This document contains the analyses for the BACN 2025 Poster Session (Poster 10, September 12, 2025, Edinburgh, UK). You can access it by scanning the central QR code titled The Brain.

Author: Dr. Adrian Yoris (ICN–UCL) 📧

Note: In this document, you will find the background, preliminary analyses and results, and concluding remarks— only accessible via QR code scanning.

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https://adrianeyoris.shinyapps.io/BACN2025board/

Introduction.

How confident can we be that our neuroscience research truly impacts people’s lives? Neuroscience prides itself on rigor, but how often do our findings truly reach the people whose lives we hope to improve? It is easy to become absorbed by feasibility, data quality, and publication targets. These matter, but translation requires more. It requires us to ask: can our findings be transformed into meaningful, reliable, and enduring tools for practice? I reflect on how a body–brain interaction framework—rooted in interoception—may help bridge this translational gap. I will share examples of how clinical realities can shape the way we design our experiments, and conversely, how neuroscience can inform new ways of thinking about lived experience and mental health care.

Interoceptive features of mental health within dimensional approaches.

Interoception is often defined as the sensing of signals from inside the body—the heartbeat, the breath, the gut (Critchley and Garfinkel, 2017). In neuroscience, it has become a powerful construct for linking brain and body, framed in terms of networks, mechanisms, and theory. Yet outside the lab, the term carries less immediate meaning. What does “interoception” means to someone who cannot feel motivation, joy, or to a family member supporting a loved one with recurrent depression? Through the Em-body Study, spanning the UK and Argentina, we connected these concepts in lived experience. Using a Patient and Public Involvement (PPI) framework, we asked patients, families, health workers, and members of the public what interoception means to them. Their responses were thought-provoking. Many described difficulties sensing or trusting bodily signals across psychiatric—and in Argentina also neurological—conditions. These challenges were not confined to diagnostic categories; they cut across them. For some, experiences aligned with clinical conditions. For others, the descriptions defied our expectations, and sometimes people struggled to find words at all. This dimensional perspective reminds us that interoceptive difficulties may be common dimensions across mental health conditions, while remaining deeply personal in expression.

PPI Argentina 2025 (EM-BODY Study). Preliminary results.

On 26th August 2025, we held the first Argentine PPI workshop of the Em-body study, extending earlier work from the UK (Hickmann et al., 2025). Patients, family members, and health workers were invited to reflect on bodily signals/symptoms using an online quiz (Slido). Figure 1 shows the proportion of contributors who highlighted each bodily signal. Strikingly, muscle tension, heartbeat, breathing, and body temperature emerged as the most problematic signals across groups. Importantly, stomach (the top ranked signal for patients in Hickmann), were more meaningful for families and health workers than patients.

We also asked participants to rate the distress associated with their most difficult bodily sensation (1 = not at all, 10 = extremely) (Figure 2). Although the online sample was very small, patients and non-patients did not differ statistically (Wilcoxon rank sum test: W = 62, p = .51). While these results remain preliminary, and considering that some contributors completed the poll on paper format (and were not analysed here), we expect to find a more reliable picture of the issue by incorporating an online version of the workshop (proposed N > 40) by Sept–Oct 2025. If this trend holds, it would suggest that the intensity of distress associated with bodily sensations is not simply a function of clinical status. This insight may refine how we conceptualize and measure bodily sensitivity across clinical and non-clinical groups.

Training interoception as an ability

A multidimensional framework of interoception (Garfinkel et al., 2016; 2022) emphasizes that bodily awareness is not a single construct but a set of interacting dimensions: from the raw strength of bodily signals, to high level metacognitive processes about one’s bodily signals. Within this framework, interoceptive accuracy (e.g., detecting heartbeats, estimating respiratory thresholds) can be distinguished from interoceptive awareness (estimating one’s own accuracy), for instance. Both may be clinically relevant, but not always in the same way. Impairments in these dimensions have been reported across conditions, including panic disorder (Yoris et al., 2015), obsessive–compulsive disorder (Yoris et al., 2016), and personality pathology. One translational question is whether training interoception can help. For instance, Quadt et al. (2021) showed that a one-week interoceptive training (2-month follow-up) reduced anxiety symptoms in autistic adults. Such findings raise further questions. Does greater interoceptive accuracy necessarily benefit mental health, or might heightened sensitivity exacerbate distress in some conditions? Might awareness of one’s own precision be a more protective factor? An additional concern is how metacognitive dimensions of interoception translate into experiences of worry. For patients who describe themselves as ‘overthinkers,’ targeting worry, rumination, and misinterpretation of bodily signals may represent an urgent clinical need. Finally, what therapeutic interventions—behavioral training, CBT, yoga, pharmacological interventions—can most effectively target these interoceptive dimensions?

From fMRI studies to clinical issues.

