In this Thesis, I systematize, clarify, and expand the current theory of emotion based on the principles of predictive processing-the interoceptive inference view of emotion-so as to show the following: (1) as it stands, this view is problematic. (2) Once expanded, the view in question can deal with its more pressing problems, and it compares favourably to competing accounts. Thus, the interoceptive inference view of emotion stands out as a plausible theory of emotion. According to the predictive processing (PP) framework, all what the brain does, in all its functions, is to minimize its precision-weighted prediction error (PE) (Clark, 2013, 2016; Hohwy, 2013). Roughly, PE consist in the difference between the sensory signals expected (and generated) from the top-down and the actual, incoming sensory signals. Now, in the PP framework, visual percepts are formed by minimizing visual PE in a specific manner: via visual perceptual inference. That is, the brain forms visual percepts in a top-down fashion by predicting its incoming lower-level sensory signals from higher-level models of the likely (hidden) causes of those visual signals. Such models can be seen as putting forward content-specifying hypotheses about the object or event responsible for triggering incoming sensory activity. A contentful percept is formed once a certain hypothesis achieves to successfully match, and thus supress, current lower-level sensory signals. In the interoceptive inference approach to interoception (Seth, 2013, 2015), the principles of PP have been extended to account for interoception, i.e., the perception of our homeostatic, physiological condition. Just as perception in the visual domain arises via visual perceptual inference, the interoceptive inference approach holds that perception of the inner, physiological milieu arises via interoceptive perceptual inference. Now, what might be called the interoceptive inference theory of valence (ITV) holds that the interoceptive inference approach can be used so as to account for subjective feeling states in general, i.e., mental states that feel good or bad-i.e., valenced mental states. According to ITV, affective valence arises by way of interoceptive perceptual inference. On the other hand, what might be called the interoceptive inference view of emotion (IIE) holds that the interoceptive inference approach can be used so as to account for emotions per se (e.g., fear, anger, joy). More precisely, IIE holds that, in direct analogy to the way in which visual percepts are formed, emotions arise from interoceptive predictions of the causes of current interoceptive afferents. In other words, emotions per se amount to interceptive percepts formed via higher-level, content-specifying emotion hypotheses. In this Thesis, I aim to systematize, clarify, and expand the interoceptive inference approach to interoception, in order to show that: (1) contrary to non-sensory theories of affective valence, valence is indeed constituted by interoceptive perceptions, and that interoceptive percepts do arise via interoceptive perceptual inference. Therefore, ITV holds. (2) Considering that IIE exhibits problematic assumptions, it should be amended. In this respect, I will argue that emotions do not arise via interoceptive perceptual inference (as IIE claims), since this assumes that there must be regularities pertaining to emotion in the physiological domain. I will suggest that emotions arise instead by minimizing interoceptive PE in another fashion. That is, emotions arise via external interoceptive active inference: by sampling and modifying the external environment in order to change an already formed interoceptive percept (which has been formed via interoceptive perceptual inference). That is, emotions are specific strategies for regulating affective valence. More precisely, I will defend the view that a certain emotion E amounts to a specific strategy for minimizing interoceptive PE by way of a specific set of stored knowledge of the counterfactual relations that obtain between (possible) actions and its prospective interoceptive, sensory consequences ("if I act in this manner, interoceptive signals should evolve in such-and-such way"). An emotion arises when such knowledge is applied in order to regulate valence.

The cognitive model of BDD (Veale, 2004) proposes high levels of self-objectification (viewing and treating oneself as an object) as an important maintaining factor; however, to date this construct has not been empirically measured in this population. In addition, recent models of the self (Damasio, 2010) point towards the central role of interoceptive awareness (IA; the ability to identify bodily signals) in developing a sense of self. Low levels of IA have been associated to body dissatisfaction, eating disorders and depression. The aim of this study was to investigate the role of self-objectification and interoceptive awareness in patients with BDD. Three groups of participants with BDD (n=14), anxiety (n=23), and non-clinical participants (n=23) completed a heartbeat detection task to measure levels of IA under two conditions: blank screen and while facing a mirror in order to also explore the impact of self-focus attention on IA. Levels of self-objectification and self-focussed attention were measured through self-report questionnaires. Statistical comparisons between groups indicated significantly lower levels of IA in the BDD group at blank screen only when compared to the non-clinical group. In the mirror condition the BDD group had significantly lower IA scores than both control groups. Furthermore, the BDD group reported significantly higher self-objectification than the non-clinical group, and there was a trend towards the group scoring at a higher level than the anxiety group. Across groups there was no significant relationship between levels of IA in either condition, and self-reported levels of self-objectification or self-focussed attention. The results support the role of self-objectification in BDD and points towards the potential contribution of somatoperception. The theoretical and clinical implications of these findings, the limitations of the methodology employed, and suggestions for future research are discussed.

