The role of mid-insula in the relationship between cardiac interoceptive attention and anxiety: evidence from an fMRI study

Abstract

Interoception refers to the perception of the internal bodily states. Recent accounts highlight the role of the insula in both interoception and the subjective experience of anxiety. The current study aimed to delve deeper into the neural correlates of cardiac interoception; more specifically, the relationship between interoception-related insular activity, interoceptive accuracy, and anxiety. This was done using functional magnetic resonance imaging (fMRI) in an experimental design in which 40 healthy volunteers focused on their heartbeat and anxious events. Interoceptive accuracy and anxiety levels were measured using the Heartbeat Perception Task and State Trait Anxiety Inventory, respectively. The results showed posterior, mid and anterior insular activity during cardiac interoception, whereas anxiety-related activation showed only anterior insular activity. Activation of the anterior insula when focused on cardiac interoception was positively correlated to state and trait anxiety levels, respectively. Moreover, the mid-insular activity during the cardiac attention condition not only related to individuals’ interoceptive accuracy but also to their levels of state and trait anxiety, respectively. These findings confirm that there are distinct neural representations of heartbeat attention and anxious experience across the insular regions, and suggest the mid-insula as a crucial link between cardiac interoception and anxiety.

Adaptive and Maladaptive Bodily Awareness: Distinguishing Interoceptive Sensibility and Interoceptive Attention from Anxiety‐Induced Somatization in Autism and Alexithymia

“…In any of these situations, increased somatization and hypervigilance associated with state, trait, or illness anxiety, would elevate scores on self‐report measures assessing self‐reported awareness of these interoceptive sensations. Several reports outside of the ASD literature have demonstrated common neural regions subserving both interoceptive attention and anxiety [Tan et al, 2018; Wu, Shi, Wei, & Qiu, 2019]. Thus, while interoceptive attention toward bodily signals may be adaptive up to a point for the purpose of regulating anxiety, excessive attention to the same signals may be maladaptive and actually increase anxiety.…”

Oxytocin differentially modulates amygdala responses during top-down and bottom-up aversive anticipation

“…The posterior insula/parietal operculum is strongly engaged in interoception, particularly the integration of interoceptive and exteroceptive multimodal sensory information, such as pain, touch, temperature, somato-visceral sensations, auditory processing, and vestibular processing (Craig, 2002;Kurth et al, 2010;Nieuwenhuys, 2012;Simmons et al, 2013;Uddin et al, 2017). Interoceptive information of the current physiological state of the body is progressively integrated with emotional awareness along a posterior to anterior gradient in the insula (Craig, 2002), and interoceptive signaling in the posterior/mid insula has been increasingly recognized as important contributor to emotional experience including anxiety (Tan et al, 2018). Exaggerated anticipation of potential threat represents a key mechanism in anxiety disorders (e.g.…”

Oxytocin Differentially Modulates Amygdala Responses during Top‐Down and Bottom‐Up Aversive Anticipation

“…[71][72][73][74][75] Interoceptive information of the current physiological state of the body is progressively integrated with emotional awareness along a posterior to anterior gradient in the insula, [73] and interoceptive signaling in the posterior/mid insula has been increasingly recognized as an important contributor to emotional experience including anxiety. [76] Exaggerated anticipation of potential threat represents a key mechanism in anxiety disorders, [77] and has been repeatedly associated with exaggerated amygdala and insula activation during the anticipation of a potential threat. For instance, Simmons et al found that in anxiety-prone individuals the anticipation of aversive visual stimuli was associated with increased activation in the insular cortex, including the posterior insula, [78] and Tan et al reported that posterior/middle insula interoception-related activation was positively associated with trait and state anxiety levels.…”

“…For instance, Simmons et al found that in anxiety-prone individuals the anticipation of aversive visual stimuli was associated with increased activation in the insular cortex, including the posterior insula, [78] and Tan et al reported that posterior/middle insula interoception-related activation was positively associated with trait and state anxiety levels. [76] By using multifaceted anatomical and physiological circuit analyses in mice, Gehrlach et al demonstrated a role for the posterior insula in the representation of anxiety-related information and described an insula-to-central amygdala pathway which mediates anxiety-related behaviors. [79] These findings support a key role for the amygdala-posterior insula circuit in anxiety-related processing including threat anticipation.…”