Urinary incontinence after a stroke significantly affects patient outcomes and quality of life. It is commonly associated with uninhibited detrusor contractions, but the underlying neural mechanisms remain poorly understood. This study aimed to explore the brain activity patterns associated with volitional and involuntary bladder contractions in stroke survivors.

This cohort study enrolled 15 stroke survivors with documented urinary incontinence and 9 healthy controls. Participants underwent simultaneous blood oxygen level-dependent functional magnetic resonance imaging of the brain and urodynamics, capturing 25 involuntary and 23 volitional bladder emptying events in patients with stroke and 35 volitional voiding events in healthy individuals. We used general linear modeling in functional magnetic resonance imaging analysis to discern neural activity patterns during these events and in the phases leading up to them, aiming to identify neural mechanisms underlying involuntary versus volitional urinary control. Statistical significance for neuroimaging analyses was set at P<0.005 with a minimum cluster size of 25 voxels.

During volitional emptying events, both healthy controls and stroke survivors exhibited increases in activation in regions implicated in sensorimotor control and executive decision-making, such as the brainstem, cingulate cortex, prefrontal cortex, and motor areas. In contrast, involuntary emptying events were associated with minimal changes in brain activity, suggesting minimal cortical involvement. Bladder filling preceding volitional contractions was associated with activity in the salience network (insula, anterior cingulate gyrus) in stroke survivors and healthy controls. Conversely, although there was an increase in overall blood oxygen level-dependent signal, activation of the salience network was conspicuously absent during bladder filling preceding involuntary contractions.

The findings suggest that the salience network plays an important role in maintaining urinary continence in stroke survivors. The inability to activate the salience network may underpin the pathophysiology of poststroke urinary incontinence. Interventions aimed at modulating this network could potentially ameliorate lower urinary tract symptoms in this patient population.

URL: https://www.clinicaltrials.gov; Unique identifier: NCT05301335.

At the start of the twenty-first century, Arthur D. (Bud) Craig brought back to the fore the Island of Reil (insular cortex or insula). He did so by following, step by step, with rigor and tenacity, the afferent sensory pathway that informs the forebrain about the ongoing physiological status of the organs and tissues of the body. Along with his demonstration of the existence of a primate-specific ascending interoceptive pathway and his subsequent re-interpretation of Sherrington's concept of interoception, Bud Craig's seminal experiments and profound interpretations led him to make the groundbreaking proposals that the dorsal posterior insular cortex provides an ideal substrate for James's concept of emotional embodiment, that the insular cortex contextualizes interoception across a posterior-to-mid-to-anterior integration with multimodal activities, and that the anterior insular cortex has a crucial role in the evolutionary emergence of the awareness of subjective feelings in humans, for the purpose of optimizing metabolic energy usage. Bud Craig's unique work paves the path for further elucidation of the role of the insula and other brain regions in subjective feelings. His discoveries and proposals rest on implacable attention to neuroanatomical and neurophysiological details and a serendipitous quest for the fundamental evolutionary Logic of Life. This chapter provides a detailed description of the ascending interoceptive pathway and the functional and comparative neuroanatomy of the insular cortex in primates. Building on Bud Craig's work, our recent findings suggest that the primary interoceptive cortex serves as a representation of the spino-solitary-parabrachial neuraxis, merging with posterior-to-mid-anterior and dorsal-to-ventral processing streams that form a latticework integration pattern. At the ventral anterior tip of this integration, the von Economo neuron area closes the corticofugal interoceptive-autonomic loop of the sensory-motor homeostatic system through projections to all brainstem nuclei integrating interoceptive afferences.

Breathing plays a critical role not only in homeostatic survival, but also in modulating other non-interoceptive perceptual and affective processes. Recent evidence from both human and rodent models indicates that neural and behavioural oscillations are influenced by respiratory state as breathing cycles from inspiration to expiration. To explore the mechanisms behind these effects, we carried out a psychophysical experiment where 41 participants categorised dot motion and facial emotion stimuli in a standardised discrimination task. When comparing behaviour across respiratory states, we found that inspiration accelerated responses in both domains. We applied a hierarchical evidence accumulation model to determine which aspects of the latent decision process best explained this acceleration. Computational modelling showed that inspiration reduced evidential decision boundaries, such that participants prioritised speed over accuracy in the motion task. In contrast, inspiration shifted the starting point of affective evidence accumulation, inducing a bias towards categorising facial expressions as more positive. These findings provide a novel computational account of how breathing modulate distinct aspects of perceptual and affective decision-dynamics.

Empathic pain, defined as the emotional resonance with the suffering of others, is akin to the observer's own experience of pain and is vital for building and sustaining positive interpersonal relationships. Despite its importance, the neural mechanism of empathic pain remains poorly understood. In this review, we integrated and summarized the currently knowledge on the neural networks associated with empathic pain, focusing on key brain regions such as the insula, anterior cingulate cortex (ACC), ventral tegmental area (VTA), nucleus accumbens (NAc), and locus coeruleus (LC)/norepinephrine (NE)-sympatho-adrenomedullar (LC/NE-SAM) system. We also reviewed the factors that affect empathic pain, including gender, personal beliefs, the intimacy of relationships, and the nature of interpersonal relationships, and highlighted the central role of the insula and ACC in the neural circuitry of empathy, the importance of the IC-BLA and ACC-NAc/VTA connections in modulating empathic pain, and the involvement of the LC/NE-SAM system in mediating pain empathy. We further discussed how gender significantly influences empathic pain, with women showing more intense emotional reactions to social distress than men. It also summarized the roles of personal pain history and empathy levels in modulating empathic responses. Furthermore, the review emphasized the impact of social factors such as the nature of interpersonal relationships and experiences of social exclusion on empathic pain. By providing a detailed exploration of the neural mechanisms and influencing factors of empathic pain, this review aims to establish a robust foundation for developing targeted therapeutic strategies and improving pain management in clinical settings.

This chapter focuses on the interconnectedness of bodily awareness, emotion, and time perception, focusing on the roles of interoception and anticipation, pioneered by A.D. (Bud) Craig and advanced by contemporary research. Pain, a pivotal aspect of human experience, serves as a conduit for understanding our relationship with the world. Anticipation of pain, vital for survival, influences subjective pain experiences and is modulated by factors such as physiological reactivity and contextual cues. Emotional states significantly shape pain perception, with chronic pain conditions and affective disorders characterized by dysregulated pain modulation mechanisms. We discuss a state space model for pain, wherein pain functions as a latent construct shaped by both anticipatory and contemporaneous factors. Understanding these mechanisms is critical for informing clinical interventions aimed at pain management and highlights the intersection of interoception, emotion, and pain.

Identifying lesion sites associated with central poststroke pain (CPSP) may facilitate targeted screening for early symptoms, possibly even paving the way for preventive measures and earlier treatment initiation. Here, we test the hypothesis that damage to a nociceptive pathway extending from the brainstem to the cerebral cortex, and including white matter tracts, is associated with CPSP. We investigated the lesion locations of 72 patients with CPSP relative to poststroke comparison subjects without pain (n = 123), divided into a discovery and independent validation data set. The study included three main analyses: (1) we compared lesion intersection with our a priori region of interest (ROI) between groups with and without CPSP, (2) we performed lesion-symptom mapping to evaluate whether lesions associated with CPSP localize to the a priori ROI, and (3) we used lesion network mapping to infer the broader structural and functional connectivity patterns associated with CPSP lesions. CPSP lesions overlapped the nociceptive pathway ROI to a greater extent than comparison lesions. Lesion-symptom mapping identified a CPSP-associated region overlapping with the ventrocaudal thalamus and adjacent white matter, which was located mostly within the a priori ROI. Lesion network mapping demonstrated that lesions associated with CPSP disrupt nodes and tracts of the nociceptive pathway ROI. Interestingly, the CPSP lesion network results demonstrated connectivity to intereffector nodes of the primary motor cortex, providing a novel link between CPSP and the somato-cognitive action network. Together, these findings indicate that CPSP can be conceptualized as a lesion-associated network disruption of the nociceptive pathway and somato-cognitive action network.

