Interoception: A Comprehensive Guide

Preface
	References
Contents
About the Editors
Chapter 1: History of Interoception: An Incomplete Jigsaw
	1.1 What Should Be Included? From Visceroception to an Integrated Approach to Interoception
		1.1.1 The Categories of Sherrington
		1.1.2 Issues with the Categories of Sherrington
		1.1.3 Multisensory Integration
		1.1.4 The Homeostatic Pathway
		1.1.5 What About Hormones?
		1.1.6 A More Inclusive Approach
		1.1.7 Summary
	1.2 From Passive Reception to Active Perception
		1.2.1 Homeostatic Regulation
		1.2.2 Allostatic Regulation and Predictions
		1.2.3 Visceral Perception
		1.2.4 Predictive Processing
		1.2.5 Summary
	1.3 Physiological Changes and Their Subjective Perception
		1.3.1 Theories of Emotions: James-Lange, Cannon-Bard, and Schachter-Singer
		1.3.2 A Methodological Side-Story: Ability and Typical Behavior
		1.3.3 Early Interoceptive Accuracy Studies
		1.3.4 Early Questionnaire Studies
		1.3.5 Accuracy Measures and Questionnaires
		1.3.6 Dissociation (Discordance) Between Actual and Perceived Physiological Processes
		1.3.7 Summary
	1.4 Conditioning, Consciousness, and Behavior
		1.4.1 Classical Conditioning
		1.4.2 Visceral Conditioning
		1.4.3 Visceral Events as Instances of the Unconscious
		1.4.4 Operant Conditioning
		1.4.5 Why Are Visceral Events Nonconscious?
		1.4.6 Summary
	1.5 Changing Interoception
		1.5.1 Ideomotor Theory
		1.5.2 Biofeedback Techniques
		1.5.3 Should We Make Nonconscious Visceral Events Conscious?
		1.5.4 Body-Focused Therapies
		1.5.5 Summary
	1.6 Body Sensations: Negative or Positive?
		1.6.1 Negative Body Sensations
		1.6.2 From Neutral Body Sensations to Positive Ones
		1.6.3 Summary
	1.7 Conclusion: The Six Parallel Stories
	References
Chapter 2: The Conceptualization and Measurement of Interoception
	2.1 Definitions of Interoception
		2.1.1 Early Demonstrations of the Existence of Interoception
		2.1.2 Evolution in the Definition of Interoception
		2.1.3 Contemporary Definitions of Interoception
		2.1.4 Working Definition of This Chapter
	2.2 Related Concepts
		2.2.1 Exteroception
		2.2.2 Proprioception
		2.2.3 Visceroception
		2.2.4 Body Awareness
		2.2.5 Symptom Perception
	2.3 Dimensions of Interoception
		2.3.1 Before 2015: Inconsistencies in the Terminology
		2.3.2 The Three-Dimensional Framework of Interoception
		2.3.3 Eight Features of Interoception
		2.3.4 A Multidimensional Framework
		2.3.5 Terminology Endorsed in This Book
	2.4 Interoception Measurement
		2.4.1 Physiological Measures
		2.4.2 Behavioral Measures
			2.4.2.1 Questionnaires
			2.4.2.2 Performance-Based Tasks
				Cardiac Domain
				Respiratory Domain
				Gastrointestinal Domain
				Genitourinary Domain and Other Domains
			2.4.2.3 Insight Measures
			2.4.2.4 Synchronicity Measures
	2.5 Perspectives for Improving Construct Validity in Interoception
	2.6 Conclusion
	References
Chapter 3: The Neural Basis of Interoception
	3.1 Introduction
	3.2 Definitions of Interoception
	3.3 Neural and Humoral Pathways Supporting Interoception
	3.4 Cortical and Limbic Areas Supporting Interoception
	3.5 Integration and Modulation of Interoceptive Information
	3.6 Priorities for Future Research on the Neural Basis of Interoception
	3.7 Conclusion
	References
Chapter 4: Being a Beast Machine: An Interoceptive Basis for Conscious Selfhood
	4.1 Introduction
	4.2 History
	4.3 What Is It Like to Be a Self?
	4.4 Interoceptive Inference
	4.5 (Un)reality of the Self
	4.6 Discussion and Conclusions
	References
Glossary
Chapter 5: The Role of Interoception in Emotion and Social Cognition
	5.1 What Is Interoception?
		5.1.1 Interoceptive System
		5.1.2 Interoceptive Traits
	5.2 Why Does Interoception Contribute to Emotion and Social Cognition?
		5.2.1 Interoception Supports Allostasis
			5.2.1.1 Setting the Stage: Allostatic Dependency and Interoception During Socioemotional Development
			5.2.1.2 Interoception, Allostatic Dependency, and Emotion
