Dr. Beate M. HerbertUKT Tuebingen, University of Tuebingen,

Psychosomatic Medicine, Research Department

EmbodimentEmbodiment and Interoception:and Interoception:

„„TheThe telltell--taletale heartheart?“ ?“ ––On On thethe relationshiprelationship betweenbetween thethe perceptionperception of of internalinternal

bodilybodily signalssignals, , feelingsfeelings and and behaviorbehavior

„And what about the rest of the „guts“?

„„TheThe telltell--taletale heartheart““

William James (1842William James (1842--1910)1910)

DefinedDefined thethe experienceexperience of an of an emotionemotion as as thethe perceptionperceptionof of bodilybodily responsesresponses in in thethe presencepresence of emotional of emotional stimulistimulioror imaginationimagination(„(„WhatWhat isis an an emotionemotion?“, ?“, MindMind, 1884), 1884)

„Are „Are wewe automataautomata?“, ?“, MindMind, 1879 , 1879 –– pure pure monismmonism / / deterministicdeterministic brainsbrains / / eveneven ourour emotionsemotions

James James inspiredinspired……

Edgar Allen Poe (1809Edgar Allen Poe (1809--1849)1849)

„„TheThe heartbeatheartbeat!“ !“ unmasksunmasks thethe murderermurderer

–– isis whatwhat thethe heartheart tellstells usus thethe truthtruth??

ExampleExample of of thethe rolerole of „of „embodimentembodiment“ “ forforpsychopathologypsychopathology

Interoception and Interoception and EmbodimentEmbodimentTheThe perceptionperception and and processingprocessing of of internalinternal bodilybodily signalssignals in in thethe brainbrain

((BudBud Craig; Cameron)Craig; Cameron)

bodilybodily visceralvisceral and and endocrineendocrine reactionsreactions in in situationssituations of of life life signalsignal saliencesalience and and relevancerelevance („(„therethere isis no no coldcold orordisinteresteddisinterested perceptionperception““ –– A. A. DamasioDamasio, Descartes Error), Descartes Error)

and and autonomicautonomic and and endocrineendocrine bodilybodily reactionsreactions areare fedfedback to back to thethe brainbrain, , areare processedprocessed and and cancan bebe perceivedperceived(„(„somaticsomatic markersmarkers“,“, DamasioDamasio))

ConsequencesConsequences forfor emotionemotion processingprocessing, emotional , emotional experienceexperience and and decisiondecision makingmaking, , behaviorbehavior……

BodilyBodily visceralvisceral reactionsreactions basisbasis of „of „embodimentembodiment““

Interoceptive (Interoceptive (cardiaccardiac) ) awarenessawarenessIn In habituallyhabitually cardiaccardiac sensitive sensitive personspersons::

•• Interoceptive Interoceptive centralcentral nervousnervous networknetwork:: greatergreater activationactivation in in personspersonswithwith good good cardiaccardiac awarenessawareness ((insulainsula, ACC, , ACC, somatosensorysomatosensory corticescortices, , VMPFC/VMPFC/dorsolateraldorsolateral PFC) PFC) duringduring heartbeatheartbeat perceptionperception ((CritchleyCritchley et et al., 2004; al., 2004; PollatosPollatos et al., 2004)et al., 2004)

•• Emotional Emotional experienceexperience//FeelingsFeelings:: experienceexperience emotionallyemotionally arousingarousingstimulistimuli as as moremore arousingarousing –– moremore intenseintense emotional emotional experienceexperience(Herbert et al., 2007a, 2010; (Herbert et al., 2007a, 2010; PollatosPollatos, 2005; Wiens et al, 2000, 2005; Wiens et al, 2000

•• Emotion Emotion processingprocessing:: moremore intenseintense processingprocessing of emotional of emotional stimulistimuli(EEG) (EEG) –– signallingsignalling moremore intenseintense attentionattention allocationallocation to to emotionallyemotionallysalientsalient stimulistimuli (Herbert et al., 2007b; (Herbert et al., 2007b; PollatosPollatos et al., 2005)et al., 2005)

HowHow cancan wewe manipulatemanipulate interoception?interoception?