Within a theoretical framework of enactive allostasis, we explore active inference strategies for minimizing surprise to achieve resilience in dynamic environments. While individual differences and extrinsic protective factors traditionally account for variability in resilience trajectories following stressor exposure, the enactive model emphasizes the importance of the physical and social environment, specifically the "enactive niche," which is both shaped by and impacts organisms living in it, accounting for variable success in allostatic prediction and accommodation. Enactive allostasis infers or predicts states of the world to minimize surprise and maintain regulation after surprise, i.e., resilience. Action policies are selected in accordance with the inferred state of a dynamic environment; those actions concurrently shape one's environment, buffering against current and potential stressors. Through such inferential construction, multiple potential solutions exist for achieving stability within one's enactive niche. Spanning a range of adaptive resilience strategies, we propose four phenotypes-fragile, durable, resilient, and pro-entropic (PE)-each characterized by a constellation of genetic, epigenetic, developmental, experiential, and environmental factors. Biological regulatory outcomes range from allostatic (over)load in the fragile and durable phenotypes, to allostatic recovery in resilience, and theoretically to increasing allostatic accommodation or "growth" in the proposed PE phenotype. Awareness distinguishes phenotypes by minimizing allostatically demanding surprise and engenders the cognitive and behavioral flexibility empirically associated with resilience. We further propose a role for awareness in proactively shaping one's enactive niche to further minimize surprise. We conclude by exploring the mechanisms of phenotypic plasticity which may bolster individual resilience.

Although sensory integration impairment and atypical bodily perception were long-lasting described in youths with psychopathology, the contribution of interoceptive deficits in pediatric mental health problems remains poorly understood. A systematic search of PubMed, Medline, Cochrane, Psycinfo, and reference lists of the included studies was conducted for articles up to November 2024. Attention was paid to distinguishing objective performance on behavioral tests (i.e., interoceptive accuracy, IAc), subjective self-assessment of competence (i.e., interoceptive sensibility, ISe), the congruence level between objective performance and subjective self-assessment (i.e., interoceptive awareness, IAw) and beliefs on interoception (interoceptive metacognition, IMe). The quality of studies was assessed using a modified version of the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. Of the 761 citations initially identified, 24 studies were finally included. IAc appeared reduced in youths with neurodevelopmental disorders, with mitigated findings regarding anxiety symptoms. ISe were positively correlated with the severity of anxiety and depressive symptoms in pediatric samples. The domain of IMe was particularly impaired among youths with eating disorder symptoms. The review identified few and highly heterogeneous studies. Such preliminary findings support the importance of accounting for different constructs related to interoception and including a trans-nosographical framework of psychopathology to explore these relations.

Endometriosis is a chronic inflammatory gynaecological condition frequently associated with chronic pelvic pain. Visceral hypersensitivity could be present, like in other chronic pain conditions, causing altered levels of interoception. So far, studies have explored interoceptive deficits in chronic pain individuals mainly using questionnaires or cardiac interoceptive accuracy tasks. Here, we explore the cardiac, gastric, and urinary domains to probe interoceptive differences between patients with endometriosis and healthy women. 30 patients and 30 controls underwent three interoceptive tasks for assessing the cardiac domain (using the Heartbeat Counting Task, HCT), the gastric domain (using the Water Load Test-II, WLT-II) and the bladder domain (using a novel Urinary Interoceptive Task, UIT). Participants also completed bladder interoceptive beliefs measures and subjective pain ratings for each endometriosis symptom (dysmenorrhea, dyspareunia, dyschezia, chronic pain). A positive correlation between the WLT-II and the UIT emerged in all participants (R = 0.47, p < 0.001), indicating that the lower the gastric interoceptive abilities, the lower the urinary ones. Moreover, compared to healthy controls, women with endometriosis exhibited lower scores in the WLT-II (t(58) = 4.6814, p < 0.001) and the UIT (t(39.931)= 5.1462, p < 0.001), as well as higher scores in the subjective bladder beliefs questions (t(57.346)= -4.0304, p < 0.001). Results indicate a dissociation between patients' poor objective performance on interoceptive tasks and their high bladder interoceptive beliefs. UIT scores were associated with pain symptoms, suggesting that patients, probably due to sensitisation, struggle to ignore discomfort sensations, resulting in reduced accuracy in detecting physiological signals coming from the pelvic area.

Insular epilepsy poses significant diagnostic challenges due to its distinctive anatomical location and heterogeneous clinical manifestations. This study aims to develop a comprehensive classification system based on anatomo-electro-clinical features through stereoelectroencephalography (SEEG) analysis. The research seeks to elucidate the specific correspondence between clinical phenotypes and ictal electro-anatomical propagation patterns, investigate the network dynamics underlying various clinical phenotypes, and establish a theoretical framework for the precise diagnosis and personalized treatment of insular epilepsy.

This single-center retrospective case series included 20 patients with pure insular epilepsy confirmed by stereoelectroencephalography (SEEG) who were treated at Guangdong Sanjiu Brain Hospital between January 2015 and July 2024. The cohort comprised 12 males and 8 females with a mean age of 14.25 ± 9.8 years. All patients underwent individualized SEEG electrode implantation (mean 12.5 ± 2.3 electrodes per patient), comprehensively covering all insular subregions (anterior and posterior insula) and key brain areas in potential propagation pathways. A standardized protocol was employed for systematic analysis of: (1) ictal onset zone localization and electro-anatomical propagation patterns; (2) ictal semiology and clinical phenotype analysis based on video-SEEG recordings; and (3) surgical strategies, pathological findings, and outcome assessment (Engel classification, with follow-up periods ranging from 6 months to 8 years).

The study identified five characteristic clinical phenotypes: the BATS phenotype (35.0 %), tonic-hypermotor phenotype (25.0 %), hypermotor-autonomic phenotype (25.0 %), pure sensory phenotype (10.0 %), and pure autonomic phenotype (5.0 %). These phenotypes demonstrated specific correspondence with six distinct SEEG propagation patterns. Posterior insular epilepsy (70.0 %) preferentially propagated through sensorimotor networks, whereas anterior insular epilepsy (30.0 %) primarily spread via limbic system networks. Focal cortical dysplasia was the predominant pathological finding (94.7 %). All surgical patients (n = 19) achieved Engel Ia outcome, with follow-up periods ranging from 6 months to 8 years.

This study established an anatomo-electro-clinical classification system for insular epilepsy and elucidated the specific correspondence between clinical phenotypes and neuronal network propagation patterns. This correspondence reflects the characteristic propagation of epileptic activity through pre-existing functional connectivity networks, providing a theoretical foundation for the precise diagnosis and personalized treatment of insular epilepsy.

The pain-suicide relationship is one of the most debated in recent literature, but theories and clinical evidence have often reached contrasting conclusions. Through a critical overview of theoretical, meta-analytical and empirical contributions, we aimed at advancing the conversation on the pain-suicide relationship by integrating research on related concepts, specifically inflammation and dissociation, and their effects on interoceptive processes and pain perception.

