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L’interocezione è definita come il senso della condizione fisiologica dell’intero organismo. Le sensazioni interocettive comprendono un ampio raggio di funzioni biologiche sia consce sia inconsce, e costituiscono la dimensione interna del nostro senso del Se. L’obiettivo primario di questa tesi è stato di capire come le percezioni interne del corpo siano in grado di modificare il nostro senso del se e come questi processi possano essere cambiati, modificati e alterati per migliorare il benessere psicofisiologico. Gli scopi di questa dissertazione sono stati 1) capire come gli input interocettivi sono processati e come contribuiscono al nostra percezione del se e al nostro benessere. 2) sviluppare nuove tecnologie per manipolare il sistema interocettivo al fine di promuovere il benessere. 3) testare queste nuove tecnologie interocettive su soggetti sani e su popolazioni cliniche. La tesi propone nuovi contributi sia teorici sia sperimentali. Nella sezione sperimentale, le tecnologie interocettive sono state testate per promuovere il benessere in popolazioni cliniche e non. I risultati hanno indicato che i trattamenti interocettivi possono promuovere il benessere nei soggetti sani e ridurre la severità dei sintomi in soggetti patologici (i.e., con dolore cronico) confermando la possibilità di manipolare la dimensione interocettiva per promuovere il benessere dell’individuo. / Interoception can be defined as the sense of the physiological condition of the entire organism (Craig, 2003). From this point of view interoceptive sensations entail a broad range of relevant biological functions that serve conscious and unconscious processes and constitute the embodied inner dimension of our sense of Self. The main objective of this thesis was to understand how the perceptions that arise from our body are able to shape our sense of Self and moreover, how these processes can be changed, modified, and altered to improve both our physiological both our psychological well-being. The purpose of this dissertation was 1) to understand how interoceptive inputs are processed and how they contribute to our self-perception and well-being. 2) to develop new interoceptive technologies to manipulate the interoceptive system to promote well-being. 3) to test these new technological applications on healthy and clinical populations. The thesis proposes both theoretical both experimental contributes. In the experimental section interoceptive technologies are tested to promote well-being in healthy and clinical populations. Results indicated that “interoceptive treatment” can both promote well-being in healthy subjects both reduce symptoms severity in clinical subjects (i.e. chronic pain) confirming the possibility to manipulate the interoceptive dimension to enhance healthy functioning.

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Anxiety Sensitivity (AS), the belief that anxiety-related sensations may have harmful implications, can alter autonomic nervous system (ANS) function. Exercise has previously been shown to reduce AS; however, the effects of an exercise intervention on heart rate variability (HRV), a measure of ANS function, has not been evaluated in individuals with high AS. This study sought to 1) compare resting HRV in individuals with either low (LAS) or high AS (HAS) and 2) evaluate the effects of a 2-week exercise intervention on HRV and AS. Using the Anxiety Sensitivity Index (ASI-3), participants were identified as LAS (n=9; ASI-3=5.89±1.39) or HAS (n=15; ASI-3=32.87±2.49) and subsequently completed six 20-minute moderate intensity exercise sessions. HRV and psychosocial measures were obtained at baseline and following the 2-week intervention. No significant differences (p>0.05) in time or frequency domain HRV values between groups were revealed at baseline; however, when considering the HAS group alone, strong associations were observed between the ASI-3 score and HRV values in the time domain: RMSSD (r=-0.56), SDNN (r=-0.61), and pNN50 (r=-0.53). Following the intervention, changes observed in HRV and the higher and lower order (subscale) ASI-3 scores were not different between the groups; however, a medium to large effect was observed for the higher order ASI-3 and the cognitive subscale score, suggesting that our findings were likely limited by the small sample size. Further research is warranted to evaluate the relationship between HRV and AS and should seek to determine the most effective exercise interoceptive exposure for improving AS symptomology.

<p>Aktuell forskning har visat att psykologiska faktorer spelar en viktig roll för upplevelsen av långvarig smärta. Denna studie undersökte effekterna av en KBT-behandling bestående av introceptiv exponering och avslappning för patienter med långvarig smärta. Studien använde en single-subject design där sex smärtpatienter genomgick en sex veckor lång individuell behandling. De variabler studien undersökte var i första hand förändringar gällande grad av acceptans samt upplevd smärtintensitet, i andra hand förändringar gällande smärtrelaterad ångest, rörelserädsla, katastroftankar samt funktion. Deltagande i behandlingen var förknippat med ökad acceptans, förbättrad funktion, minskad smärtintensitet, minskad smärtrelaterad ångest, mindre katastroftankar samt minskad rörelserädsla. Studien tyder på att denna behandling kan leda till positiva förändringar hos smärtpatienter för såväl kognitiva och känslomässiga komponenter som beteendemässiga komponenter.</p> / <p>Current research has shown that psychological factors play an important role in the experience of chronic pain. This study examined the effects of a CBT treatment containing interoceptive exposure and relaxation for patients with chronic pain. The study used a single-subject design where six patients underwent a six week long individual treatment. The variables the study examined were changes concerning degree of acceptance, pain intensity, changes concerning pain related anxiety, kinesiophobia, catastrophizing and function. Participation in the treatment was associated with increased acceptance, improved function, reduced pain intensity, reduced pain related anxiety, less catastrophizing and reduced kinesiophobia. The study indicates that this treatment can lead to positive changes with pain patients in both cognitive and emotional components as well as behavioral components.</p>

