Psychological interventions for interoception in mental health disorders: A systematic review of randomized-controlled trials.

Disturbed interoception (i.e., the sensing, awareness, and regulation of internal body signals) has been found across several mental disorders, leading to the development of interoception-based interventions (IBIs). Searching PubMed and PsycINFO, we conducted the first systematic review of randomized-controlled trials (RCTs) investigating the efficacy of behavioral IBIs at improving interoception and target symptoms of mental disorders in comparison to a non-interoception-based control condition [CRD42021297993]. Thirty-one RCTs fulfilled inclusion criteria. Across all studies, a pattern emerged with 20 (64.5%) RCTs demonstrating IBIs to be more efficacious at improving interoception compared to control conditions. The most promising results were found for post-traumatic stress disorder, irritable bowel syndrome, fibromyalgia and substance use disorders. Regarding symptom improvement, the evidence was inconclusive. The IBIs were heterogenous in their approach to improving interoception. The quality of RCTs was moderate to good. In conclusion, IBIs are potentially efficacious at improving interoception for some mental disorders. In terms of symptom reduction, the evidence is less promising. Future research on the efficacy of IBIs is needed.

Mother knows best: Mothers are more egocentric towards their own child's bodily feelings.

Our emotional state can influence how we understand other people's emotions, leading to biases in social understanding. Yet emotional egocentric biases in specific relationships such as parent-child dyads, where not only understanding but also emotional and bodily regulation is key, remain relatively unexplored. To investigate these biases and control for sensory priors, we first conducted two experiments in dyads of adult strangers (total N=75) using a bodily Emotional Egocentricity Task that enables simultaneous affective tactile stimulation within a dyad. We showed its effectiveness in eliciting both classical and sensory-controlled egocentric biases. We then recruited 68 mother-child dyads and found that mothers exhibit higher classical and sensory-controlled emotional egocentric biases towards their own child compared to an unfamiliar child. Results suggest that mothers tend to rely on their bodily feelings more when judging the states of their own child than those of other children, possibly consistent with their regulatory parental role.

Development and validation of a self-report measure of epistemic trust.

Epistemic trust (ET) refers to trust in communicated knowledge. This paper describes the development and validation of a new self-report questionnaire, the Epistemic Trust, Mistrust and Credulity Questionnaire (ETMCQ). We report on two studies (Study 1, n = 500; Study 2, n = 705) examining the psychometric properties of the ETMCQ and the relationship between EMTCQ scores (i.e., an individual's epistemic stance) and exposure to adverse childhood experiences, mental health symptoms, attachment, mentalizing and general self-efficacy. The factor structure of the ETMCQ was examined using Exploratory and Confirmatory Factor Analyses, and its reliability and test-retest reliability were tested. Both studies yielded three correlated yet distinct factors-Trust, Mistrust and Credulity-and confirmed the reliability and validity of the ETMCQ. Preregistered hypotheses were confirmed and replicated across both studies. Main findings suggest intriguing links between the ETMCQ and developmental psychopathology constructs and are consistent with thinking on the role of epistemic stance in undermining adaptation and increasing the developmental risk of mental health problems. Mistrust and Credulity scores were associated with childhood adversity and higher scores on the global psychopathology severity index and both factors partially mediated the link between early adversity and mental health symptoms. Mistrust and Credulity were positively associated with difficulties in understanding mental states and insecure attachment styles. Post-hoc analysis identified that different attachment styles were associated with differences in epistemic stance. In addition, Trust was not associated with reduced levels of mental health symptoms and did not moderate the impact of childhood adversity-findings are congruent with the suggestion that the reduction of mistrust and credulity may be crucial common factors in promoting resilience and the effectiveness of psychotherapeutic interventions. This investigation and the ETMCQ provide an empirical measure of what until now has been largely a theoretical concept and open new avenues for future research.

Self-Blame Mediates the Link between Childhood Neglect Experiences and Internalizing Symptoms in Low-Risk Adolescents.