Ideation-to-action theories consider increased pain tolerance a key risk factor for the transition from suicidal ideation to attempt. However, several meta-analytical findings suggest that suicidal thoughts and behaviors are associated with inflammation-induced pain sensitization. On the one hand, inflammation contributes to the development and maintenance of chronic pain conditions and mood disorders, and is associated with interoceptive hypervigilance and pain hypersensitivity. Moreover, a trait of increased pain tolerance does not seem to distinguish the individuals attempting suicide among those living with suicidal thoughts. On the other, temporary hypoalgesia is often activated by dissociative experiences. Highly dissociative individuals can indeed be exposed to frequent disintegration of interoceptive processes and transitory hyposensitivity to pain. In light of this, two different patterns of responses to stress (i.e. inflammation vs. dissociation) may characterize different kinds of patients at risk of suicide, associated with specific patterns of interoceptive functioning, pain sensitivity and possibly suicidal ideation. This proposition is partially supported by neuroimaging studies on post-traumatic stress disorder and psychodynamic perspectives on neurodevelopment, as well as alternative clustering models of suicidal behavior. Theoretical, meta-analytical and neurobiological evidence highlight two opposite directions in the pain-suicide relationship: hyper- vs. hyposensitivity. Such contrasts may be explained by the existence of two tendencies in stress-response, namely inflammation and dissociation, defining two different subtypes of patients at risk of suicide. We thus propose the existence of a hypersensitive subtype, defined by underlying neuroinflammatory processes, increased vulnerability to chronic pain and mood disorders, interoceptive hypervigilance, pain hypersensitivity and potentially more persistent suicidal ideation. We further hypothesize a dissociative subtype, characterized by greater trait dissociation, vulnerability to depersonalization and derealization, frequent disintegration of interoceptive processes, transient pain hyposensitivity and abrupt peaks in suicidal ideation.

Due to the absence of objective diagnostic criteria, tinnitus diagnosis primarily relies on subjective assessments. However, its neuropathological features can be objectively quantified using electroencephalography (EEG). Despite the existing research, the pathophysiology of tinnitus remains unclear. The objective of this study was to gain a deeper comprehension of the neural mechanisms underlying tinnitus through the comparison of cognitive event-related potentials in patients with tinnitus and healthy controls (HCs). Furthermore, we explored the potential of EEG-derived features as biomarkers for tinnitus using machine learning techniques.

Forty-eight participants (24 patients with tinnitus and 24 HCs) underwent comprehensive audiological assessments and EEG recordings. We extracted N2 and P3 components of the midline electrodes using an auditory oddball paradigm, to explore the relationship between tinnitus and cognitive function. In addition, the current source density for N2- and P3-related regions of interest was computed. A linear support vector machine classifier was used to distinguish patients with tinnitus from HCs.

The P3 peak amplitudes were significantly diminished in patients with tinnitus at the AFz, Fz, Cz, and Pz electrodes, whereas the N2 peak latencies were significantly delayed at Cz electrode. Source analysis revealed notably reduced N2 activities in bilateral fusiform gyrus, bilateral cuneus, bilateral temporal gyrus, and bilateral insula of patients with tinnitus. Correlation analysis revealed significant associations between the Hospital Anxiety and Depression Scale-Depression scores and N2 source activities at left insula, right insula, and left inferior temporal gyrus. The best classification performance showed a validation accuracy of 85.42%, validation sensitivity of 87.50%, and validation specificity of 83.33% in distinguishing between patients with tinnitus and HCs by using a total of 18 features in both sensor- and source-level.

This study demonstrated that patients with tinnitus exhibited significantly altered neural processing during the cognitive-related oddball paradigm, including lower P3 amplitudes, delayed N2 latency, and reduced source activities in specific brain regions in cognitive-related oddball paradigm. The correlations between N2 source activities and Hospital Anxiety and Depression Scale-Depression scores suggest a potential link between the physiological symptoms of tinnitus and their neural impact on patients with tinnitus. Such findings underscore the potential diagnostic relevance of N2- and P3-related features in tinnitus, while also highlighting the interplay between the temporal lobe and occipital lobe in tinnitus. Furthermore, the application of machine learning techniques has shown reliable results in distinguishing tinnitus patients from HCs, reinforcing the viability of N2 and P3 features as biomarkers for tinnitus.

Mindfulness-Based Stress Reduction (MBSR) helps counteract the negative consequences of stress. An essential aspect of mind-body therapies is learning to be mindful of emotional reactions and bodily sensations, a process defined as interoceptive awareness. This awareness can also be enhanced by providing physiological feedback from a smartwatch. However, the impact of using smartwatch-generated physiological signals during mindfulness training has not been studied yet. The study aims at verifying, whether physiological signals from a smartwatch would support the MBSR.

We conducted a mixed-design randomized controlled trial to investigate the effects of MBSR training, with and without monitoring physiological signals via a smartwatch, on mental functioning parameters, with measurements taken at baseline and after 8 weeks. Participants were classified into three groups (N = 72): the MBSR group, the MBSR + smartwatch group, and the control group. Between measurement sessions, two groups of participants were engaged in MBSR training, while the third group did not participate in any training.

Results showed a significant reduction in subjectively perceived stress levels, eating disorder symptoms, and intrusive ruminations in both groups participating in MBSR, compared to the control group. However, a notable difference emerged between the two MBSR groups: in the group with smartwatches, a significant increase in mindfulness was observed. In contrast, in the MBSR group without smartwatches, there was a significant decrease across multiple stress-related components, including: anxiety, cognitive impairment, addictions, sleep disorders symptoms, behaviors indicating lack of entertainment, and poor functioning.

The results suggest that supplementing MBSR with monitoring interoceptive signals by a smartwatch enhances mindfulness, and maintains the effect of stress and eating disorders symptoms reduction but does not decrease anxiety nor improve general mental functioning. This imposes the need for further research to investigate mechanisms involved when observing interoceptive signals by a smartwatch.

The sensation of dyspnea is related to various cardiopulmonary and neuromuscular diseases and is characterized by its sensory and affective qualities. Although there is a vast number of studies investigating its pathophysiology, less is known about the neuroanatomy of dyspnea perception. An activation likelihood estimation (ALE) meta-analysis of 13 studies investigating different breathing challenges using either PET or fMRI was performed to demonstrate the neuroanatomical correlates of dyspnea perception. The ALE meta-analysis was performed using the GingerAle software 3.0.2 and was displayed with the Mango software 4.1. Synthesizing the results of all included studies, clusters involving the insula and cingulated cortex in both hemispheres were observed. Subgroup analysis for the restrained breathing condition revealed activation involving the right and left cingulate cortex and left anterior cingulate cortex. For the loaded breathing condition, statistically significant activation was found for the postcentral gyrus, the superior temporal gyrus, and the right thalamus. The combined ALE map for both conditions showed activity patterns in the right cingulate cortex, the right insula, and the right thalamus. This ALE meta-analysis demonstrates that two separate neuronal pathways related to either the affective or intensity domain are involved in the central processing of dyspnea perception.

Interoception may be linked to central sensitization in chronic pain.

We aimed to provide evidence about the role of interoceptive sensibility on central sensitization in vulvodynia.

In this cross-sectional study, a sample of females who received a diagnosis of vulvodynia filled out validated questionnaires relative to the individual level of interoceptive sensibility and the symptoms of central sensitization.

Interoceptive sensibility and symptoms of central sensitization were measured with the Multidimensional Assessment of Interoceptive Awareness and the Central Sensitization Inventory, respectively.

A lower level of trust and a higher level of emotional awareness predicted a higher number of central sensitization symptoms in our sample.

Our evidence may increase the researchers' and physicians' attention toward the involvement of the central nervous system in pain phenomenology in vulvodynia.

No ad-hoc control sample was collected. No behavioral assessments about interoception were performed.

