Anxiety as a Gut Feeling: Understanding Interoception

Marcus Paulus presented the April 2011 Warren Neuroscience Frontiers in Neuroscience Lecture.  The presentation was titled: Interoception and Anxiety.

Interoception is the summation of a variety of bodily perceptions that make up the integrated sense of our own physiological state.  Perceptions included in interoception include: pain, temperature, tickle, sensual touch, stomach discomfort to due acidity, air hunger and muscle tension.  Here are my notes from Dr. Paulus' presentation and his research manuscript on this topic area.

• Anxiety proneness is a trait that can be measured and is associated with high risk of later development of an anxiety disorder
• Anxiety proneness linked to increased activation of the dorsal amygdala and the anterior insula in brain fMRI tasks such as the Emotion Face Assessment task of Hariri
• Patients with anxiety also show insular hyperactivation in anticipation of negative cues
• Benzodiazepines like Valium reduce activation of the insula as well as the amygdala in response to angry faces

• There is growing awareness the brain insular cortex plays a key role in interoception--receiving signals from the body and integrating these signals with emotional response and regulation (see a previous post summarizing the function of the insula and possible roles in clinical neuroscience disorders)
• The insula also connects to a central pathway important in anxiety involving the anterior cingulate cortex and the dorsolateral prefrontal cortex--these areas provide input to the insula for planning and acting in the face of

• Key properties of the interoception include the signals from internal organs including the lungs, heart, gastrointestinal tract and genitourinary systems
• Many of these signals provide awareness of body and help promote homeostasis
• These signals also are involved in our sense of self and the passing of time

• A new area of understanding is the important role of personal beliefs in emotional processing--personal beliefs may modulate interoception and the perception of emotional cues
• A belief that a situation or cue is more dangerous than it really is, i.e. I will embarrass myself at the party, can modulate how emotion is processed, and can amplify a anxious response to the situation

Future research in the area of interoception and anxiety will target:

• Genetic influences on interoception
• How cognitive interventions may influence dysfunctional beliefs related to anxiety
• How interoception may help with more biological classification of types of anxiety
• Can people be trained to up or down regulate the insular cortex to reduce anxiety?
• How treatments for anxiety effect the elements of interoception

Brain Tutor iPad Screenshot of Insular Cortex in Green Courtesy of Author

Paulus MP, & Stein MB (2010). Interoception in anxiety and depression. Brain structure & function, 214 (5-6), 451-63 PMID: 20490545