•• In order to In order to studystudy thethe consequencesconsequences on on ororthethe relationshiprelationship to „to „emotionemotion“, „“, „cognitioncognition“ “ and and behaviorbehavior

IsIs interoception of „interoception of „thethe heartheart“ “ relatedrelated to to thethe perceptionperception of of otherother bodilybodily signalssignals??

TwoTwo QuestionsQuestions

EffectsEffects of of foodfood deprivationdeprivation on on interoception and interoception and bodilybodily

functionsfunctionsHerbert et al., subm.

EffectsEffects of of foodfood deprivationdeprivation on on interoceptioninteroception

Background: Background: EatingEating disordersdisorders::

• Anorexia n., Bulimia n.: impairedinteroceptive awareness(statement, mostly paper-penciltests) and distorted body image

• „ disorders of the embodiedmind“

• Food deprivation and hungerrelevant for evoking symptoms(distorted body image, impairedinteroception)

Basic researchClinical research

EffectsEffects of of foodfood deprivationdeprivation on on interoceptioninteroception

•• DoesDoes shortshort--termterm foodfood deprivationdeprivation leadlead to to changeschanges in interoceptive in interoceptive awarenessawareness??

•• IsIs therethere a a relationshiprelationship betweenbetween IA and IA and feltfelthungerhunger ??

•• AutonomicAutonomic cardiaccardiac changeschanges ? Are ? Are thesetheserelatedrelated to IA?to IA?((e.ge.g. Herbert at al., 2010). Herbert at al., 2010)

Food Food deprivationdeprivation

HealthyHealthy, , femalefemale studentsstudents, , withoutwithout eatingeating disordersdisorders and and furtherfurtherpsychiatricpsychiatric, , somaticsomatic oror neurolneurol. . diseasesdiseasesN = 22N = 22

ScreeningScreening JuneJune//JulyJuly 2009: 50 2009: 50 femalefemale subjectssubjects

PrePre--teststests 2 2 weeksweeks beforebefore beginbegin of of fastingfasting

Age: 21Age: 21--31 (M=24.4, SD=2.8)31 (M=24.4, SD=2.8)BMI: 20BMI: 20--25 (M=22.43, SD=2.07)25 (M=22.43, SD=2.07)

ControlledControlled 2424--hs hs shortshort--termterm fastingfasting at at thethe MetabolicMetabolic Unit of Unit of thetheUniv. Univ. ClinicClinic of of TuebingenTuebingen in August 2009in August 2009

1-9 scale1-9 scale

AutonomicAutonomic cardiaccardiac activityactivity andandcardiodynamiccardiodynamic activityactivity

HeartbeatHeartbeat PerceptionPerception

ECG ECG ((electrocardiographyelectrocardiography))HeartHeart rate rate variabilityvariability: : IBIsIBIsHF band (nu): HF band (nu): vagalvagal activityactivity(HF: 0.15(HF: 0.15--0.40 Hz)0.40 Hz)

ICGICG((impedanceimpedance cardiographycardiography: : bloodblood flowflow in in thethe thoraxthorax))PreejectionPreejection periodperiod (PEP):(PEP):sympatheticsympathetic activityactivityCardiodynamicCardiodynamic markersmarkers: : e.ge.g. CO. CO

ResultsResultsInteroceptive (Interoceptive (cardiaccardiac) ) awarenessawareness

IncreaseIncrease of of heartbeatheartbeat perceptionperception scorescore inducedinduced byby fastingfasting

AutonomicAutonomic and and cardiodynamiccardiodynamic activityactivity

PEP (ms)

111

113

115

117

119

121

123

125

1 2

PEP (ms)

Herzrate (bpm)

64

65

66

67

68

69

70

71

72

bpm

HFnu

34

36

38

40

42

44

46

48

50

HFnu

CO (l/min)

5

5.5

6

6.5

7

7.5

8

IncreaseIncrease in HRin HR

DecreaseDecrease in in vagalvagal activityactivity

IncreaseIncrease in in sympatheticsympathetic activityactivity

IncreaseIncrease in in cardiaccardiac outputoutput∆∆IA IA –– ∆∆CO: r = .58, p = .01CO: r = .58, p = .01

*

*

*

*

„„CardiacCardiac awarenessawareness and and autonomicautonomic cardiaccardiacreactivityreactivity duringduring emotional emotional picturepicture viewingviewing and and mental stress“mental stress“ (Herbert et al., 2010)(Herbert et al., 2010)