As registered in other chronic pain conditions, interoceptive sensibility may play a crucial role in the expressions of symptoms of central sensitization in vulvodynia.

Neuroscientists in decision science have advanced an affect-integration-motivation (AIM) framework, demonstrating that neural activity associated with positive affect or value integration can predict individual and aggregate choice. Given that individuals with higher interoceptive sensibility (IS) have tendency to engage their bodily sensations and thus exhibit a more coherent pattern between their neural, affective, and behavioral measures, we investigated how IS may interact with the affective/integrative components for predicting individual and aggregate choice. Thus, we 1) explored neural underpinnings of individual choice, affective ratings, aggregate outcomes, 2) examined how the above-mentioned measures predict individual and aggregate choices on mobile games, and 3) tested the moderation effect of IS by comparing the differences in how these measures perform in prediction models between subgroups of IS. Neuroimaging results showed that individual choice associated with NAcc activity, aggregate download rate tracked by regions in salience network, and revenue additionally tracked by regions in motor tendency and attention regulation. Affective ratings and AIns activity predicted individual download choice; mPFC activity forecasted aggregate download rate, and positive arousal forecasted aggregate revenue. As hypothesized, the high IS group displayed coherent correlations between affective ratings, individual choice, and neural measures. More importantly, at the aggregate level, mPFC activity (integrative component), forecasted aggregate download rate above and beyond ratings and individual choice in the high IS group, with this prediction significantly stronger compared with the low IS group. These findings extend the AIM framework by shedding light on the influence of interoceptive sensibility on the neurobehavioral mechanisms underlying human decision-making.

Several influential theories have proposed that interoceptive signals, sent from the body to the brain, contribute to neural processes that coordinate complex behaviors. We altered the physiological state of the body using compounds that have minimal effect on the brain and evaluated their effect on decision making in rhesus monkeys. We used glycopyrrolate, a nonspecific muscarinic (parasympathetic) antagonist, and isoproterenol, a beta-1/2 (sympathetic) agonist, to create a sympathetic-dominated state in the periphery, that was indexed by increased heart rate. Rhesus monkeys were trained on two variants of an approach-avoidance conflict task. The tasks offered a choice between enduring mildly aversive stimuli in exchange for a steady flow of rewards, or canceling the aversive stimuli, forgoing the rewards. The latency to interrupt the aversive stimuli was used as a measure of monkeys' tolerance for contact with a hot but not painful stimulus or airflow directed at their muzzle. Both drugs reduced tolerance for the aversive stimuli. To determine whether the drug-induced autonomic state reduced the subjective value of the reward, we tested the effects of glycopyrrolate on a food preference task. Food preference was unaltered, suggesting that the sympathetic dominated state in the periphery selectively reduces tolerance for aversive stimuli without altering reward-seeking behaviors. As the drugs used are expected to have little or no direct effect on the brain, the observed biases in decision making are likely induced by interoceptive afferents that signal to the brain the physiological state of the body.

The number of mindfulness-based wellness promotion programs offered by institutions, by governments, and through mobile apps has grown exponentially in the last decade. However, the scientific understanding of what mindfulness is and how it works is still evolving. Here, I focus on 2 common mindfulness practices: focused attention (FA) and open monitoring (OM). First, I summarize what is known about FA and OM meditation at the psychological level. While they share similar emotion regulation goals, they differ in terms of some of their attention regulation goals. Second, I turn to the neuroscientific literature, showing that FA meditation is associated with consistent activations of cortical control network regions and deactivations of cortical default network regions. In contrast, OM meditation seems to be most consistently associated with changes in the functional connectivity patterns of subcortical structures, including the basal ganglia and cerebellum. Finally, I present a novel account of the mental changes that occur during FA and OM meditation as understood from within the Dynamic Framework of Thought-a conceptual framework that distinguishes between deliberate and automatic constraints on thought. Although deliberate self-regulation processes are often emphasized in scientific and public discourse on mindfulness, here I argue that mindfulness may primarily involve changes in automatic constraints on thought. In particular, I argue that mindfulness reduces the occurrence of automatized sequences of mental states or habits of thought. In this way, mindfulness may increase the spontaneity of thought and reduce automatically constrained forms of thought such as rumination and obsessive thought.

Anxiety disorders, affecting approximately one in nine individuals globally, impose significant socioeconomic and health burdens, with many individuals failing to achieve symptom remission despite standard treatments. Difficult-to-Treat Anxiety (DTA) encompasses a broad spectrum of persistent anxiety disorders that remain refractory to conventional interventions, necessitating a shift from rigid response-based criteria to a mechanistically driven framework integrating computational psychiatry and systems neuroscience. Central to DTA is dysregulated approach-avoidance decision-making, where heightened punishment sensitivity, inflexible belief updating, and uncertainty misestimation drive persistent avoidance behaviors and reinforce maladaptive anxiety cycles. Computational modeling of reinforcement learning tasks reveals exaggerated Pavlovian biases and impaired exploratory learning, while predictive processing models highlight overestimation of threat and rigidity in safety learning, perpetuating chronic anxiety. Neural dysfunction in default mode and negative affective networks, characterized by hyperstable attractor states in the amygdala and impaired top-down regulation by the prefrontal cortex, further sustains maladaptive anxiety states. Novel interventions targeting these dysfunctions-such as neuromodulation, precision pharmacotherapy, and personalized digital therapeutics-offer potential breakthroughs in managing DTA. This review synthesizes current evidence on computational, neural, and behavioral mechanisms underlying DTA, proposing an integrative, process-targeted approach to assessment and treatment. Future research must refine biomarker-driven subtyping and individualized interventions, moving beyond trial-and-error approaches toward mechanistically informed, precision psychiatry for persistent anxiety disorders.

A.D. (Bud) Craig (1951-2023) redefined the concept of interoception and provided a novel, revolutionary understanding of the neural basis for human awareness. In unsurpassed anatomical-physiological studies in monkeys, Craig showed that the insular cortex is the primary sensory cortex for interoception, or the image of the "material me" that provides a homeostatic representation of the physiological condition of the body. He showed that the insula contains a postero-anteriorly organized somatotopic map of the interoceptive sensations, and that it encodes both the localization and the intensity discrimination of interoceptive sensations. In seminal work in humans, he demonstrated that the interoceptive feelings are re-represented, and multimodally integrated, in anterior portions of the insula in sequence of increasingly homeostatically efficient representations that integrate all salient neural activity. He further showed that subjective awareness is associated with activation of the anterior insular cortex and suggested that this brain region also is critical for fluid intelligence and the perception of time. His work has led to a paradigm shift in our understanding of interoception and how interoceptive sensations underlie consciousness, a topic that long has been considered elusive, or even beyond our comprehension.

Interoception refers to the sensation of internal and physiological bodily states, such as heart rate, and contributes to the maintenance of bodily internal homeostasis. Some studies showed that interoceptive awareness is related to experiencing nightmares and subjective sleep quality. Similarly to the perception of heart rate variability, sleepiness is thought to be mainly evoked by homeostatic processes and is based on the awareness and recognition of internal body signals. However, the relationship between subjective excessive daytime sleepiness and interoceptive awareness has not been addressed. Therefore, this study examined the relationship between interoceptive awareness and multiple sleep variables including subjective excessive sleepiness in daytime workers. A web questionnaire survey was conducted targeting daytime workers in Japan, and data from 461 participants were used for analyses. Multiple regression analyses showed weak but significant relationships between subjective excessive daytime sleepiness, insomnia symptoms, nightmare distress, and dream frequency and the components of interoception awareness measured by the Multidimensional Assessment of Interoceptive Awareness. However, no components of interoceptive awareness were related to workday sleep loss or social jetlag of day workers. The results of this study suggest that subjective sleepiness, in addition to nightmare distress and sleep quality, is associated with interoceptive awareness. To the best of our knowledge, this study is the first to analyze the relationship between subjective daytime excessive sleepiness and interoceptive awareness. Further investigation of this relationship is expected to lead to a better understanding of sleep disorders and to elucidate individual differences in the accuracy of subjective assessments of sleepiness.

