Self-reported interoception, worries and protective behaviors during the COVID-19 pandemic: a longitudinal study.

BACKGROUND: Protective behaviors were essential for minimizing the spread of the virus during the coronavirus disease 2019 (COVID-19) pandemic. It is often assumed that awareness of bodily sensations (interoception) can improve decision-making and facilitate adaptive behavior. OBJECTIVE: This paper investigates cross-sectional and longitudinal relationships between different aspects of self-reported interoception, trait anxiety, COVID-related worry, and health protective behaviors. METHODS: The study was conducted on a community sample of 265 adults. The two data collection phases took place online, before (baseline) and during the second wave of the COVID-19 pandemic in Hungary. RESULTS: Contrary to our expectations, neither cross-sectional nor longitudinal associations were found between protective behaviors and indicators of self-reported interoception. However, worry at baseline predicted protective behaviors during the second wave, even after controlling for socio-economical characteristics and protective behaviors at baseline. CONCLUSION: Our results highlight the adaptivity of health-related worry when behavioral steps to avoid threats are known and available. Also, higher level of perceived interoception did not appear to be health protective under these circumstances.

Self-reported interoception, worries and protective behaviors during the COVID-19 pandemic: a longitudinal study

Background Protective behaviors were essential for minimizing the spread of the virus during the coronavirus disease 2019 (COVID-19) pandemic. It is often assumed that awareness of bodily sensations (interoception) can improve decision-making and facilitate adaptive behavior. Objective This paper investigates cross-sectional and longitudinal relationships between different aspects of self-reported interoception, trait anxiety, COVID-related worry, and health protective behaviors. Methods The study was conducted on a community sample of 265 adults. The two data collection phases took place online, before (baseline) and during the second wave of the COVID-19 pandemic in Hungary. Results Contrary to our expectations, neither cross-sectional nor longitudinal associations were found between protective behaviors and indicators of self-reported interoception. However, worry at baseline predicted protective behaviors during the second wave, even after controlling for socio-economical characteristics and protective behaviors at baseline. Conclusion Our results highlight the adaptivity of health-related worry when behavioral steps to avoid threats are known and available. Also, higher level of perceived interoception did not appear to be health protective under these circumstances. (AU)

Questionnaires of interoception do not assess the same construct.

There are a number of questionnaires assessing the self-reported trait-like aspect of interoception, also called interoceptive sensibility (ISb). Based on the varying purposes of their development and characteristics, however, it is not likely that they assess exactly the same construct. In a community sample of 265 adults, we examined this assumption for three commonly used questionnaires of ISb, namely the Body Awareness subscale of the Body Perception Questionnaire (BPQ-BA), the Body Awareness Questionnaire (BAQ), and the eight subscales of Multidimensional Assessment of Interoceptive Awareness (MAIA). We investigated their associations, and their relation to positive and negative affect and somatosensory amplification. According to the results of correlation analysis, BPQ-BA, BAQ and MAIA were partly unrelated to each other, partly showed weak to moderate positive associations. Also, differences with respect to their association with positive and negative affect were found. These findings suggest that the investigated questionnaires cannot be used interchangeably to assess the subjective aspect of interoception, and the term ISb is not appropriately defined.

Mental heartbeat tracking and rating of emotional pictures are not related.

Our aim was to conceptually replicate the findings of previous empirical studies showing that people with higher cardiac interoceptive accuracy experience more intense emotions. Apart of the mental heartbeat tracking task of Schandry, Hungarian (n = 46, 76.0% female, mean age 22.28 ± 2.228) and Norwegian (n = 50, 60.0% female, mean age 24.66 ± 3.048) participants rated the arousal and valence evoked by positive, neutral and negative pictures. Multivariate repeated analysis of variance (applying both frequentist and Bayesian approaches) did not reveal any connection between heartbeat perception scores and the subjective ratings (i.e., arousal and valence) of the pictures in any of the two groups. The lack of the expected association between cardioceptive accuracy and arousal might partly be explained by the methodological differences between previous studies and this one; for example, we did not split or preselected the sample based on the performance on the Schandry task and applied a relatively strict instruction (i.e., by encouraging to count felt heartbeats only, and to report zero if no sensations were detected).