PersonsPersons withwith habituallyhabitually greatergreater cardiaccardiacawarenessawareness (good (good heartbeatheartbeat perceiversperceivers)) showshow greatergreaterautonomicautonomic reactivityreactivity in in arousingarousing situationssituationsevokingevoking autonomicautonomic activityactivity (mental stress (mental stress ororemotional emotional scenesscenes) ) thanthan poorpoor HPsHPsespeciallyespecially: : cardiaccardiac outputoutput e.ge.g. . correlatedcorrelated withwithgreatergreater cardiaccardiac awarenessawareness ((signalsignal strengthstrength) ) ––

„„LearningLearning processesprocesses overover lifelife--timetime“ (“ (howhow to to becomebecome a a good HP? good HP? –– startingstarting withwith greatergreater autonomicautonomic reactivityreactivity))

FeltFelt HungerHunger

0

1

2

3

4

5

6

7

8

9

1 2

Hungerempfinden

FeltFelt hungerhunger increasedincreased

Positive Positive correlationcorrelation::Hunger Hunger increaseincrease -- IA IA increaseincrease

**

SummarySummary

•• ShortShort--termterm foodfood deprivationdeprivation inducesinduces an an increaseincrease of of cardiaccardiac awarenessawareness via an via an increaseincrease of of thethe „„signalsignal strengthstrength“ of “ of thetheheartheart

•• CardiacCardiac awarenessawareness isis positivelypositivelyassociatedassociated withwith thethe feelingfeeling of of hungerhunger

WhatWhat aboutabout thethe restrest of of thethe „„internalinternal“ “ bodybody??

• CardiacCardiac awarenessawareness –– interoceptive interoceptive awarenessawareness

„gut „gut feelingsfeelings“ (“ (somaticsomatic markermarker hypothesishypothesis, , DamasioDamasio) ) –– e.ge.g. . gastricgastric functionsfunctions??

((e.ge.g. to . to havehave thethe heartheart to do to do sthsth, to , to bebe closeclose to to one‘sone‘sheartheart, to , to bebe sicksick at at heartheart

e.ge.g. to . to hatehate so‘ s so‘ s gutsguts, he , he did‘tdid‘t havehave thethe gutsguts to…, to to…, to spillspill one‘sone‘s gutsguts to so)to so)

Gerd Gerd GigerenzerGigerenzer: Gut : Gut feelingsfeelings, , thethe intelligenceintelligence of of thetheunconsciousunconscious, , directordirector of of thethe centercenter forfor adaptive adaptive behaviorbehavior and and cognitioncognition, MPI Berlin, MPI Berlin

““Gut feelings” across Gut feelings” across modalities: On the relationship modalities: On the relationship

between cardiac awareness and between cardiac awareness and the sensitivity for gastric the sensitivity for gastric

functionsfunctionsHerbert et al. in prep

AcrossAcross modalitiesmodalities•• WhiteheadWhitehead & Drescher (1980): & Drescher (1980):

recordedrecorded stomachstomach contractionscontractions byby thethe perfusedperfusedcathetercatheter methodmethod. Sterile . Sterile waterwater was was perfusedperfused pastpastthethe sensingsensing elementelement of a of a physiologicalphysiological pressurepressuretransducertransducer throughthrough a a nasogastricnasogastric tubetube..

●● MeasurementMeasurement of of gastricgastric contractionscontractions-- light light flashesflashes at at peakpeak of a of a stomachstomach contractioncontraction of of 12 12 –– 15 sec 15 sec followingfollowing●● MeasurementMeasurement of of HeartbeatHeartbeat PerceptionPerception-- RR--waveswaves ECG ECG –– light light flashesflashes 128 128 msecmsec oror 384 384 msecmsec afterafter RR--wavewave

r = .51r = .51 (N = 20)(N = 20)

AcrossAcross modalitiesmodalities

•• N = 69 N = 69 youngyoung womenwomen ((studentsstudents))

►►HeartbeatHeartbeat perceptionperception::HP test (HP HP test (HP scorescore))

►►GastricGastric perceptionperception::WaterWater loadload test (Drink test)test (Drink test)drinkdrink waterwater untiluntil feelingfeeling fullfull (ml) (ml) duringduring 5 min5 min

Electrocardiogram - ECG

ElectrogastrogramElectrogastrogram -- EGGEGG

EGGEGGFig. 1. Position of multiple electrodes on abdomen. Electrodeclosest to xiphoid process is connected to each of the 4 electrodes placed along gastric axis, yielding 4 bipolar electrogastrogram(EGG) signals. Electrode on left costal margin is a ground.