Alexithymia is a subclinical condition that affects individuals' processing of emotions. Emerging evidence suggests that alexithymia results from a multidomain and multidimensional interoceptive failure. Although extensive research has examined the relationship between alexithymia and interoception, less is known about how alexithymia modulates the brain activity evoked by interoceptive sensations. In this study, we used task-based functional magnetic resonance imaging (fMRI) to assess intersubject correlations in response to interoceptive sensation words in individuals with high alexithymia and low alexithymia. Participants with high alexithymia (n = 29) and low alexithymia (n = 28) were instructed to view words during MRI scanning, each word corresponding to a specific emotional category related to interoceptive sensations. Intersubject correlation analysis identified several brain regions exhibiting increased synchronization in individuals with high alexithymia, including those involved in cognitive control. Follow-up analyses revealed that the left middle occipital gyrus and the right inferior frontal gyrus (orbital part) were more active during interoceptive sensation events in individuals with high alexithymia. Validation analyses revealed that the amygdala and insula are also crucial in representing interoceptive sensations. These findings shed light on the neural basis of interoceptive deficits in high alexithymia and have significant implications for the mechanisms regulating these differences.

Visual stimulation to the embodied virtual body could modulate human perception, however the associated neurophysiological mechanisms have not elucidated yet. The present study aimed to reveal the underlying neurophysiological mechanisms from a neurophysiological viewpoint. Fifteen healthy participants were subjected to three visual conditions (i.e., fire, water, and non-visual effect conditions) and psychological pain stimulation (thermal grill stimulation). Oscillatory neural activities during stimulation were measured with electroencephalogram. The association between accessory visual stimulation applied to the embodied virtual body, induced by virtual reality, and perception was examined through neuronal oscillatory analysis using electroencephalogram data. Regression analysis was performed to obtain data on brain regions contributing to sensory modulation with body illusion. The results of subjective measures under the fire and water conditions showed that thermal perception were modulated by a visual stimulus to the virtual hand. Furthermore, we found that the insula was commonly associated with thermal perception under the fire and water conditions. This result indicate that the insula may control sensory information as a gatekeeper as well as facilitate the access to human attention and cognition as a hub, suggesting the influence on perception and cognition.

Concepts have traditionally been categorized as either concrete (e.g., ROSE) or abstract (e.g., ROMANCE) based on whether they have a direct connection to external sensory experience or not. However, there is growing consensus that these conceptual categories differ in their reliance on various additional sources of semantic information, such as motor, affective, social, and linguistic experiences, and this is reflected in systematic differences in the semantic properties that typically contribute to their informational content. However, it remains unclear whether concrete and abstract concepts also differ in how their constituent semantic properties relate to one another. To explore this, we compared the organization of 15 semantic dimensions underlying concrete and abstract concept knowledge using data-driven network analyses. We found striking differences in both (1) the centrality of conceptual properties and (2) their pairwise partial correlations. Distinct sensorimotor dimensions emerged as pivotal in organizing each concept type: haptic information for concrete concepts, and interoception and mouth action for abstract concepts. Social content was higher in abstract concepts. However, it played a more central role in structuring concrete meanings, suggesting distinct contributions of social experience to each concept type. Age of acquisition was related exclusively to dimensions quantifying sensorimotor and affective experiences, with sensorimotor properties supporting the acquisition of concrete concepts and affective properties contributing more to the acquisition of abstract concepts. Overall, our findings offer novel insights into the interplay between the diverse sources of semantic information proposed by multiple representation theories in shaping both abstract and concrete concept knowledge.

Sensory phenomena (SP) are aversive sensations driving repetitive behaviors in obsessive-compulsive disorder (OCD) and Tourette's disorder that are not well addressed by standard treatments. SP are related to the functioning of an interoceptive-sensorimotor circuit that may be modulated by the 5-HT3 receptor antagonist ondansetron. The present study employed an experimental medicine approach to test the effects of 4 weeks of high-dose ondansetron compared to placebo on SP severity and brain connectivity in a cohort of individuals with OCD and/or Tourette's disorder.

Of 51 participants who completed the study, 27 were assigned to receive 24 mg/day of ondansetron and 24 to receive placebo. Analyses examined changes in SP severity and, for participants with OCD, overall OCD severity from baseline to final visit. Functional MRI data were collected at both visits for analysis of intrinsic functional connectivity metrics characterizing global correlation (reflecting area "hubness") and local correlation (reflecting near-neighbor coherence).

There were no significant differences between ondansetron and placebo in the reduction of SP or overall OCD severity in the full sample. In a subsample of participants with OCD taking concomitant serotonin reuptake inhibitors (SRIs), ondansetron was associated with a significant decrease in overall OCD severity and global connectivity of the medial sensorimotor cortex compared with placebo. Longitudinal reductions in SP severity were related to decreases in right sensorimotor hubness in both groups, and to brainstem local coherence only in participants taking ondansetron.

There was no effect of high-dose ondansetron on SP. However, when used as an augmentation to SRIs, ondansetron reduced overall OCD severity, which may be related to changes in the "hubness" of the sensorimotor cortex. Ondansetron's ability to modulate brainstem connectivity may underlie its variable effectiveness in reducing SP.

Aberrant interoceptive processing has been hypothesized to contribute to the pathophysiology of functional neurological disorder, although findings have been inconsistent. Here, we utilized functional magnetic resonance imaging (fMRI) to examine neural correlates of interoceptive attention - the conscious focus and awareness of bodily sensations - in functional movement disorder (FMD).

We used voxelwise analyses to compare blood oxygenation level-dependent responses between 13 adults with hyperkinetic FMD and 13 healthy controls (HCs) during a task requiring attention to different bodily sensations and to an exteroceptive stimulus. Additionally, we examined between-group differences in self-reported measures of interoception and evaluated their relationship with neural activity.

Interoceptive conditions (heartbeat, stomach and 'body', indicating sensations from the body part or limb affected in FMD participants) activated a network involving the precuneus, the posterior cingulate cortex (PCC) and caudate nucleus (CN) bilaterally, and the right anterior insula (aINS) (p <0.05, corrected). Group differences in brain activity were mainly driven by processing of disease-related interoceptive signals, which in the FMD group was associated with a broader neural activation than monitoring gastric interoception, while no group differences were detected during cardiac interoception. Differences based on interoceptive focus (body vs heartbeat and stomach) between FMD subjects and HCs were found in PCC, CN, angular gyrus, thalamus, and in the mid-insula (p <0.05, corrected).

This is, to our knowledge, the first study showing that FMD is associated with abnormal interoceptive processing in regions involved in monitoring body state, attentional focus, and homeostatic inference.

