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.
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