FrequenciesFrequencies of of interestinterest (FFT):(FFT):

NormogastriaNormogastria:: 2.5 2.5 –– 3.75 3.75 cpmcpm (3 (3 cpmcpm) ) e.ge.g. . pleasantpleasant mealmealBradygastriaBradygastria: 1 : 1 –– 2.5 2.5 cpmcpm ((disgustdisgust, emotional , emotional

arousalarousal))TachygastriaTachygastria: 3.75 : 3.75 –– 10 10 cpmcpm nauseanausea,,

motionmotion sicknesssickness

ElectrogastrogramElectrogastrogram (EGG): FFT(EGG): FFTN = 50 N = 50

EGGEGGFigFig 1:1: EGG FFT in a EGG FFT in a healthyhealthy personperson, , beforebefore and and afterafter ingestioningestion of of waterwater. . TheThe normal 3 normal 3 cpmcpm was was seenseen in in thethe EGGEGG

FigFig 2: 2: EGG FFT in a EGG FFT in a personperson withwith functionalfunctionaldyspespiadyspespia, , beforebefore and and afterafteringestioningestion of of waterwater. . ClearClear episodesepisodes of of bradygastiabradygastia withwith a rate of 1 a rate of 1 –– 2.5 2.5 cpmcpm and and absenceabsence of of 3 3 cpmcpm activityactivity areare shownshown

Results

N = 50

F(1,49) = 5.16,p = .02

Increase in % 3 cpm

ResultsCorrelationCorrelation HeartbeatHeartbeat PerceptionPerception Score Score –– WaterWater IntakeIntake (ml) in WLT(ml) in WLT

r = -.48, p = .001

Cardiac awareness isnegatively associatedwith water intake (feeling full)

Sensitivity for gastric functions

N = 69

N = 50r = -.45, p = .001

Results•• WhatWhat aboutabout EGG ?EGG ?

Correlations HP – EGG (N = 50)

• Baseline:• % 3 cpm: r = -.10, p = .31

• WLT:• % 3 cpm: r = .11, p = .15

SummarySummary•• CardiacCardiac awarenessawareness isis associatedassociated withwith sensitivitysensitivity

forfor gastricgastric functionsfunctions ((fullnessfullness) ) –– „interoceptive „interoceptive awarenessawareness““

Special Special situationsituation::•• In a In a situationsituation thatthat allowedallowed thethe selfself--regulationregulation of of

waterwater intakeintake accordingaccording to to visceralvisceral sensationssensations(no EGG (no EGG effectseffects))„„CardiacCardiac sensitives“ sensitives“ showshow greatergreater behavioralbehavioralselfself--controlcontrol of of waterwater intakeintake untiluntil feelingfeeling fullfull

IsIs in in accordanceaccordance withwith ……

CardiacCardiac awarenessawareness and and thethe selfself--controlcontrolof of physicalphysical loadload

Herbert et al., 2007b

In a setting where persons can freely decide on theirphysical load, good HPs experienced the same level of fatigue as poor HPs while expending less physical effort(a smaller rise in hr and CO, and a shorter covereddistance).

Cardiac awareness is positivley associated withgreater self-control of physical load in accordance withgreater (more accurately) perceived bodily cues and fatigue

Method:Cycle on a bicycle ergometer for 15 min., were free to chose the pace of cyclingDVs: + behavioral self-control: distance covered in kilometers+ physiological effort: Heart rate (bpm) and cardiac output (CO)+ subjectively rated effort: VAS (rated fatigue)

Finally• „Fasting“ as a reasonable paradigm in order to

study interoceptive processes

• Cardiac awareness is related to sensitivity of the „rest of the guts“ (interoceptive awareness)

• IA is positively related to „self-regulation“ of behavior according to ones visceral cues

Thank you very much!