Acupuncture is a medical tool in which a sterile needle is used to penetrate and stimulate a certain body area (acupoint), inducing a series of sensations such as numbness, dullness, or aching, often referred to as de-qi. But is that all? In this article, we adopt a Bayesian perspective to explore the cognitive and affective aspects of acupuncture beyond needling, specifically, how the body integrates bottom-up sensory signals with top-down predictions of acupuncture perception. We propose that the way in which we discern acupuncture treatment is the result of predictive coding, a probabilistic, inferential process of our brain. Active inference from both prior experience and expectations of acupuncture, when integrated with incoming sensory signals, creates a unique, individual internal generative model of our perception of acupuncture. A Bayesian framework and predictive coding may, therefore, aid in elucidating and quantifying the cognitive components of acupuncture and facilitate understanding of their differential interactions in determining individual expectations of treatment. Thus, a perception-based Bayesian model of acupuncture presented in this article may expand on how we perceive acupuncture treatment, from simply inserting needles into our body to one that encompasses a complex healing process supported by belief and hope of regaining health. By exploring how cognitive factors influence individual responsiveness to acupuncture treatment, this review sheds light on why acupuncture treatment is more effective in some individuals than in others.

Pregnancy is a sensitive period of development in adult life characterized by massive changes in physical, emotional, and cognitive function. Such changes may be adaptive, e.g., facilitating adjustment to physical demands, but they may also reflect or contribute to risks inherent to this stage of life, e.g., prenatal depression. One cognitive ability that may undergo change during pregnancy and contribute to mental wellness is interoception - the ability to perceive, integrate, and model sensory information originating from the body. Strong interoceptive abilities are associated with lower rates of depression in non-pregnant adult populations, and interoception is generally weaker in individuals at higher risk for depression, for example, exposure to early life adversity (ELA). In the present online, cross-sectional study, we investigated whether interoception in pregnant women differed based on histories of ELA, in ways that increased their relative risk for prenatal depression symptoms.

The pregnant individuals were in the second trimester of their first pregnancy and were compared to a group of nulliparous, non-parenting women.

Previous exposure to ELA significantly moderated pregnancy-related differences in self-reported interoception (interoceptive sensibility). A further moderated-mediation analysis revealed that the extent to which interoceptive sensibility buffered against depressive symptoms was conditional on ELA exposure, suggesting more ELA is associated with lower interoceptive sensibility during pregnancy, which increased prenatal depression risk.

Together this work suggests that levels of interoception during pregnancy are sensitive to previous adversity exposure. It also suggests that interoceptive-focused interventions for preventing/treating prenatal depressive symptoms in high-risk women may be worth exploring.

Interoception is a bidirectional process, with both descending predictions and ascending sensation playing a role in the regulation and perception of homeostatic states. Mistuning of both streams has been associated with psychopathology in mental disorders, including hyperprecise prior beliefs and altered sensory representations. However, empirical research has typically focused on associations between self-report scales and objective physiology during rest or bodily perturbations, without manipulating or measuring descending. Therefore, we developed the novel Adjustment to Interoceptive Discrepancy (AID) paradigm, that builds and then violates interoceptive beliefs to measure expectations and adjustment of expectations over subsequent trials following an unexpected stimulus. We validated this paradigm in the nociceptive domain in a total of 57 university-aged participants. The AID paradigm successfully induced interoceptive discrepancy (i.e., a difference between expectation and perception ratings) that was resolved as participants adjusted expectations appropriately across subsequent trials. This adjustment was more rapid for stimuli that were perceived as more versus less intense than expected. Notably, there were individual differences in the pattern of this adjustment, revealing different strategies in how individuals adjust to unexpected interoceptive sensations, although these were unrelated to interoceptive sensibility scores. Overall, the AID paradigm provides a useful method to assess interoception across expected versus unexpected stimuli, to probe interindividual differences of interoceptive predictions, and ultimately to enable research on the bidirectional processing of internal stimuli in mental health.

The amygdala responds to a large variety of socially and emotionally salient environmental and interoceptive stimuli. The context in which these stimuli occur determines their social and emotional significance. In canonical neurophysiological studies, the fast-paced succession of stimuli and events induce phasic changes in neural activity. During inter-trial intervals, neural activity is expected to return to a stable and featureless level of spontaneous activity, often called baseline. In previous studies we found that context, such as the presence of a social partner, induces brain states that can transcend the fast-paced succession of stimuli and can be recovered from the spontaneous, inter-trial firing rate of neurons. Indeed, the spontaneous firing rates of neurons in the amygdala are different during blocks of gentle grooming touches delivered by a trusted social partner, and during blocks of non-social airflow stimuli delivered by a computer-controlled air valve. Here, we examine local field potentials (LFPs) recorded during periods of spontaneous activity to determine whether information about context can be extracted from these signals. We found that information about social vs. non-social context is present in the local field potential during periods of spontaneous activity between the application of grooming and airflow stimuli, as machine learning techniques can reliably decode context from spectrograms of spontaneous LFPs. No significant differences were detected between the nuclei of the amygdala that receive direct or indirect inputs from areas of the prefrontal cortex known to coordinate flexible, context-dependent behaviors. The lack of nuclear specificity suggests that context-related synaptic inputs arise from a shared source, possibly interoceptive inputs, that signal the physiological state of the body during social and non-social blocks of tactile stimulation.

Altered neural signaling in fibromyalgia syndrome (FM) was investigated with functional magnetic resonance imaging (fMRI). We employed a novel fMRI network analysis method, Structural and Physiological Modeling (SAPM), which provides more detailed information than previous methods. The study involved brain fMRI data from participants with FM (N = 22) and a control group (HC, N = 18), acquired during a noxious stimulation paradigm. The analyses were supported by fMRI data from the brainstem and spinal cord in FM and HC, brain fMRI data from participants with provoked vestibulodynia (PVD), and eye-tracking data from an fMRI study of FM. The results demonstrate differences in connectivity, and in blood oxygenation-level dependent (BOLD) responses, between FM and HC. In the FM group, BOLD signals underwent a large increase during the first 40 seconds of each fMRI run, prior to the application of any stimuli, compared to much smaller increases in HC. This indicates a heightened state of neural activity in FM that is sustained during fMRI runs, and dissipates between runs. The exaggerated initial rise was not observed in PVD. Autonomic functioning differed between groups. Pupil sizes were larger in FM than in HC, and the groups exhibited pupil dilation to the same levels during noxious stimulation. The initial BOLD increase varied in relation to state and trait anxiety scores. The results indicate that people with FM enter a heightened state of neural activity associated with anxiety and autonomic functioning, during every fMRI run, concurrent with increased pupil sizes, and heightened pain sensitivity. These findings may relate to the well-known hypervigilance and global hypersensitivity of FM participants.

Body awareness (BA) is a complex multi-dimensional construct that refers to the subject's ability to consciously perceive and integrate sensory and proprioceptive information related to the position, movement, and balance of one's own body and body parts. Since it involves multiple brain regions and include different functional networks, it is very often affected by cerebrovascular damage such as stroke. Deficits in the ability to monitor our actions and predict their consequences or recognize our body parts and distinguish them from those of others may emerge after stroke. In this study, we decided to explore whether specific treatments targeting BA are discussed in current literature, and whether BA is considered as an outcome in neurorehabilitation processes for stroke patients. To achieve our goal, a scoping review on this often-underreported problem was performed. After analyzing the existing literature, emerged BA in stroke patients is rarely assessed or rehabilitated through specific stimulation or rehabilitation protocol. Additionally, treatment outcomes related to BA are often considered only from a "physical" perspective such as improvements in walking, balance, or the movement of specific body parts, rather than from a proprioceptive standpoint. Further research is needed to facilitate developing early and effective intervention strategies for the recovery of BA after stroke.

SARS-CoV-2 affects brain, body, and their interchange. We investigated interoceptive mechanisms in COVID-19 survivors focusing on their potential link with psychopathology and inflammatory biomarkers.