Childhood neglect is the most common type of maltreatment, ranging from minor isolated incidents to consistent failures in emotional/physical caregiving. It has been associated with developmental impairments and considered a risk factor for the emergence of psychopathology, particularly internalizing disorders. This study aimed to explore individual differences in response to the continuum of severity of neglect in community adolescents, as well as the role of specific cognitive emotion regulation strategies (CERSs) as mediators between childhood neglect and current internalizing symptoms. Low-risk adolescents (12-19 years old; M age 15.88 years; N = 123; 64 Females) completed questionnaires assessing these experiences. We employed a regression model and a simple mediation analyses. Findings indicate a positive association between childhood neglect, internalizing behaviors, and the adoption of self-blame as CERS. Moreover, the use of self-blame in response to everyday stress partially mediated the relationship between neglect and internalizing behaviors (effect size: .28). Findings support the hypothesis that even in a low risk sample, neglect is associated with internalizing symptoms, and highlight the importance of assessing individual differences in the experience of neglect. Moreover, the mediation effect of the CERSs of self-blame might serve as a potential target for psychotherapeutic interventions aimed at reducing internalizing symptoms.

Cortical thickness of the insula and prefrontal cortex relates to externalizing behavior: Cross-sectional and prospective findings.

Externalizing behaviors (EBs) pertain to a diverse set of aggressive, antisocial, and potentially destructive behaviors directed toward the external environment. They range from nonclinical to clinical in severity, associated with opposition, aggression, hyperactivity, or impulsivity, and are considered a risk factor for the emergence of psychopathology later in adulthood. Focusing on community adolescents (N = 102; 49 female and 53 male adolescents; age range 12-19 years), this study aimed to explore the relations between EBs and the cortical thickness of regions of interest as well as to identify possible risk markers that could improve understanding of the EB construct. Using a mixed cross-sectional and prospective design (1-year follow-up), we report specific associations with cortical thickness of the left insular, right orbitofrontal, and left anterior cingulate cortex. Specifically, thinner left insular and right orbitofrontal cortex was associated with higher EBs, and thinner left anterior cingulate cortex predicted less reduction in EBs 1 year later. In addition, further examination of the aggression and rule-breaking subscales of the Youth/Adult Self-Report, used to assess EBs, revealed specific associations with insular subregions. Findings suggest that cortical structure morphology may significantly relate to the expression and maintenance of EBs within the general population of adolescents.

Associations between schizotypal personality features, mentalizing difficulties and thought problems in a sample of community adolescents.

AIM: Schizotypal trait expression and mentalizing impairments represent key factors associated with increased vulnerability for schizophrenia. In the current study, we analysed the nature of associations linking specific schizotypal personality features to mentalizing difficulties during adolescence. Furthermore, we examined the extent to which mentalizing difficulties mediate the relationship between schizotypal trait features and self-reported thought problems. METHODS: One hundred and five community adolescents (Mage = 15.72; SD = 1.91) completed a recently developed self-report measure of mentalizing (Reflective Functioning Questionnaire [RFQ]), evaluating the degree of certainty (RFQc-scale) and uncertainty (RFQu-scale) with which individuals utilize mental state information to understand their own and others' behaviour. High scores on the RFQu-scale reflect poor usage of mental state information, while high scores on the RFQc-scale capture adaptive levels of certainty about mental states. Self-report questionnaires were also used to assess schizotypal trait expression, thought problems and symptoms of anxiety/depression. RESULTS: Linear regression models indicated that schizotypal features of social anxiety and odd speech accounted for increased RFQu scores, while odd speech also accounted for reduced RFQc scores. RFQu partially mediated the effects of social anxiety and odd speech on the level of thought problems in the sample. CONCLUSIONS: Present findings suggest that schizotypal features that impede interpersonal communication during adolescence are linked to difficulties in mental state understanding. Our study also provides original data suggesting that the effects of social anxiety and odd speech on psychosis-risk may partially depend upon the level of mentalizing uncertainty. Mentalizing difficulties may constitute important clinical assessment and early prevention treatment targets in adolescents who demonstrate schizotypal features.

Self-Monitoring for speech and its links to age, cognitive effort, schizotypal trait expression and impulsivity during adolescence.

Introduction: Disruptions in self-monitoring processes represent key cognitive factors associated with schizophrenia spectrum disorders. In the current study, we assessed the effects of age and cognitive effort on self-monitoring for speech in adolescence, as well as its associations with personality dimensions pertaining to schizotypy and impulsivity.Methods: 121 community adolescents undertook a self-monitoring task that assesses the capacity to discriminate between self-generated overt and silent speech, for items requiring different levels of cognitive effort. Self-report measures were used to assess trait dimensions of schizotypy and impulsivity.Results: Cognitive effort, but not age, contributed to the overall rate of self-monitoring errors. Contrary to clinical psychosis and high risk samples, increased cognitive effort in healthy adolescents led to more internalising than externalising self-monitoring errors. Higher scores on the interpersonal dimension of schizotypy were associated with increases in the total rate of self-monitoring errors. No associations were found between positive schizotypy and externalising self-monitoring misattributions. Finally, trait impulsivity dimensions were not associated with self-monitoring performance.Conclusions: The present findings suggest that self-monitoring confusions may be linked to trait-risk for psychosis in adolescence. Future studies can prospectively assess whether the association between negative schizotypal traits and self-monitoring represents a distal marker of psychosis vulnerability.

