The neural mechanisms underlying interoception and HEP are outlined, followed by a comprehensive overview of the methodologies commonly employed in HEP research, and three types of HEP-related experimental designs are identified: bottom-up bodily sensory input, top-down predictive perception, and top-down regulation.
Abstract
Abstract Interoception refers to the ability to perceive and integrate physiological signals originating from within the body, such as heartbeat and respiration. This process involves both bottom-up and top-down. As a key neurophysiological marker of interoception, the heartbeat-evoked potential (HEP) reflects the cortical processing of cardiac signals in the brain. In this review, we first outline the neural mechanisms underlying interoception and HEP, followed by a comprehensive overview of the methodologies commonly employed in HEP research. Based on the directionality of interoceptive information flow, we categorize HEP-related experimental designs into three types: bottom-up bodily sensory input, top-down predictive perception, and top-down regulation. Additionally, we explore the clinical relevance of HEP in areas such as psychiatric disorders and cardiac-related conditions. Finally, we recommend expanding research on top-down predictive perception and top-down regulation in clinical contexts.
The heartbeat-evoked potential (HEP) is an implicit, electrophysiological marker of cortical heartbeat processing and interoception, with increasing clinical relevance. However, on the scalp, HEP are low-amplitude signals mixed with cardiac field artefacts (CFA), requiring signal processing pipelines to separate HEP from CFA. This review evaluates current analytical approaches and addresses methodological gaps in HEP pipelines. A scoping review of the literature was conducted focusing on previously published HEP studies. This was to extract HEP processing methods and parameters used in EEG (199 included papers) and MEG (8 included papers). Parameters investigated included the HEP window, filters, baseline correction window, epoch timeframes, minimum RR intervals, epoch amplitude rejection threshold, and CFA removal. EEG and MEG studies revealed clear heterogeneity and variability in the methods used to derive HEP. These clear inconsistencies in HEP parameter use and reporting would appear to challenge the level replicability between studies. In order to ensure reproducibility and transparency, publications should report critical values for reliable HEP extraction, emphasising the need for standardised methods to enhance study comparability and reproducibility.
Rania-Iman Virjee, Rohan Kandasamy, Sarah N. Garfinkel et al.· Social Cognitive and Affecti...· 0 citations
Background Somatic Symptom Disorder (SSD) is defined by distressing physical symptoms and exaggerated psychological responses, and interoceptive hypersensitivity is widely regarded as a central feature, but the neuro-psychological pathway from neural interoceptive processing to clinical symptoms is not well elucidated. Hence, the present study sought to investigate the neurophysiological basis of interoceptive hypersensitivity in SSD and the mediating role of alexithymia. Methods Fifty-two medication-naive patients with SSD and 52 age- and sex-matched healthy controls (HC) underwent clinical assessment with PHQ-15 and TAS-20, as well as high-resolution EEG recording, and interoceptive hypersensitivity was quantified via heartbeat-evoked potential (HEP) amplitudes obtained during a heartbeat tracking task and resting-state Phase Lag Index (PLI). A structural equation model (SEM) was then used to formally test the proposed parallel multiple mediation pathway. Results SSD patients exhibited significantly higher somatic distress, alexithymia, and interoceptive accuracy compared to HCs (p< 0.001). Neurophysiologically, the SSD group demonstrated significantly increased resting-state PLI and higher HEP amplitudes (2.20 ± 1.10 vs. 1.20 ± 0.80 μV, p< 0.001), presenting a robust and clinically realistic effect size (Cohen’s d = 1.04). Mediation analysis confirmed that alexithymia significantly and specifically mediated the relationship between HEP amplitude and somatic symptom severity (specific indirect effect = 0.820, p = 0.025). A combined diagnostic model using HEP and TAS-20 scores achieved an Area Under the Curve (AUC) of 0.866. Conclusion SSD is characterized by amplified cortical processing within the interoceptive network, and this neural hypersensitivity to visceral signals is strongly associated with clinical somatic distress, a process partially mediated by impaired emotional identification. Therefore, HEP amplitude and alexithymia are exploratory candidate indicators that directly support the use of neurophysiological and emotional regulation interventions in the treatment of SSD.