We assessed interoceptive accuracy (IAc) and time-perceiving (TA) skills of 57 COVID-19 survivors one month after hospital discharge through, respectively, a heartbeats perception task and a time duration task. Each participant was assessed about his interoceptive awareness (IAw) through Multidimensional Assessment of Interoceptive Awareness questionnaire (MAIA) and then, screened for post-traumatic (Impact of Events Scale - IES-R), anxious (State-Trait Anxiety Inventory - STAI-Y1) and depressive (Zung Self-Rating Depression Scale - ZSDS; Beck Depression Inventory - BDI-13) symptoms. Biomarkers of inflammation (platelet count, PC; mean platelet volume, MPV and systemic immune-inflammation index, SII) were obtained in a subsample of 40 survivors by a blood sampling conducted at admission and discharge time from the hospital. Correlational, GLM, GLMZ, and mediation analyses were performed.

IAc did not correlate with TA confirming the reliability of interoceptive measure. IAc positively predicts MAIA's Trusting subscale and negatively predicts anxious psychopathology which fully mediates the effect of IAc on Trusting.PC at hospital admission predicts anxiety at one month after recovery. Again, a higher decrease of SII during hospitalization predicts higher IAc skill and lower anxiety state at one month. The link between SII change and anxiety is fully mediated by IAc.

Our results unveil a potential key role of interoception and brain-body interchange in the exacerbation and maintenance of anxiety psychopathology in COVID-19 survivors.

Understanding how hydration status influences pain perception is particularly important in older adults, as both dehydration and pain are prevalent in this population. Ten individuals (70 ± 4 yr) completed two randomized and counterbalanced trials. They were exposed to passive heat until they lost 1% body mass through sweat and urine (∼100 min), with the loss either unreplaced (sham infusion, HYPO) or fully replaced via 0.45% saline infusion (EUH). Nociceptive electrical stimulation was applied to the sural nerve 1) before heat exposure (baseline), 2) 60 min following hydration manipulation (R60, ∼160 min after baseline), 3) after mouth rinsing with water (MR, ∼170 min after baseline), and 4) following water ingestion (ING, ∼185 min after baseline). Pain-related event-related potentials were assessed using electroencephalography (EEG) at R60, MR, and ING. After hydration manipulation, body mass loss and plasma osmolality were greater, and plasma volumes were lower in HYPO than in EUH, although thirst did not differ between the conditions. There were no differences between the two conditions regarding pain intensity and unpleasantness. Still, EEG analyses revealed that the peak-to-peak amplitude of the pain-related N200-P300 potential (∼136-310 ms) was significantly greater in HYPO than in EUH (P = 0.036) and significantly greater in R60 compared with both MR (P = 0.01) and ING (P = 0.03), either with HYPO and EUH. These results suggest that mild hypohydration in healthy older adults may influence some neurophysiological processes related to nociception without significantly affecting pain perception.NEW & NOTEWORTHY This study reveals, for the first time, that mild hypohydration equivalent to ∼1% of body mass does not alter pain perception in healthy older adults when they are blinded to their hydration status, despite electroencephalography signals showing modulation of pain-related brain responses.

Interoception has been the subject of renewed interest over the past 2 decades. The involvement of interoception in a variety of fundamental human abilities (e.g., decision-making and emotional regulation) has led to the hypothesis that interoception is a central transdiagnostic process that causes and maintains mental disorders and physical diseases. However, interoception has been inconsistently defined and conceptualized. In the first part of this article, we argue that the widespread practice of defining interoception as the processing of signals originating from within the body and limiting it to specific physiological pathways (lamina I spinothalamic afferents) is problematic. This is because, in humans, the processing of internal states is underpinned by other physiological pathways generally assigned to the somatosensory system. In the second part, we explain that the consensual dimensions of interoception are empirically detached from existing measures, the latter of which capture loosely related phenomena. This is detrimental to the replicability of findings across measures and the validity of interpretations. In the general discussion, we discuss the main insights of the current analysis and suggest a more refined way to define interoception in humans and conceptualize its underlying dimensions.

Early regulatory problems (RPs), i.e., problems with crying, sleeping, and/or feeding during the first years, increase the risk for avoidant personality traits in adulthood, associated with social withdrawal and anxiety. Even more, RPs are linked with functional alterations in the adult default mode and salience networks, comprising the brain's allostatic-interoceptive system (AIS) and playing a role in social interactions. We investigated whether RPs assessed in infancy are associated with difficulties in adult peer relationships mediated by functional alterations of the AIS.

As part of a large case-controlled prospective study, 42 adults with previous RPs and 70 matched controls (mean age = 28.48, SD = 2.65, 51% male) underwent fMRI during rest. The analysis focused on the intrinsic functional connectivity (iFC) of key nodes of the AIS. Peer relationship quality was assessed via a semi-structured Life Course Interview and the YASR scale. In these same individuals, RPs were assessed at ages 5, 20 and 56 months.

RPs in infancy were associated with lower-quality peer relationships and enhanced functional connectivity of the AIS nodes in adulthood, with a stronger effect for multiple and persistent RPs compared with transient-multiple or single-persistent RPs. Importantly, iFC changes of the dorsal mid insula, a primary interoceptive cortex with frontal and temporal regions, mediated the relationship between early RPs and adult peer relationship quality.

Results indicate long-lasting social and neural changes associated with early RPs. Our findings further implicate the AIS in both interoceptive and social processes, while indicating the need for early screening of early RPs.

Mood disorders often involve attenuated interoception, which impairs the accurate perception and interpretation of internal bodily signals. Functional magnetic resonance imaging has been used to explore the neurobiology of interoception in vivo while participants are performing interoceptive tasks.

The aim of this review is to present the progress in neuroimaging studies of interoception in mood disorders.

We performed a systematic search in Pubmed, Scopus and Web of Science with the terms "interoception", "depression", "bipolar disorder", "mood disorders", "neuroimaging" and derivative terms.

461 records have been identified in the 3 databases, 34 records were assessed for eligibility and finally 17 reports were selected. The main findings were: disrupted cardioception in Major Depressive Disorder (MDD) which was related to reduced insular activity; altered visceroception in major depression has been linked to hypoactivation in the dorsal mid-insula; reduced nociception was reflected by hypoactivation in the insula in both MDD and Bipolar Disorder, and altered insular activity has been linked to maladaptive eating behavior.

The current review demonstrated that neuroimaging studies focusing on interoceptive tasks in mood disorders are limited in both number and sample size. This is notably relevant to bipolar disorder where only one publication was found. Nevertheless, we were able to outline the findings on four separate aspects of interoception - cardioception, visceroception, nociception and appetite all of which are pointing to the insula as core dysfunctional region. Further research is needed to draw more conclusive insights and improve our understanding of interoception in mood disorders.

There is mounting evidence that cardiac interoception, the perception of one's heartbeat, is central to affective experiences. It has been proposed that symptoms of psychosis could arise from interoceptive dysfunction. Here we hypothesized that people with psychotic disorders would have a specific impairment in cardiac interoception, over and above broader perceptual deficits.

43 adults with a history of psychosis (31 schizophrenia, 12 schizoaffective disorder) and 41 matched control participants completed a heart rate discrimination task. Participants responded to whether they perceived a sequence of auditory tones to be faster or slower than their heart rate. By trialing a range of auditory tone rates, we estimated a threshold for each participant, the difference between perceived heart rate and actual heart rate. To test whether differences were specific to interoception, participants completed an exteroceptive control condition, testing their discrimination of the rate of 2 sets of audible sounds instead of heart rate.

Participants with a history of psychosis had greater absolute differences between perceived and actual heart rate, indicating over- or under-estimation of heart rate compared to healthy controls. This difference was specific to the interoceptive condition, and not explained by group differences in exteroceptive perception.

Psychotic disorders are associated with misestimation of heart rate. Further research may elucidate whether interoceptive abnormalities contribute to specific symptoms such as somatic delusions or affective features, and whether interoception could be a treatment target in psychotic disorders.