			5.2.1.3 Interoception, Allostatic Dependency, and Selfhood
		5.2.2 Summary
	5.3 Interoception and Social and Emotional Cognition in Adulthood
		5.3.1 Interoception and Emotion
		5.3.2 Interoception and Social Cognition
			5.3.2.1 Interoception and Selfhood
			5.3.2.2 Interoception and Affective and Social Perception
	5.4 Conclusion
	References
Chapter 6: The Impact of Interoception on Learning, Memory, and Decision-Making
	6.1 Introduction
	6.2 Interoceptive Dimensions and Their Impact on Cognition
	6.3 Interoception in Learning and Memory
		6.3.1 Implicit Learning Processes
			6.3.1.1 Fear Conditioning
			6.3.1.2 Implicit Learning and Memory Paradigms
		6.3.2 Explicit Learning Processes
			6.3.2.1 Emotion-Based Memory
			6.3.2.2 Hippocampal-Based Memory
	6.4 Interoception and Decision-Making
		6.4.1 Decision Making Under Uncertainty
		6.4.2 Decision-Making with Social Interaction
	6.5 Conclusions
	References
Chapter 7: Cognitive Processes Supporting Interoception and the Influence of Activation States
	7.1 Introduction
	7.2 Models of Interoception
		7.2.1 Deterministic Models
			7.2.1.1 The Process Model
			7.2.1.2 The Multi-faceted Model
			7.2.1.3 The 2 × 2 Factorial Model
			7.2.1.4 Multi-dimensional Framework Model
		7.2.2 Probabilistic Models
			7.2.2.1 Predictive Coding Model
	7.3 Attention
		7.3.1 Attentional Facets and Networks
		7.3.2 Attentional Systems Involved in Interoception
		7.3.3 HEPs as an Index of IAt
	7.4 Interoceptive Learning and Memory
		7.4.1 Perceptual Learning
		7.4.2 Classical Conditioning
	7.5 Activation States
		7.5.1 Stress
			7.5.1.1 Physiological Stress Axes
			7.5.1.2 Stress Effects on Receptor Stimulation and CNS Representation
			7.5.1.3 Stress Effects on Interoceptive Attention
			7.5.1.4 Stress Effects on Interoceptive Learning and Memory
			7.5.1.5 Chronic Stress
		7.5.2 Physical Exercise
			7.5.2.1 Baseline Interoception and Physical Fitness
			7.5.2.2 Exercise-Induced Changes in Interoception
		7.5.3 Food Deprivation
		7.5.4 Relaxation and Meditation
			7.5.4.1 States of Low Activation
			7.5.4.2 Resting Condition
			7.5.4.3 Standardized Procedures of Relaxation
		7.5.5 Sleep
			7.5.5.1 Theoretical Links Between Sleep and Interoception
			7.5.5.2 Sleep Stages
			7.5.5.3 Sleep Difficulties
		7.5.6 Implications for Probabilistic Models
	7.6 Attribution
	7.7 Conclusions
	References
Chapter 8: Interoception and Physical Health
	8.1 Introduction
	8.2 Interoception in Cardiorespiratory Disease
		8.2.1 Asthma
		8.2.2 Chronic Obstructive Pulmonary Disease (COPD)
		8.2.3 Cardiovascular Disease
	8.3 Interoception and Pain
	8.4 Interoception and Nutrition
		8.4.1 Hunger, Satiety, and Thirst
		8.4.2 Intuitive Eating
		8.4.3 Diet
	8.5 Interoception in Metabolic Disease
		8.5.1 Diabetes Mellitus
		8.5.2 Obesity
	8.6 Interoception and Physical Activity
	8.7 Conclusion
	References
Chapter 9: Interoception and Mental Health
	9.1 Introduction
	9.2 Interoception in Psychiatric Disorders
		9.2.1 Inequitable Investigation
		9.2.2 The Usual Suspects
			9.2.2.1 Major Depressive Disorder
			9.2.2.2 Eating Disorders
			9.2.2.3 Anxiety Disorders
				Panic Disorder
				Generalized Anxiety Disorder
				Social Anxiety Disorder
			9.2.2.4 Posttraumatic Stress Disorder
			9.2.2.5 Substance Use Disorders
		9.2.3 Knowledge Gaps
			9.2.3.1 Schizophrenia
			9.2.3.2 Autism Spectrum Disorder
			9.2.3.3 Bipolar Disorder
			9.2.3.4 Specific Phobia
			9.2.3.5 Obsessive Compulsive Disorder (OCD)
			9.2.3.6 Tic Disorders
			9.2.3.7 Borderline Personality Disorder
			9.2.3.8 Functional Disorders
	9.3 Interoceptive Approaches in Mental Health Treatment
		9.3.1 Putative Biomarkers
		9.3.2 Treatments
			9.3.2.1 Manipulating Signals
			9.3.2.2 Training to Improve Interoceptive Regulation
	9.4 Interoception as a Constituent of Well-Being
	9.5 Environmental Stressors
	9.6 Conclusion
	References
Chapter 10: Interoception Across the Lifespan
	10.1 Introduction
