Perception of the bodily cues, interoceptive sensibility (but not interoceptive accuracy), has a significant positive impact on subjective well‐being; a clear exception is gastric sensitivity

Do body‐related sensations make feel us better? Subjective well‐being is associated only with the subjective aspect of interoception. Eszter Ferentzi  Áron Horváth  Ferenc Köteles. Psychophysiology, 2019;e13319, January 10 2019. https://doi.org/10.1111/psyp.13319

Abstract: According to the proposition of several theoretical accounts, the perception of the bodily cues, interoceptive accuracy and interoceptive sensibility, has a significant positive impact on subjective well‐being. Others assume a negative association; however, empirical evidence is scarce. In this study, 142 young adults completed questionnaires assessing subjective well‐being, interoceptive sensibility, and subjective somatic symptoms and participated in measurements of proprioceptive accuracy (reproduction of the angle of the elbow joint), gastric sensitivity (water load test), and heartbeat tracking ability (Schandry task). Subjective well‐being showed weak to medium positive associations with interoceptive sensibility and weak negative associations with symptom reports. No associations with measures of interoceptive accuracy were found. Gastric sensitivity as opposed to heartbeat perception and proprioceptive accuracy moderated the association between interoceptive sensibility and well‐being. Thus, subjective well‐being is associated only with the self‐reported (perceived) aspect of interoception but not related to the sensory measures of interoceptive accuracy.


IAc =interoceptive accuracy

4 | DISCUSSION

In a cross‐sectional study with the participation of young healthy adults, subjective well‐being showed weak‐ to medium‐level associations with interoceptive sensibility even after controlling for gender and negative body‐related sensations (i.e., perceived symptoms). However, no associations with interoceptive accuracy (as assessed by heartbeat tracking ability, gastric sensitivity, and the proprioceptive error with respect to the elbow joint) were found. Moreover, an interaction between interoceptive sensibility and gastric sensitivity was revealed.

The positive association between subjective well‐being and interoceptive sensibility (i.e., the subjective or perceived aspect of interoception) replicates the findings of previous studies (Hanley et al., 2017; Tihanyi, Böőr, et al., 2016; Tihanyi, Sági, Csala, Tolnai, & Köteles, 2016). One explanation is that better psychological functioning and lower levels of perceived stress enable healthy individuals to allocate more attentional resources to various stimuli, including information originating in the body (Köteles et al., 2013). The finding that body‐mind interventions have a positive impact on interoceptive sensibility (Bornemann, Herbert, Mehling, & Singer, 2015; Fissler et al., 2016; Mehling et al., 2013; Rani & Rao, 1994) also supports this idea. It is also possible, however, that a more positive cognitive‐emotional condition simply biases self‐reports in a positive direction (Ferentzi, Drew, et al., 2018). Finally, in accordance with the tenets of body‐mind theorists, paying more attention to the body (i.e., gut feelings, emotions) may also lead to better functioning and improved well‐being (Bakal, 1999; Daubenmier, 2005; Farb et al., 2015; Mehling et al., 2009, 2011). This association might be behaviorally mediated; for example, more focus on body sensations might enable the individual to recognize symptoms of diseases and seek medical help earlier or change potentially risky behaviors in their early phase (Bakal, 1999; Fogel, 2013). However, interoception is a special perceptual process where raw sensory input plays a less salient role in shaping the conscious content than in the case of exteroception (Ádám, 1998). In other words, nonpathological interoceptive sensory information is usually ambiguous, thus its perception of being heavily influenced by top‐down factors such as expectations, previous experiences, environmental cues (Brown, 2004; Friston, 2005; Friston, Kilner, & Harrison, 2006; Pennebaker, 1982). In conclusion, the aforementioned top‐down factors will play a substantial role in the behaviors improving mental and physical health. The strength of the association (interoceptive sensibility explained approximately only 6%–8% of the variance of well‐being) appears realistic; as both constructs are influenced by a number of various factors, a substantially stronger association would be spurious.