Sustained attention is related to heartbeat counting task performance but not to self-reported aspects of interoception and mindfulness.

Although association between sustained attention and various aspects of interoception (i.e. the perception of the body state) seems plausible, research on this subject is scarce. In the present study, 74 undergraduate students (41 females; age: 22.3 ± 4.04 yrs) filled out the Body Awareness Questionnaire, the Mindful Attention Awareness Scale, and the Somatosensory Amplification Scale and completed the Heartbeat Counting Task (HCT), a sensory-perceptual measure of cardiac interoception and the PEBL Continuous Performance Test (CPT) assessing sustained attention. The HCT score showed a weak to moderate negative correlation with the number of commission errors shown in CPT, indicating a lack of response inhibition (frequentist analysis: rs = -0.313, p = 0.008; Bayesian analysis: τb = -0.216, BF10 = 5.865). Questionnaire measures did not show any connection with CPT-performance. These findings suggest that the subjective representation of attentiveness to bodily processes is unrelated to the objectively measured sustained attention. Response inhibition, however, is moderately related to HCT performance.

Examining the Factor Structure and Validity of the Multidimensional Assessment of Interoceptive Awareness.

The goal of this study was to psychometrically evaluate the Multidimensional Assessment of Interoceptive Awareness (MAIA), a popular self-report questionnaire claimed to assess the most important subjective aspects of interoception. We collected data in two samples (N = 644 and N = 1,516) and focused on the factor structure and validity of MAIA, as well as its associations with personality traits. Confirmatory Factor Analysis suggested that six of the eight subscales measure a common general factor of self-reported interoception; two MAIA subscales, Not-Worrying and Not-Distracting were only weakly related to this factor. Whereas the general factor correlated strongly with a measure of perceived attentiveness to normal nonemotive body processes, and moderately with Extraversion, Openness and Conscientiousness, the Not-Worrying factor showed moderate to strong negative correlations with Emotionality, pain catastrophization, and anxiety-related aspects of body focus. Not-Distracting was only weakly associated with the validating scales. Overall, these findings do not support the claimed eight-factor structure of the MAIA but indicate the existence of an overarching general factor. Additionally, this study provides evidence that interoceptive awareness, as measured by the MAIA, is related to, but distinct from personality.

Cardiac and Proprioceptive Accuracy Are Not Related to Body Awareness, Perceived Body Competence, and Affect.

Interoception in the broader sense refers to the perception of internal states, including the perception of the actual state of the internal organs (visceroception) and the motor system (proprioception). Dimensions of interoception include (1) interoceptive accuracy, i.e., the ability to sense internal changes assessed with behavioral tests, (2) confidence rating with respect to perceived performance in an actual behavioral test, and (3) interoceptive sensibility, i.e., the self-reported generalized ability to perceive body changes. The relationship between dimension of cardioceptive and proprioceptive modalities and their association with affect are scarcely studied. In the present study, undergraduate students (N = 105, 53 males, age: 21.0 ± 1.87 years) filled out questionnaires assessing positive and negative affect (Positive and Negative Affect Schedule), interoceptive sensibility (Body Awareness Questionnaire), and body competence (Body Competence Scale of the Body Consciousness Questionnaire). Following this, they completed a behavioral task assessing cardioceptive accuracy (the mental heartbeat tracking task by Schandry) and two tasks assessing proprioceptive accuracy with respect to the tension of arm flexor muscles (weight discrimination task) and the angular position of the elbow joint (joint position reproduction task). Confidence ratings were measured with visual analog scales after the tasks. With the exception of a weak association between cardioceptive accuracy and the respective confidence rating, no associations between and within modalities were found with respect to various dimensions of interoception. Further, the interoceptive dimensions were not associated with state and trait positive and negative affect and perceived body competence. In summary, interoceptive accuracy scores do not substantially contribute to conscious representations of cardioceptive and proprioceptive ability. Within our data, non-pathological affective states (PANAS) are not associated with the major dimensions of interoception for the cardiac and proprioceptive modalities.