	10.2 Interoception in Infancy
		10.2.1 Pain Processing
		10.2.2 Affective Touch Processing
		10.2.3 Cardiac Processing
		10.2.4 Summary
	10.3 Interoception in Childhood
		10.3.1 Cardiac Perception
			10.3.1.1 Interoceptive Accuracy in the Cardiac Domain
			10.3.1.2 Neural Basis of Cardiac Interoception
			10.3.1.3 Relationship Between Cardiac Interoception and Other Psychological Processes
			10.3.1.4 Relationship Between Cardiac Interoception and Mental Health
			10.3.1.5 Relationship Between Cardiac Interoception and Physical Health
		10.3.2 Beyond Cardiac Interoceptive Accuracy
			10.3.2.1 Pain Perception
	10.4 Interoception in Adolescence
		10.4.1 Direct Investigation of Interoception in Adolescence
		10.4.2 Relationship Between Interoception and Mental and Physical Health
		10.4.3 Outstanding Questions
	10.5 Interoception in Late Adulthood
		10.5.1 Indirect Evidence
		10.5.2 Direct Investigation of Interoception in Late Adulthood
		10.5.3 Relationship Between Interoception and Other Psychological Processes
		10.5.4 Relationship Between Interoception and Mental Health
	10.6 Conclusion
	References
Chapter 11: Demographic Differences in Interoception
	11.1 Introduction
	11.2 Cultural Variation in Interoception
		11.2.1 Cultural Variation in Self-Reported Interoception
			11.2.1.1 Measuring Self-Reported Interoception Via the MAIA
			11.2.1.2 Self-Reported Interoception and Perceptions of the Body
			11.2.1.3 Mapping of Emotions onto the Body
			11.2.1.4 Interoceptive Attention to Specific Body Parts
			11.2.1.5 Interoceptive Attention and the Body in Social Situations
		11.2.2 Cultural Variation in Objective Interoceptive Accuracy
			11.2.2.1 Cultural Variation in Measures of Accuracy Revisited
			11.2.2.2 Cultural Variation in Related Interoceptive Phenomena
			11.2.2.3 Objective Interoceptive Accuracy and Bodily Self-Awareness
			11.2.2.4 Objective Interoceptive Accuracy and Body Image
			11.2.2.5 Culture and Psychopathology
			11.2.2.6 Culture and Somatisation
		11.2.3 Neurological Findings on the Link Between Culture and Interoception
		11.2.4 Summary: Cultural Differences in Interoception
	11.3 Sex and Gender Differences in Interoception
		11.3.1 Evidence for Sex and Gender Differences in Interoception
			11.3.1.1 Interoceptive Accuracy
			11.3.1.2 Methodological Differences
			11.3.1.3 Self-Report Measures
			11.3.1.4 Section Summary
		11.3.2 Causes of Sex and Gender Differences in Interoception
			11.3.2.1 Neuroanatomy
			11.3.2.2 Anatomical and Functional Differences
			11.3.2.3 Signal Strength
			11.3.2.4 Physiological and Hormonal Changes
			11.3.2.5 Stress
			11.3.2.6 Use of Internal and External Cues
			11.3.2.7 Socialisation
			11.3.2.8 Section Summary
		11.3.3 Implications of Sex and Gender DifferencesGender differences in Interoception
			11.3.3.1 Mental Health
			11.3.3.2 Somatisation and Somatic Symptom Disorder
			11.3.3.3 Emotion and Cognitive Domains
			11.3.3.4 Section Summary
		11.3.4 Summary: Sex and Gender DifferencesGender differences in Interoception
	11.4 Chapter Summary: Demographic Differences in Interoception
	References
Chapter 12: Interoceptive Interventions
	12.1 Introduction
	12.2 Chronic Somatic Disease: Examples in Asthma and Diabetes
		12.2.1 Training in Perception of Lung Function in Asthma
		12.2.2 Training of Blood Glucose Control in Diabetes
	12.3 Psychopathology: Example in Anxiety Disorders
		12.3.1 Interoceptive Exposure Therapy
		12.3.2 Hypoventilation Training as Interoceptive Exposure
		12.3.3 Interoceptive Signals as Early Warning Signs of Impending Syncope in Blood-Injection-Injury Phobia
	12.4 Interoceptive Training for Stress Management and General Well-being
		12.4.1 Jacobsen’s Progressive Muscle Relaxation
		12.4.2 Autogenic Training
		12.4.3 Mindfulness Meditation
		12.4.4 Body Scan
		12.4.5 Yoga Techniques
	12.5 Conclusion: Challenges and Perspectives
	References
Chapter 13: Interoception: Where Next?
Index