Altered topology of neural circuits in congenital prosopagnosia.

Using a novel, fMRI-based inter-subject functional correlation (ISFC) approach, which isolates stimulus-locked inter-regional correlation patterns, we compared the cortical topology of the neural circuit for face processing in participants with an impairment in face recognition, congenital prosopagnosia (CP), and matched controls. Whereas the anterior temporal lobe served as the major network hub for face processing in controls, this was not the case for the CPs. Instead, this group evinced hyper-connectivity in posterior regions of the visual cortex, mostly associated with the lateral occipital and the inferior temporal cortices. Moreover, the extent of this hyper-connectivity was correlated with the face recognition deficit. These results offer new insights into the perturbed cortical topology in CP, which may serve as the underlying neural basis of the behavioral deficits typical of this disorder. The approach adopted here has the potential to uncover altered topologies in other neurodevelopmental disorders, as well.

Phasic alertness enhances processing of face and non-face stimuli in congenital prosopagnosia.

Congenital prosopagnosia (CP) is a severe face processing impairment that occurs in the absence of any obvious brain damage and has often been associated with a more general deficit in deriving holistic relations between facial features or even between non-face shape dimensions. Here we further characterized this deficit and examined a potential way to ameliorate it. To this end we manipulated phasic alertness using alerting cues previously shown to modulate attention and enhance global processing of visual stimuli in normal observers. Specifically, we first examined whether individuals with CP, similarly to controls, would show greater global processing when exposed to an alerting cue in the context of a non-facial task (Navon global/local task). We then explored the effect of an alerting cue on face processing (upright/inverted face discrimination). Confirming previous findings, in the absence of alerting cues, controls showed a typical global bias in the Navon task and an inversion effect indexing holistic processing in the upright/inverted task, while CP failed to show these effects. Critically, when alerting cues preceded the experimental trials, both groups showed enhanced global interference and a larger inversion effect. These results suggest that phasic alertness may modulate visual processing and consequently, affect global/holistic perception. Hence, these findings further reinforce the notion that global/holistic processing may serve as a possible mechanism underlying the face processing deficit in CP. Moreover, they imply a possible route for enhancing face processing in individuals with CP and thus shed new light on potential amelioration of this disorder.

Project PAVE (Personality And Vision Experimentation): role of personal and interpersonal resilience in the perception of emotional facial expression.

The aim of the proposed theoretical model is to illuminate personal and interpersonal resilience by drawing from the field of emotional face perception. We suggest that perception/recognition of emotional facial expressions serves as a central link between subjective, self-related processes and the social context. Emotional face perception constitutes a salient social cue underlying interpersonal communication and behavior. Because problems in communication and interpersonal behavior underlie most, if not all, forms of psychopathology, it follows that perception/recognition of emotional facial expressions impacts psychopathology. The ability to accurately interpret one's facial expression is crucial in subsequently deciding on an appropriate course of action. However, perception in general, and of emotional facial expressions in particular, is highly influenced by individuals' personality and the self-concept. Herein we briefly outline well-established theories of personal and interpersonal resilience and link them to the neuro-cognitive basis of face perception. We then describe the findings of our ongoing program of research linking two well-established resilience factors, general self-efficacy (GSE) and perceived social support (PSS), with face perception. We conclude by pointing out avenues for future research focusing on possible genetic markers and patterns of brain connectivity associated with the proposed model. Implications of our integrative model to psychotherapy are discussed.

Selective dissociation between core and extended regions of the face processing network in congenital prosopagnosia.

There is growing consensus that accurate and efficient face recognition is mediated by a neural circuit composed of a posterior "core" and an anterior "extended" set of regions. Here, we characterize the distributed face network in human individuals with congenital prosopagnosia (CP)-a lifelong impairment in face processing-relative to that of matched controls. Using functional magnetic resonance imaging, we first uncover largely normal activation patterns in the posterior core face patches in CP. We also document normal activity of the amygdala (emotion processing) as well as normal or even enhanced functional connectivity between the amygdala and the core regions. Critically, in the same individuals, activation of the anterior temporal cortex (identity processing) is reduced and connectivity between this region and the posterior core regions is disrupted. The dissociation between the neural profiles of the anterior temporal lobe and amygdala was evident both during a task-related face scan and during a resting state scan, in the absence of visual stimulation. Taken together, these findings elucidate selective disruptions in neural circuitry in CP and offer an explanation for the known differential difficulty in identity versus emotional expression recognition in many individuals with CP.