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Anxiety sensitivity (AS) is associated with health behaviors such as low rates of physical activity, overeating, alcohol use, and poor sleep; however, interventions targeting AS via exercise-based interoceptive exposure have not assessed these as outcomes. In addition, previous studies are limited by brief follow-up periods. This study aimed to replicate previous aerobic exercise interoceptive exposures with an extended (6-week) follow-up and measurement of health behaviors. Participants were 44 sedentary young adults with elevated AS randomized to intervention (6 20-minute sessions of moderate-intensity treadmill walking) or assessment-only control. Assessments took place at baseline, week 2 (post-treatment), week 4, and week 8 with measurements of AS (ASI-3), physical activity (7-Day PAR), sleep (ISI), binge eating, alcohol use, depression (PHQ-8), anxiety (GAD-7), and stress (PSS-4). The intervention condition demonstrated a marginally significant reduction in AS compared to control at week 4 which eroded by week 8. There were no significant between-group differences for health behavior change. The intervention condition demonstrated decreases in depression, general anxiety, and perceived stress compared to control, but these effects eroded by week 4. There was no difference in findings for participants with BMI<25 vs. those with BMI>=25. Findings indicate that a brief intervention might not be sufficient to produce lasting changes in AS without additional treatment. Intervention effects were not as strong in this study compared to previous reports, which may be due to the size and greater racial/ethnic diversity of the current sample. Future research should objectively measure physical activity and explore individual variability in treatment response.

Anxiety sensitivity, defined as the fear of anxiety-related sensations and their consequences (Reiss & McNally, 1985), has been consistently shown to be associated with risk for anxiety psychopathology as well as other mental health problems. The primary objective of the present secondary prevention trial sought to examine strategies to reduce anxiety sensitivity among persons with elevated anxiety sensitivity by testing the singular and combined efficacy of two commonly used strategies in multi-component interventions for reducing anxiety sensitivity: (a) anxiety psychoeducation emphasizing the benign nature of stress and (b) interoceptive exposure (i.e. repeated inhalations of 35% CO₂ gas mixture). To provide a stringent control for non-specific effects associated with anxiety psychoeducation and interoceptive exposure with CO₂, two control strategies were included in the study design: general health and nutrition education and repeated inhalations of regular room air. Utilizing a 2X2 design, participants were randomly assigned to receive an education component and intervention sessions consisting of one of two gas mixtures. The current study did not support the relative efficacy of hypothesized active intervention strategies. Rather, all conditions led to significant reductions in anxiety sensitivity. In addition, within-condition effect sizes for conditions in the present study were comparable to effect sizes of active interventions that were efficacious in previous research. Findings from the present study support that anxiety sensitivity is malleable following brief, cost-efficient interventions and these reductions are maintained over a one-month follow-up period. Data from the present study suggest that in the presence of stringent control conditions, hypothesized active intervention strategies provided little additional benefit. The present study has implications for methodological considerations for future secondary prevention trials for the reduction of anxiety sensitivity. The absence of stringent control groups might lead to premature conclusions that reductions in anxiety sensitivity are due to the specific effects of active interventions. Further research is needed to elucidate specific effects of intervention strategies for the reduction of anxiety sensitivity in at risk populations in order to refine secondary prevention interventions aimed to reduce risk for psychopathology. / text

Sexual trauma, in addition to being a human rights violation, harms people in numerous ways, including negative psychological and physical outcomes. Body-based interventions reduce sexual trauma symptoms, but limited information exists about how these interventions work. Researchers propose changes in internal body sensation awareness (i.e., interoceptive awareness; IA) as a potential mechanistic explanation. We are not aware of any studies testing that claim. Further, there is scant extant information on IA – sexual trauma relationships. Before evaluating mechanistic therapeutic hypotheses, studies need to test sexual trauma – IA associations. We focus on this understudied area here. Through a multi-method study (behavioral, self-report and qualitative data), we tested the associations between IA and sexual trauma among females. Aim 1: Characterize IA among sexual trauma survivors. We hypothesized that survivors would have significantly lower self-reported IA than existing literature. Aim 2: Quantify the amount of variance IA explains in posttraumatic stress disorder (PTSD) symptoms. We hypothesized that IA would predict significant variance in PTSD, such that increases in IA would predict increases in PTSD. We expected that an IA – dissociation symptom interaction would qualify that main effect via weakening it for survivors with higher dissociation. Aim 3: Through a moderated mediation model, test if IA mediates the sexual trauma – PTSD association. We hypothesized that IA would mediate that association. Further, we predicted that the IA – PTSD relationship would be moderated by dissociation: higher dissociation would attenuate the IA – PTSD association. In this manuscript, we report results from two samples: 1) University (n = 153), and 2) community (n = 21) participants. Given ongoing community participant recruitment, the following are university participant results. Aim 1: Self-reported IA is significantly lower among survivors than comparator samples. Aim 2: Behavioral IA explained significant variance in PTSD, though opposite to the direction we predicted: we observed that as IA increased, PTSD decreased. We observed a significant interaction between self-reported IA and dissociation in predicting declines in PTSD. PTSD symptoms were lowest among survivors with high dissociation and high IA. Aim 3: IA did not mediate the sexual trauma – PTSD association. We discuss clinical implications, limitations and future directions.

Interoceptive sensitivity (IS) is the ability to feel one’s own bodilysignals accurately. The connection between IS, emotional processingand consecutive behavior is a popular research topic. In this study, Itried to replicate a study by Piech and colleagues from 2017. Theoriginal study reported on a correlation between strong IS and beingmore altruistic. In this replication attempt, I used the same methodologyas in the original study; a dictator game as a measure of altruistictendencies and a heartbeat detection task as a measure of IS. However,I did not find a relationship between strong IS and being more altruistic.An analysis of the new data indicates that a minor methodologicaldifference for this replication - using a purely hypothetical dictatorgame - resulted in a generally larger amount of money given away inthe test. This complicates interpretation, since this new result can beinterpreted either as resulting from individual differences in respondingto a hypothetical game (as compared to a real game), or from an actualnull relationship found between IS and altruism. The strength of therelationship reported in the original study is still questioned, afterarguments are made that the data in replicating most favorably supportthe null relationship being a valid estimate.

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