Body‐focused attention does not necessarily improve the accuracy of detection of body signals (Ceunen et al., 2013; Silvia & Gendolla, 2001); in other words, there is a considerable dissociation between perceived and actual body‐related events (Ainley & Tsakiris, 2013; Ferentzi et al., 2017; Pennebaker, 1982). For example, subjective somatic symptoms were not related to either indicator of IAc in the current study, which basically reflects the often‐reported independence of symptom reports and body events (van den Bergh, Witthöft, Petersen, & Brown, 2017). Similarly, power posing (i.e., voluntarily adopting powerful postures to improve performance) evoked self‐reported changes in mood but did not influence hormone levels and behavior in risky situations (Ranehill et al., 2015). Although interoceptive sensibility was weakly associated with the cardiac indicators of IAc in our study, IAc did not contribute to subjective well‐ being after controlling for gender, BMI, and resting HR in the regression analysis, and no interaction between interoceptive sensibility and cardioception was revealed. Taking into consideration that the regression analyses were also controlled for somatic symptoms (i.e., sensations from the body that are negative by definition), it can be concluded that the accuracy of detection of interoceptive changes does not have a direct positive or negative impact on well‐being.

The only interaction we found (i.e., gastric sensitivity moderates the association between interoceptive sensibility and well‐being) only partially supports the adaptivity hypothesis, as the contribution of interoceptive sensibility to well‐being is positive only for low and medium levels of gastric sensitivity. According to our result, the interaction between gastric sensitivity and interoceptive sensibility contributes to a higher level of well‐being in the two following cases: firstly, if low to medium gastric sensitivity is accompanied by high interoceptive sensibility, and, secondly, if high gastric sensitivity is accompanied by low interoceptive sensibility. We can only speculate about the interpretation of this result as well as why it was found for gastric sensitivity only. First of all, gastric fullness above a certain level is an unpleasant feeling, which leads to terminating the ongoing food and drink intake. This feeling occurs on a regular basis for everyone, whereas heart‐related and conscious proprioceptive experiences are less frequent under everyday circumstances. Concerning the interpretation of the interaction, high gastric sensitivity can turn the positive association between well‐being and interoceptive sensibility into negative because increased body focus might amplify the unpleasantness of the feeling of distension. This is in accordance with the view that bottom‐up and top‐down processes occur and interact with each other at almost every level of the interoceptive sensory system (Smith & Lane, 2015). Thus, making bodily sensations more conscious might not be beneficial in all cases; it is also an open question, however, whether our finding represents clinical relevance. We would also like to emphasize that this interpretation is speculation only, and the result needs to be confirmed by the replication of the study.

One of the limitations of the current study is that its conclusions are valid for healthy individuals only; atypical interoception may lead to issues in psychological development and represent a general susceptibility to psychopathology (Murphy, Brewer, Catmur, & Bird, 2017). Extremely low and high levels of interoceptive accuracy with respect to one single modality might also have modality‐specific pathological consequences. However, interoceptive accuracy is not a unitary construct (i.e., various interoceptive modalities are independent of each other with respect to IAc; Ferentzi, Bogdány, et al., 2018). This also implies that differences in the accuracy of detection of various bodily cues and modalities within the normal domain can even compete with each other, providing a complex body sensation (Smith & Lane, 2015). Thus, sensitivity with respect to a single channel does not necessarily influence everyday psychological functioning. Interoceptive sensibility, on the other hand, represents a more unitary (i.e., integrated) construct, therefore it may impact self‐reported characteristics such as well‐being.

Issues related to the sensory measurements of interoception have to be mentioned among the limitations of the current study. As IAc is not generalizable across modalities, the current study assessed three interoceptive channels. However, other modalities might be more relevant concerning subjective mental well‐being, such as breathing, the change of heart rate (rather than its actual state), sweating, or the sensation of body temperature change. The context and the interpretation of the bodily cues were also not investigated here, although both might influence self‐rated well‐being. Moreover, the Schandry task has received several criticisms recently and is not considered a reliable indicator of cardioceptive accuracy by some authors (Brener & Ring, 2016; Ring & Brener, 2018). Finally, participants were not screened for mental disorders and chronic conditions that might impact their performance. These issues and the characteristics of the sample (young adult with a relatively high subjective well‐being score) limit the external validity of the findings. In summary, subjective well‐being of healthy young adults is associated with the subjective (perceived) aspect of interoception but not related to interoceptive accuracy. Thus, the level of well‐being depends more on our subjective bodily report than on the actual accuracy of our bodily sensations.