Does social support protect against recognition of angry facial expressions following failure?

Herein we examined the ability of perceived social support to modulate the recognition of facial expressions. Specifically, we hypothesised that perceived social support would serve as a "protective lens", biasing individuals against recognition of angry faces and towards recognizing happy ones. Experimentally inducing failure and success in a performance task, we examined both main and interactive effects of perceived social support. Under experimentally induced failure, perceived social support was negatively associated with recognizing angry emotional face expression. Interestingly, we also found a trend toward a positive association between perceived social support and recognition of happy facial expression, irrespective of the failure/success experimental manipulation. These findings elucidate a potential link between social/personality and cognitive processes underlying the perception of emotional facial expression.

General holistic impairment in congenital prosopagnosia: evidence from Garner's speeded-classification task.

Congenital prosopagnosia (CP), a lifelong impairment in face processing in the absence of brain damage, is often ascribed to impairment in holistic processing. It is still debated whether such difficulties are restricted to faces or whether they can also be observed for nonfacial stimuli. Here, we investigate this issue by examining CP individuals and their controls on two variations of the Garner speeded classification task tailored to assess holistic processing of nonfacial stimuli. In Experiment 1, participants were asked to judge the width of visually presented rectangles while ignoring their irrelevant height, or to judge changes in width while height remained constant. Critically, while controls exhibited the expected Garner interference, no such interference was observed for the CPs, indicating impaired holistic processing of integral, nonfacial shape dimensions. Experiment 2, utilized the same Garner paradigm, but here participants were asked to judge integral dimensions that are unrelated to shape (colour). Importantly, both CPs and controls exhibited the same level of Garner interference, indicating intact integral processing of colour dimensions. This dissociation between the performance on the two Garner tasks indicates that CPs do not exhibit a general local processing bias or impaired integration of any perceptual dimensions, but rather a deficit that is restricted to tasks requiring holistic integral perception of shape dimensions. Taken together, these results provide evidence for the existence of a general impairment in holistic shape perception in CP, which may be related to the mechanisms underlying this disorder.

Impaired holistic processing in congenital prosopagnosia.

It has long been argued that face processing requires disproportionate reliance on holistic or configural processing, relative to that required for non-face object recognition, and that a disruption of such holistic processing may be causally implicated in prosopagnosia. Previously, we demonstrated that individuals with congenital prosopagnosia (CP) did not show the normal face inversion effect (better performance for upright compared to inverted faces) and evinced a local (rather than the normal global) bias in a compound letter global/local (GL) task, supporting the claim of disrupted holistic processing in prosopagnosia. Here, we investigate further the nature of holistic processing impairments in CP, first by confirming, in a large sample of CP individuals, the absence of the normal face inversion effect and the presence of the local bias on the GL task, and, second, by employing the composite face paradigm, often regarded as the gold standard for measuring holistic face processing. In this last task, we show that, in contrast with controls, the CP group perform equivalently with aligned and misaligned faces and was impervious to (the normal) interference from the task-irrelevant bottom part of faces. Interestingly, the extent of the local bias evident in the composite task is correlated with the abnormality of performance on diagnostic face processing tasks. Furthermore, there is a significant correlation between the magnitude of the local bias in the GL and performance on the composite task. These results provide further evidence for impaired holistic processing in CP and, moreover, corroborate the critical role of this type of processing for intact face recognition.

A double dissociation between action and perception in the context of visual illusions: opposite effects of real and illusory size.

The idea that there are two distinct cortical visual pathways, a dorsal action stream and a ventral perception stream, is supported by neuroimaging and neuropsychological evidence. Yet there is an ongoing debate as to whether or not the action system is resistant to pictorial illusions in healthy participants. In the present study, we disentangled the effects of real and illusory object size on action and perception by pitting real size against illusory size. In our task, two objects that differed slightly in length were placed within a version of the Ponzo illusion. Even though participants erroneously perceived the physically longer object as the shorter one (or vice versa), their grasping was remarkably tuned to the real size difference between the objects. These results provide the first demonstration of a double dissociation between action and perception in the context of visual illusions and together with previous findings converge on the idea that visually guided action and visual perception make use of different metrics and frames of reference.