Aktuell forskning har visat att psykologiska faktorer spelar en viktig roll för upplevelsen av långvarig smärta. Denna studie undersökte effekterna av en KBT-behandling bestående av introceptiv exponering och avslappning för patienter med långvarig smärta. Studien använde en single-subject design där sex smärtpatienter genomgick en sex veckor lång individuell behandling. De variabler studien undersökte var i första hand förändringar gällande grad av acceptans samt upplevd smärtintensitet, i andra hand förändringar gällande smärtrelaterad ångest, rörelserädsla, katastroftankar samt funktion. Deltagande i behandlingen var förknippat med ökad acceptans, förbättrad funktion, minskad smärtintensitet, minskad smärtrelaterad ångest, mindre katastroftankar samt minskad rörelserädsla. Studien tyder på att denna behandling kan leda till positiva förändringar hos smärtpatienter för såväl kognitiva och känslomässiga komponenter som beteendemässiga komponenter. / Current research has shown that psychological factors play an important role in the experience of chronic pain. This study examined the effects of a CBT treatment containing interoceptive exposure and relaxation for patients with chronic pain. The study used a single-subject design where six patients underwent a six week long individual treatment. The variables the study examined were changes concerning degree of acceptance, pain intensity, changes concerning pain related anxiety, kinesiophobia, catastrophizing and function. Participation in the treatment was associated with increased acceptance, improved function, reduced pain intensity, reduced pain related anxiety, less catastrophizing and reduced kinesiophobia. The study indicates that this treatment can lead to positive changes with pain patients in both cognitive and emotional components as well as behavioral components.

Anxiety sensitivity (AS; fear of anxiety-related bodily sensations) is a risk factor for anxiety and related psychological disorders. Preliminary evidence also associates high AS with reduced levels of physical exercise and fitness. The primary objectives of the five studies comprising this dissertation were 1) to further explore the relationships between AS levels and exercise/fitness levels, and 2) to evaluate outcomes and processes of a brief group cognitive behaviour therapy (CBT) that included a novel exercise-based interoceptive exposure (IE; exposure to feared anxiety-related sensations) component of running, with female undergraduate students. High AS female undergraduate participants endorsed more barriers to exercise than low AS participants, and these accounted for the inverse relationships between AS group and exercise/fitness levels (Study 1). The brief CBT/IE led to decreases in AS levels (Studies 2 and 4) and in symptoms of stress, depression, and anxiety (Study 4) for high AS participants. Processes involved in the brief CBT’s therapeutic effects were explored by examining cognitive (i.e., catastrophic thoughts), affective (i.e., feelings of anxiety), and somatic (i.e., physical sensations) reactions to the running IE component with an existing measure, the hyperventilation questionnaire (HVQ; Study 2), and a brief version of the measure, the HVQ-B, developed and validated in Study 3 (Study 5). Changes in cognitive and affective reactions to running were most closely associated with the brief CBT/IE’s therapeutic benefits, underlying the importance of changing the meaning of and emotional reaction to physiological arousal. Surprisingly, a health education control (HEC) intervention consisting of an interactive discussion on exercise, nutrition and sleep for health, including problem-solving barriers to health behaviours, also led to decreases in AS levels and in symptoms of depression and anxiety (Study 4). Physical exercise, the common link between the two interventions, may be partially driving the interventions’ therapeutic benefits. More specifically, perhaps both interventions addressed barriers to exercise, either by altering the meaning of and emotional reaction to exercise (CBT/IE), or through problem-solving (HEC). Encouraging physical exercise in high AS individuals by acknowledging and addressing barriers to exercise might help decrease these individuals’ AS levels and improve their overall mental health

