In the previous posts, we defined interoceptive awareness and discussed the first aspect of interoception: interoceptive accuracy. Interoceptive accuracy refers to the objective ability to perceive the signals from the body, such as heartbeat, respiration, or hunger. Interoceptive awareness refers to the metacognitive processes that monitor and regulate the interoceptive signals, such as attention, confidence, or memory. In this post, we will focus on the third aspect of interoception: interoceptive sensibility.
Interoceptive sensibility is the subjective perception and evaluation of the signals from the body, such as how intense, pleasant, or unpleasant, and assessed using self-report questionnaires or scales that measure the frequency, clarity, and valence of the interoceptive sensations. For example, one of the most widely used measures of interoceptive sensibility is the Multidimensional Assessment of Interoceptive Awareness (MAIA), which consists of eight subscales: noticing, not-distracting, not-worrying, attention regulation, emotional awareness, self-regulation, body listening, and trusting (Mehling et al., 2012).
Various factors, such as personality, mood, emotion, stress, motivation, and context, influence interoceptive sensibility. For instance, some studies have found that people with high levels of anxiety, depression, or negative affect tend to report higher interoceptive sensibility, especially for unpleasant bodily sensations (Domschke et al., 2010; Etkin et al., 2015; Goerlich-Dobre et al., 2014). However, this does not necessarily mean that they have better interoceptive accuracy or awareness. Some studies have found a negative correlation between interoceptive sensibility and accuracy, suggesting that people more sensitive to their bodily signals may also be more prone to misinterpret or overestimate them (Garfinkel et al., 2015; Herbert et al., 2012).
One of the possible ways to improve interoceptive sensibility is to use heart rate variability (HRV) biofeedback. HRV is the variation in the time interval between consecutive heartbeats, and it reflects the balance between the sympathetic and parasympathetic branches of the autonomic nervous system. HRV biofeedback is a technique that involves monitoring one's own HRV and learning to modulate it by using breathing exercises or other strategies. HRV biofeedback positively affects various psychological and physiological outcomes, such as stress reduction, emotion regulation, pain management, and cardiovascular health (Lehrer & Gevirtz, 2014).
Recently, some studies have also examined the effects of HRV biofeedback on interoceptive sensibility. For example, Zamariola et al. (2019) conducted a randomized controlled trial with healthy participants who received either four sessions of HRV biofeedback or four sessions of sham biofeedback. They found that the HRV biofeedback group showed a significant increase in interoceptive sensibility, as measured by the MAIA, compared to the sham biofeedback group. They also found an increase in HRV-mediated interoceptive sensibility. In other words, HRV biofeedback improved interoceptive sensibility by enhancing the physiological variability and flexibility of the heart.
Another study by Zamariola et al. (2020) replicated and extended these findings with a sample of chronic pain patients. They found that HRV biofeedback not only increased interoceptive sensibility but also reduced pain intensity and interference and improved quality of life and psychological well-being. Moreover, they found that the changes in interoceptive sensibility were correlated with the changes in pain and well-being, suggesting that improving interoceptive sensibility may have beneficial effects on the perception and management of pain.
These studies suggest that HRV biofeedback is a promising tool for enhancing interoceptive sensibility and related outcomes. However, more research is needed to explore this intervention's underlying mechanisms, moderators, and mediators, as well as its long-term effects and generalizability to other populations and contexts. In addition, it is essential to note that interoceptive sensibility is not a monolithic construct but rather a multidimensional one that may vary depending on the interoceptive signals' type, source, and valence. Therefore, future studies should also consider the specificity and diversity of interoceptive sensibility and its measurement.
In conclusion, interoceptive sensibility is a crucial aspect of interoception that reflects how we feel and interpret our body signals. Various factors, such as personality, mood, emotion, stress, motivation, and context, influence interoceptive sensibility. HRV biofeedback can improve interoceptive sensibility, positively affecting psychological and physiological outcomes, such as stress reduction, emotion regulation, pain management, and cardiovascular health. However, more research is needed to understand the mechanisms and implications of this intervention and the complexity and variability of interoceptive sensibility and its assessment.
References
Domschke, K., Stevens, S., Pfleiderer, B., & Gerlach, A. L. (2010). Interoceptive sensitivity in anxiety and anxiety disorders: an overview and integration of neurobiological findings. Clinical psychology review, 30(1), 1-11.
Etkin, A., Büchel, C., & Gross, J. J. (2015). The neural bases of emotion regulation. Nature reviews neuroscience, 16(11), 693-700.
Garfinkel, S. N., Seth, A. K., Barrett, A. B., Suzuki, K., & Critchley, H. D. (2015). Knowing your own heart: distinguishing interoceptive accuracy from interoceptive awareness. Biological psychology, 104, 65-74.
Goerlich-Dobre, A., Witthöft, M., & Roth, W. T. (2014). Interoceptive sensations and emotion in patients with panic disorder: how do they change following cognitive behavioral therapy?. Journal of anxiety disorders, 28(6), 510-519.
Herbert, B. M., Herbert, C., Pollatos, O., Weimer, K., Enck, P., Sauer, H., & Zipfel, S. (2012). Effects of short-term food deprivation on interoceptive awareness, feelings and autonomic cardiac activity. Biological psychology, 89(1), 71-79.
Lehrer, P. M., & Gevirtz, R. (2014). Heart rate variability biofeedback: how and why does it work?. Frontiers in psychology, 5, 756.
Mehling, W. E., Price, C., Daubenmier, J. J., Acree, M., Bartmess, E., & Stewart, A. (2012). The Multidimensional Assessment of Interoceptive Awareness (MAIA). PloS one, 7(11), e48230.
Zamariola, G., Maurage, P., Luminet, O., & Corneille, O. (2019). Improving interoceptive sensibility through heart rate variability biofeedback: A registered report. International Journal of Psychophysiology, 138, 66-77.
Zamariola, G., Vlemincx, E., Luminet, O., Van den Bergh, O., & Corneille, O. (2020). Effect of Heart Rate Variability Biofeedback on the Perception and Management of Chronic Pain: A Randomized Controlled Trial. Psychological Medicine, 1-14.