Cunyou Gao, Yujie Yuan, Xiaojun Zhuang et al.· Frontiers in Psychiatry· 0 citations
Interoception, the processing and perception of internal bodily signals, regulates a wide range of psychological and somatic functions, including emotional experiences, bodily symptom perception, self-awareness and decision-making, highlighting its important role in the maintenance of bodily and mental homeostasis. Traditionally, interoception has been studied within single organ domains, with findings often generalized to interoception as a whole. However, evidence suggests interoceptive abilities may be domain-specific rather than a general ability. This pilot study investigated how perceptual and affective dimensions of interoception relate across organ systems. Thirty-three healthy adults completed comparable magnitude estimation and sustained stimulation tasks, allowing for comparisons across the respiratory, esophageal, and cardiac domain in a within-subjects design. Respiratory sensations were evoked through inspiratory resistive loads, esophageal sensations through balloon inflations, and cardiac sensations via graded cycle ergometer exercise. Interoceptive sensitivity, the ability to perceptually discriminate between stimulation levels, was quantified as the slope of intensity ratings relative to stimulation intensity. Acute affective responses were assessed through unpleasantness ratings during sustained stimulation. Results revealed no significant correlations in interoceptive sensitivity across domains, with Bayesian analyses providing anecdotal support for the null hypothesis. In contrast, acute affective responses showed partial convergence: respiratory unpleasantness ratings correlated significantly with both esophageal and cardiac ratings, whereas esophageal and cardiac ratings were not significantly correlated. These findings support a multidimensional model of interoceptive processing, where interoceptive sensitivity appears domain-specific, while acute affective responses show partial generalization across organ systems. The results caution against generalizing findings from single-organ paradigms to overall interoceptive functioning.
Tabea Eimer, Maaike Van Den Houte, Livia Guadagnoli et al.· Biological Psychology· 0 citations
Loneliness is associated with heightened affective sensitivity and increased vulnerability to stress, yet its psychophysiological mechanisms remain incompletely understood. Drawing on the three-dimensional model of interoception (Garfinkel et al., 2015), the present study examined whether loneliness is associated with variation in interoceptive sensibility (self-report), interoceptive accuracy (behavioral), and cortical processing of cardiac signals (heartbeat-evoked potential; HEP). Two primary hypotheses were tested: higher loneliness would be associated with lower interoceptive sensibility, particularly in dimensions involving emotional and regulatory appraisal of bodily states; and higher loneliness would be associated with attenuated resting-state HEP amplitude over fronto-central electrodes. Thirty-nine healthy adults completed the Multidimensional Assessment of Interoceptive Awareness (MAIA), heartbeat counting (HBC) and heartbeat discrimination (HBD) tasks, and resting-state EEG with simultaneous ECG recording. HEPs were analyzed using cluster-based permutation test, and source localization was performed using sLORETA. The first hypothesis was partially supported: four MAIA subscales - Not Worrying, Emotional Awareness, Self-Regulation, and Trusting - showed significant negative correlation with loneliness, whereas interoceptive accuracy was not significantly associated with loneliness. The second hypothesis was supported: higher loneliness was associated with attenuated late HEP amplitudes over left frontal electrodes, with source localization implicating the left dorsolateral cortex (DLPFC). The HEP-loneliness association remained significant after controlling for depressive symptoms and demographic factors (sex and age). These findings are consistent with a regulation-based account in which loneliness is associated with altered appraisal and impaired higher-order cortical processing of bodily signals, a pattern consistent with the hypervigilance model of loneliness.
Kentaro Ono, T. Sasaoka, Shigeto Yamawaki· Biological Psychology· 0 citations
A scoping, narrative roadmap of SSVEP applications organized into three primary domains is provided, highlighting the versatility of SSVEPs in investigating neural mechanisms, supporting diagnosis and treatment of neurological and psychiatric conditions, and advancing brain-computer interface technology.
T. Tsoneva, P. Desain, G. G. Molina et al.· NeuroImage· 0 citations
Interoception represents the brain’s ability to sense and interpret internal bodily signals, integrating cardiovascular, autonomic, and cortical processes to maintain homeostasis and shape emotional states. Cardiac interoception links physiological signals with affective experience. Mitral valve prolapse (MVP), a common valvular condition, is frequently associated with anxiety and autonomic dysfunction, yet its mechanisms remain poorly understood. Altered valve mechanics in MVP may modify baroreceptor signaling and autonomic balance, potentially contributing to distorted afferent input and heightened interoceptive sensitivity, although direct evidence for this pathway in MVP patients is currently lacking. Experimental optogenetic studies in animal models demonstrate that cardiac afferent modulation can causally influence anxiety-related behaviors, providing mechanistic proof-of-concept rather than direct evidence in MVP. Brain–computer interfaces (BCIs) using heartbeat-evoked potentials are being explored as experimental tools for real-time assessment and closed-loop neurofeedback, though clinical translation remains preliminary. Cardiac interoception offers a candidate, hypothesis-generating framework linking cardiac pathology and neuropsychiatric symptoms. Future work integrating circuit-level insights with BCI-based monitoring may help clarify whether earlier detection and personalized interventions can improve outcomes in MVP-related anxiety.
A. AbdelMassih, Noha Khalil, Baraa Ali Osman et al.· Egyptian Pediatric Associati...· 0 citations
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