisfaction was related to poorer IAcc in the "Self" condition. : Our findings suggest that using self-focused attention reduces IAcc in AN while the opposite pattern was observed in controls. Confronting anorexic patients with bodily features might increase body-related avoidance and therefore decrease IAcc. The current study introduces a new perspective concerning the role of interoceptive processes in AN and generates further questions regarding the therapeutic utility of methods targeting self-focus in the treatment of AN.
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http://dx.doi.org/10.3389/fnhum.2016.00484DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5037175PMC
September 2016

Normal interoceptive accuracy in women with bulimia nervosa.

Psychiatry Res 2016 06 22;240:328-332. Epub 2016 Apr 22.

Clinical & Health Psychology, Institute of Psychology, Ulm University, Germany.

Previous studies suggest that patients suffering from bulimia nervosa (BN) have difficulties in perceiving internal bodily signals, mostly assessed by self-report questionnaires. Whether interoception is, in this case, attenuated or not remains an open question. Therefore, interoceptive processes were examined in twenty-three patients with current BN and were compared to healthy participants. We investigated Interoceptive Accuracy (IAc) assessed by the heartbeat detection task and Interoceptive Awareness (IA) assessed by the Eating Disorder Inventory-2. Patients with BN and healthy participants did not differ in terms of IAc when controlling for BMI, depression and anxiety, whereas IA among BN patients was found to have decreased. Although IAc and IA were not related among controls, we observed an inverse correlation in BN, suggesting that an abnormal overlap between these two levels of interoceptive signal processing is present in BN. The current study introduces a new perspective concerning the role of interoceptive processes in BN and generates further questions regarding the therapeutic utility of methods targeting the interaction between different levels of interoception in the treatment of BN.
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http://dx.doi.org/10.1016/j.psychres.2016.04.072DOI Listing
June 2016
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