Updating Prospective, Self-Efficacy Beliefs About Cardiac Interoception in Anorexia Nervosa: An Experimental and Computational Study

Abstract

Patients with anorexia nervosa (AN) typically hold aberrant beliefs about their body that they struggle to update, including global, prospective beliefs about their ability to know and regulate their body and particularly their interoceptive states. While clinical, questionnaire studies have provided ample evidence on the role of such beliefs in the onset, maintenance, and treatment of AN, psychophysical studies have typically focused on perceptual and ‘local’ beliefs. Across two experiments, we examined how women with AN (N=86) and weight-restored from anorexia (AN-WR, N=87), in comparison to matched healthy controls (HCs, N=180) updated their self-efficacy beliefs about their ability to count their own heartbeats in an adapted heartbeat counting task (HCT). As preregistered, we found that while AN patients do not differ from controls in interoceptive accuracy per se, they hold and maintain ‘pessimistic’ interoceptive, metacognitive self-efficacy beliefs after performance. Modelling using a simplified, computational Bayesian learning framework showed that neither local evidence from performance, nor retrospective beliefs following that performance (that themselves were suboptimally updated) seem to be sufficient to counter and update pessimistic, self-efficacy beliefs in AN. Patients with AN showed lower learning rates than controls, revealing a tendency to base their posterior beliefs more on prior beliefs rather than prediction errors in both retrospective and prospective belief updating. Further explorations showed that while these differences in both explicit beliefs, and the latent mechanisms of belief updating, were not explained by general cognitive flexibility differences, they were explained by negative mood comorbidity, even after the acute stage of illness.