The roles of interoceptive sensitivity and metacognitive interoception in panic

Author: Adrián Yoris 134, Sol Esteves 1, Blas Couto 124, Margherita Melloni 124, Rafael Kichic 13, Marcelo Cetkovich 13, Roberto Favaloro 1, Jason Moser 5, Facundo Manes 1247, Agustin Ibanez 12467 and Lucas Sedeño 124*
Corresponding author: Lucas Sedeño Author Affiliations 1 Laboratory of Experimental Psychology and Neuroscience (LPEN), INECO (Institute of Cognitive Neurology) and Institute of Neuroscience, Favaloro, Favaloro University, Pacheco de Melo 1860, Buenos Aires C1078AAI, Argentina 2 UDP-INECO Foundation Core on Neuroscience (UIFCoN), Diego Portales University, Santiago, Chile 3 Anxiety and Trauma Clinic, INECO (Institute of Cognitive Neurology), Buenos Aires, C1078AAI, Argentina 4 National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina 5 Department of Psychology, Michigan State University, East Lansing, MI, USA 6 Universidad Autónoma del Caribe, Barranquilla, Colombia 7 Australian Research Council (ACR) Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, NSW 2109, Australia
Conference/Journal: Behavioral and Brain Functions
Date published: 2015
Other: Volume ID: 11 , Pages: 14 , Special Notes: doi:10.1186/s12993-015-0058-8 , Word Count: 253

Interoception refers to the ability to sense body signals. Two interoceptive dimensions have been recently proposed: (a) interoceptive sensitivity (IS) –objective accuracy in detecting internal bodily sensations (e.g., heartbeat, breathing)–; and (b) metacognitive interoception (MI) –explicit beliefs and worries about one’s own interoceptive sensitivity and internal sensations. Current models of panic assume a possible influence of interoception on the development of panic attacks. Hypervigilance to body symptoms is one of the most characteristic manifestations of panic disorders. Some explanations propose that patients have abnormal IS, whereas other accounts suggest that misinterpretations or catastrophic beliefs play a pivotal role in the development of their psychopathology. Our goal was to evaluate these theoretical proposals by examining whether patients differed from controls in IS, MI, or both. Twenty-one anxiety disorders patients with panic attacks and 13 healthy controls completed a behavioral measure of IS motor heartbeat detection (HBD) and two questionnaires measuring MI.

Patients did not differ from controls in IS. However, significant differences were found in MI measures. Patients presented increased worries in their beliefs about somatic sensations compared to controls. These results reflect a discrepancy between direct body sensing (IS) and reflexive thoughts about body states (MI).

Our findings support the idea that hypervigilance to body symptoms is not necessarily a bottom-up dispositional tendency (where patients are hypersensitive about bodily signals), but rather a metacognitive process related to threatening beliefs about body/somatic sensations.

Keywords: Anxiety disorder; Panic attacks; Interoception sensitivity; Metacognitive interoception; Heartbeat detection