Interoceptive Processes in Anorexia Nervosa in the Time Course of Cognitive-Behavioral Therapy: A Pilot Study

Abstract

ObjectivePrevious studies report reduced interoceptive abilities in anorexia nervosa (AN) using various methods. Recent research suggests that different levels of interoceptive processes aiming at different subdomains of interoceptive abilities must be further distinguished as these levels can be differentially affected. Two important levels refer to interoceptive accuracy (IA) derived from objective performance tasks such as the heartbeat detection task and interoceptive sensibility (IS) as assessed by self-report. There is a lack of studies investigating both IA and IS in AN and examining them in the time course of therapy. The aim of this pilot study was to evaluate the different interoceptive processes – especially IA and IS – in the time course of therapy.MethodsFifteen patients with AN (restricting type) from the Psychosomatic Clinic in Windach were investigated three times (T1, T2, T3) during a standardized cognitive-behavioral therapy and compared with 15 matched healthy controls assessed at Ulm University in a comparable design. All participants performed the heartbeat detection task examining IA and completed standard psychological assessments including an assessment of IS.ResultsPatients with AN showed a significantly decreased weight, higher levels of depression, and both reduced IA and IS compared to healthy controls at T1. Following therapy, patients recovered in terms of weight and depression symptomatology. A descriptive trend for recovering from IA and IS was observed.DiscussionOur findings suggest that interoceptive deficits are present in recovered patients. Therefore, further investigations are needed with more patients, differentiating between relapsed and recovered patients, and more specific training methods to improve interoceptive processes.

Associations between interoceptive sensitivity, intuitive eating, and body mass index in patients with anorexia nervosa and normal‐weight controls

“…In contrast to previous reports (Fischer et al, ; Pollatos et al, ), but in line with others (Ambrosecchia et al, ; Eshkevari et al, ), we did not find evidence for lower heartbeat perception in AN patients compared with HCs using a heartbeat perception task. This may be due to sample differences (e.g., inpatient vs. outpatient, smaller sample sizes, or presence of comorbidities) and resulting heterogeneity in weight and treatment progress.…”

“…This may be due to sample differences (e.g., inpatient vs. outpatient, smaller sample sizes, or presence of comorbidities) and resulting heterogeneity in weight and treatment progress. Whereas we tested 37 AN patients (~80% of restrictive type) at different stages of treatment, Fischer et al () tested 15 AN patients with a restrictive type at three relatively systematic measurement points. Furthermore, Pollatos et al () recruited 28 AN outpatients (~80% of restrictive type), suggesting that treatment progress may be of importance when investigating interoceptive deficits in AN.…”

“…Yet the known limitations of self‐report have driven the search for more objective measures. One psychophysiological indicator of interoceptive processes—accuracy of heartbeat perception (e.g., Schandry, )—yielded more heterogeneous results: Although some studies indeed found lower accuracy in perceiving heartbeats in AN (e.g., Fischer et al, ; Pollatos et al, ), others did not find evidence for altered heartbeat perception (e.g., Ambrosecchia et al, ; Eshkevari, Rieger, Musiat, & Treasure, ). Thus, moderating factors might contribute to such heterogeneity.…”

“…Such relationships would explain previous inconsistent results: When interoceptive deficits are not stable but improve in the course of inpatient treatment, this may blur group differences in cross‐sectional studies. To date, only one study has examined heartbeat perception accuracy in patients with AN using multiple measurement points and found that reduced interoceptive sensitivity did not improve in the course of inpatient treatment (Fischer et al, ). However, this finding was based on only 15 AN patients of restrictive type and, thus, does not provide conclusive evidence that interoceptive deficits in AN are temporally stable.…”

Interoceptive accuracy is related to long‐term stress via self‐regulation

“…In light of the nonsignificant mediation effect concerning the cortisol/DHEA ratio, future studies should also use larger sample sizes to increase statistical power for the mediation analyses. In addition to this, an investigation of patients with somatic or mental disorders would be interesting due to reported IAcc impairments in such populations (Dunn, Dalgleish, Ogilvie, & Lawrence, 2007;Fischer et al, 2016;Pollatos & Georgiou, 2016;Schultchen et al, 2019;Weiss et al, 2014). In this regard, Weiss and colleagues found that individuals with somatic disorders show decreased IAcc and self-regulation.…”