Body awareness (BA) is the process of gaining sensory awareness based on the physiological states and actions of the body. It is influenced by an individual's attitudes, perceptions, beliefs, and experiences within the social and cultural contexts. Following a stroke, impairments in BA are thought to be widespread and could have a significant impact on recovery results. Regaining body awareness, however, is often neglected in the neurorehabilitation field. This study aimed to assess body image perception in two stroke patients and the potential effect of motor and cognitive rehabilitative treatments on possible improvement of BA.

Patients were evaluated through a multidimensional neuropsychological assessment before and after a 3-month motor and cognitive rehabilitative training. Sessions were scheduled 6 times per week with a total duration of 3 h per session.

After the neurorehabilitative treatment, both patients showed an improvement in BA, cognition, mood, and motor skills. Differences emerged related to the progression and improvement of their respective performances.

The causes of these differences could include the following: different brain areas affected, the ischemic or hemorrhagic nature of the stroke, age, and sex. Further research is needed to better understand the differences and similarities in the correlations between deficit and lesional sites. Structured and early multidisciplinary intervention can certainly guarantee a better functional recovery for patients after a stroke. However, in this study we show how complementary assessment methods (such as human figure drawing) may be highly informative in choosing treatment modalities and verifying rehabilitation outcomes.

The purpose of this paper is to propose the Intentional and Attuned Therapeutic Relationship Model as a means to emphasize an intentional and attuned therapeutic relationship among the therapist, autistic child, and their caregiver. Neurodiversity-affirming practice is strengths-based, collaborative, and inclusive of the needs and goals of the autistic child and their caregiver. As this necessitates reevaluating occupational therapy models of care delivered to autistic children, this paper provides a brief review of sensory processing and emotional regulation; discusses the Intentional Relationship Model and the phenomenon of attunement, respectively; and proposes the Intentional and Attuned Therapeutic Relationship Model, which combines elements of the Intentional Relationship Model and attunement to develop the therapeutic relationship in alignment with the neurodiversity-affirming paradigm.

The sensory/discriminative domain of pain is often given more consideration than the cognitive and affective influences that ultimately make pain what it is: a highly subjective experience that is based on an individual's life history and experiences. While many investigations of the underlying mechanisms of pain have focused on solely noxious stimuli, few have compared somatosensory stimuli that cross the boundary from innocuous to noxious. Of those that have, there is little consensus on the similarities and differences in neural signaling across these sensory domains. The purpose of this study was to apply our established network connectivity analyses toward the goal of understanding the neural mechanisms behind sensory, cognitive, and affective responses to noxious and innocuous stimuli. Functional MRI data were collected from 19 healthy women and men that experienced warm and hot thermal stimuli across multiple trials. This is a within-subjects cross-sectional experimental study with repeated measures. Ratings of stimulus intensity and unpleasantness that were collected during each run confirmed significant perceptual differences between the two types of stimuli. Despite this finding, no group differences in network connectivity were found across conditions. When individual differences related to pain ratings were investigated, subtle differences were found in connectivity that could be attributed to sensory and association regions in the innocuous condition, and cognitive, affective, and autonomic regions in the pain condition. These results were reflected in the time-course data for each condition. Overall, signaling mechanisms for innocuous and noxious somatosensation are intricately linked, but pain-specific perception appears to be driven by our psychological and autonomic states.

Fatigue is a state of exhaustion that influences our willingness to engage in effortful tasks. While both physical and cognitive exertion can cause fatigue, there is a limited understanding of how fatigue in one exertion domain (e.g., cognitive) affects decisions to exert in another (e.g., physical). We use functional magnetic resonance imaging (fMRI) to measure brain activity while human participants make decisions to exert prospective physical effort before and after engaging in a cognitively fatiguing working memory task. Using computational modeling of choice behavior, we show that fatiguing cognitive exertion increases participants' subjective costs of physical effort compared to a baseline rested state. We describe how signals related to fatiguing cognitive exertion in the dorsolateral prefrontal cortex influence physical effort value computations instantiated by the insula, thereby increasing an individual's subjective valuation of prospective physical effort while cognitively fatigued. Our results support the idea of a general fatigue signal that integrates exertion-specific information to guide effort-based choice.

The vagus nerve (VN) is the main neural pathway linking the gut and brain in Parkinson's disease (PD). In this study, we utilized high-resolution ultrasound to measure the VN cross-sectional area (CSA) in 96 healthy controls (HCs) and 75 PD patients. The PD group was further categorized into three subgroups: PD-preRBD, PD-postRBD, and PD-nonRBD. PD-preRBD was the body-first subtype, and PD-postRBD and PD-nonRBD were the brain-first subtype. The PD group had a significantly lower VN CSA than HCs. Subgroup analysis revealed that the PD-preRBD group tended to exhibit a smaller VN CSA than both the PD-postRBD and PD-nonRBD groups. The VN CSA, specifically the right VN, was significantly correlated with the body-first subtype and some components of PD-related assessment scales. Overall, these findings provide evidence of VN atrophy in PD, especially in body-first PD, suggesting that VN ultrasound could serve as an adjunctive diagnostic tool.

Several influential theories have proposed that interoceptive signals, sent from the body to the brain, contribute to neural processes that coordinate complex behaviors. We altered the physiological state of the body using compounds that have minimal effect on the brain and evaluated their effect on decision-making in rhesus monkeys. We used glycopyrrolate, a non-specific muscarinic (parasympathetic) antagonist, and isoproterenol, a beta-1/2 (sympathetic) agonist, to create a sympathetic-dominated state in the periphery, that was indexed by increased heart rate. Rhesus monkeys were trained on two variants of an approach-avoidance conflict task. The tasks offered a choice between enduring mildly aversive stimuli in exchange for a steady flow of rewards, or cancelling the aversive stimuli, forgoing the rewards. The delay to interrupt the aversive stimuli was used as a measure of monkeys' tolerance for contact with a hot but not painful stimulus or airflow directed at their muzzle. Both drugs reduced tolerance for the aversive stimuli. To determine whether the drug-induced autonomic state reduced the subjective value of the reward, we tested the effects of glycopyrrolate on a food preference task. Food preference was unaltered, suggesting that the sympathetic dominated state in the periphery selectively reduces tolerance for aversive stimuli without altering reward-seeking behaviors. As the drugs used are expected to have little or no direct effect on the brain, the observed biases in decision making are likely induced by interoceptive afferents that signal to the brain the physiological state of the body.

To understand how occupational therapy literature conceptualizes, discusses, describes, implies, and operationalizes self-regulation.

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and JBI methodology guided the review. MEDLINE, Embase, CINAHL, PsychInfo and ERIC databases were searched with studies from 2000 - June 2023 deemed eligible. Two reviewers extracted data with results presented in figurative, tabular, and narrative synthesis. Critical appraisal was conducted using the Mixed Methods Appraisal Tool and the Critical Appraisal Skills Programme checklist for systematic reviews. Content analysis of construct descriptions was conducted.

A total 4159 articles were screened for eligibility, and eighty-one assessed at full text. Nine additional studies were retrieved through hand-searching. Sixty-four studies were included and underwent critical appraisal. Content analysis revealed five self-regulation constructs and associated terms in the occupational therapy literature, including self-regulation, executive function, emotion regulation, interoception and social-emotional learning.

Five distinct self-regulation constructs were analyzed in the occupational therapy literature, with various terms used to describe and define these. Self-regulation and executive function were often described as linked constructs. Similarly, lack of congruence between self-regulation measures, identified interventions and the underlying self-regulation construct was identified.