Embodiment is the experience of one's own body. It is often studied using the Rubber Hand Illusion (RHI). This illusion varies the consistency between visual, tactile and proprioceptive signals to elicit a change to embodiment. Changes to embodiment are typically measured using a single sensory outcome measure of proprioceptive drift, which is interpreted as a proxy measure of embodiment. This approach obscures the unique contribution of other modalities such as vision and touch. The work presented in this thesis uses a mixed method approach to investigate the unique contribution of visual, tactile and proprioceptive modalities within the multisensory process of embodiment. In study one, a qualitative analysis showed that when visual-tactile discrepancies were present in the RHI, participants described both body ownership and body extension type changes to embodiment, and changes to tactile perception. In study two, psychophysical measurements of the RHI showed changes to visual, tactile and proprioceptive aspects of embodiment, suggesting that embodiment in the RHI could be measured using multiple sensory outcomes. Studies three and four assessed the utility of measuring multiple sensory outcomes of the RHI, by exploring changes to embodiment following internal and external forms of body perception training. Study three showed that brief body scan meditation, as a form of internal body perception training, reduced the longevity of the visual sensory outcome of the RHI and that this reduction was negatively correlated with improvements in interoceptive sensitivity. Study four showed that learning about the body through anatomical dissection training, as a form of external body perception training, reduced the longevity of the visual sensory outcome measure and decreased interoceptive sensitivity, but only in medical students who were high in trait personal distress. Collectively, these findings suggest that aspects of the multisensory processes of embodiment can become specialised and identify some unique contributions of individual sensory modalities to embodiment. The proprioceptive sensory outcome appears to be stable over time but the visual sensory outcome is a longer-term change to embodiment, which is susceptible to interference from body perception training. In study five, confirmatory factor analysis was used to assess the psychometric properties of an embodiment change questionnaire measuring body ownership, body extension and perceived causality in the RHI. Factor scores from the questionnaire were correlated with visual and proprioceptive outcome measures of the RHI and measures of trait empathy. The results suggested factor scores had better convergent validity than the standard illusion score used in previous research. This work has improved subjective and perceptual measures of the RHI and specified ways that individual sensory modalities provide a unique contribution to embodiment. The methods developed have further applications for studying the multisensory process of embodiment and investigating embodiment in a number of clinical groups.

Anxiety involves both bodily reactions and subjective feelings.Research suggests a positive link between heightened interoception -the perception of bodily signals - and experiences of emotions andanxiety. It has also been theorized that believing bodily signals to havenegative implications (interoceptive fear) can increase the awarenessof these signals, in turn increasing levels of anxiety. In this master’sthesis the goal was to assess this proposal. Self-reported fear of bodilysensations (interoceptive fear) and awareness of bodily sensations(interoceptive sensibility) were used to predict levels of anxiety. Theresults showed that all three variables were positively related and thatincluding interoceptive fear as a second predictor of anxiety in amultiple regression model attenuated the unique predictive value ofinteroceptive sensibility. Despite some limitations, such as the factthat some potential confounders could not be controlled for, and thatthe study was cross-sectional, the study highlights the importance ofconsidering fear and awareness of bodily sensations in anxiety.

Panic disorder (PD) and claustrophobia are commonly co-occurring anxiety disorders associated with high distress and impairment. Interoceptive exposure (IE; exposure focused on anxiety about somatic sensations) is a well-established component of treatments for PD, but little is known about the specificity of its effects or individual response patterns resulting from this intervention. This study investigated the utility of IE in the treatment of PD with claustrophobia, examining its mechanisms in isolation and in combination with more traditional exposure to phobic situations (situational exposure). Ten adults with PD and claustrophobia (aged 23-74, 30% female) were treated with a flexible single-case experimental approach. Participants received up to 6 sessions of IE exercises (e.g., running in place to build tolerance to racing heart). Nonresponders received up to 6 additional sessions of IE combined with situational exposure entailing entering a closet to induce claustrophobia. Hypotheses included: 1) Reductions in somatic anxiety coinciding with the introduction of IE; 2) Reductions in agoraphobic symptoms coinciding with the introduction of situational exposure for initial nonresponders; 3) Habituation to both interventions whereby distress and participants’ expectancy of the most feared outcome (e.g., fainting) would decrease, and fear tolerance would increase, with improvements maintained at retest. Four participants experienced a clinically significant reduction in somatic anxiety coinciding with IE as predicted; three other participants improved following the addition of situational exposure. One aspect of agoraphobic anxiety – willingness to enter enclosed spaces – generally improved only after combined exposure, as predicted. Both IE and combined exposure elicited habituation whereby distress and expectancies of feared outcomes decreased and fear tolerance increased, supporting hypotheses. All improvements were maintained at retest. Ideographic analysis suggested that IE can rapidly change beliefs about somatic sensations and lead to distress habituation, but has variable immediate effects on overall somatic anxiety and does not reliably reduce related symptom sets (e.g., agoraphobia). IE appeared more helpful to participants who were fearful of the physical consequences of somatic sensations (e.g., heart attack) vs. other consequences (e.g., embarrassment). The observed variability in response to IE and combined exposure suggests a need for individualized implementation of treatments in PD with claustrophobia.