Interoception has found evidence of activation of specific structures and networks within the brain. For instance, fMRI studies demonstrated that brain regions such as the insula and anterior cingulate cortex (ACC) integrate bodily signals with higher-order processes like decision making and emotion regulation. Dysregulated connectivity between these areas has been observed in individuals experiencing depression, stress, and fatigue, suggesting that interoceptive dysfunction may contribute to broader cognitive difficulties. A significant recent advance comes from Allen and colleagues (2025), who investigated respiratory interoception using quantitative neuroimaging. They found that individual differences in respiratory interoceptive sensitivity, metacognitive awareness, and emotional dimensions were associated with microstructural variations in the insula, ACC, primary sensory cortex, and periaqueductal gray (Nikolova et al., 2025) This underscores the importance of exploring interoception beyond cardiac signals and reinforces the anatomical significance of these regions for breath-based interoception. Again, science lacks of translational language to incorporate these valuable findings into interventions that sort real clinical problems.

Alexithymia, a not easily translated interoceptive construct

Alexithymia -ie., the difficulty in identifying and describing emotions— represents a key dimension where interoception and mental health intersect. It has been proposed that can exacerbate symptoms of anxiety, depression, and even physical pain. Considering alexithymia within interoceptive frameworks, we expected to better understand how deficits in awareness and labeling of bodily signals. Although many patients report bodily sensations that cannot link to specific feelings, leading to distress and misinterpretation of internal states, alexithymia is a sub-clinical construct which scientific status is still under review (Brewer et al., 2016; Brewer, Murphy and Bird, 2021).

However, current evidence does not consistently demonstrate a direct correlation between deficits in interoceptive dimensions (e.g., precision, awareness) and high levels of alexithymia (Brewer, Murphy and Bird, 2021). Mixed findings may partly reflect the limitations of existing assessment tools, many of which rely heavily on self-report and capture only specific facets of the construct. One promising avenue would be the development and validation of questionnaires that assess alexithymia in a more dimensional and multimodal way, explicitly incorporating both interoceptive and cognitive–linguistic components. In parallel, an open question for future research is whether interoceptive training—through behavioral, contemplative, or neurocognitive interventions—can enhance individuals’ ability to identify and label their emotions more effectively. Addressing these issues may help clarify the mechanistic role of interoception in alexithymia and inform targeted therapeutic approaches.

Sleep, stress, fatigue, and pain

Beyond mood, interoceptive difficulties are also implicated in symptoms such as poor sleep, stress, fatigue, and pain. These experiences are deeply embodied, often marked by heightened bodily awareness (e.g., muscle tension in stress, restlessness in insomnia) or blunted awareness (e.g., exhaustion in fatigue). Recent evidence shows that chronic pain is associated with reduced interoceptive accuracy but increased interoceptive sensibility (Valenzuela-Moguillansky et al., 2024). Nevertheless, most of these clinical issues are still in a very early stage in experimental settings, where more sophisticated and ecologically validated designs are needed.

EMA time series analysis can detect transition towards mental ill-health in depression.

Ecological Momentary Assessment (EMA) allows us to capture real-time fluctuations in mood, cognition, and behavior within people’s natural environments. It minimizes recall bias and provides dense temporal data, revealing the unfolding dynamics of mental health. Importantly, such approaches open the possibility of detecting early warning signals—subtle changes in temporal structure that may precede the onset or worsening of depression.

In an exploratory time series analysis of EMA data (N = 1172, 85.9% female) from the WARN-D Study (Fried et al., 2023), we sought to examine depression as a complex and temporally dynamic condition (Yoris, 2025*). Our hypothesis was that dimensions of depression, such as mood fluctuations, could be continuously tracked using EMA methods to identify potential early warning signals. Data were collected over 90 consecutive days (four times per day), and the temporal structure of mood dynamics was evaluated with three complementary methods: autocorrelation, sudden gains and losses, and multivariate kernel change point detection (KCP-RS).

Figure 3 presents sudden gain and loss detection in EMA data in one example participant. Daily trajectories of 11 emotional variables, overlaid with predicted values from regression tree models (black lines) and change point detections (dashed vertical lines). PHQ-9 scores are displayed as gray bars on a secondary axis, allowing temporal alignment between mood fluctuations and clinical symptom dynamics.

We observed that negative emotions—particularly stress and sadness—showed persistent autocorrelations up to lag-4 across the full sample, indicative of mood inertia. Sudden gains and losses, defined as abrupt shifts relative to each participant’s baseline, were frequent and often co-occurred with changes in depressive symptom severity on the PHQ-9. At the individual level, KCP-RS analyses revealed clear reorganizations of mean-level mood over time, with breakpoints particularly evident in participants with higher depression scores. In contrast, mood variance and inter-emotion correlations appeared more temporally stable and less closely linked to depression.

These findings suggest that negative mood not only persists over time (inertia) but also undergoes abrupt reorganizations across a three-month observation period. The question we would like to answer in this regard is to what extent interoception can explain those changes in stability and transitions between healthy and mental ill-health. By assessing bodily signals on EMA studies, such as heartbeats, HR, HRV, can we improve our understanding of interoception beyond a latent variable framework? Despite the inherent challenges of EMA data, such as random missingness and reliance on self-report, longitudinal designs provide a unique opportunity to model individual emotional trajectories with high temporal precision. Interoception research can move toward more ecologically valid and clinically relevant insights into the temporal dynamics of mood and depression.

Conclusion

Together, these findings illustrate how interoception can provide a unifying framework for understanding mental health across dimensions and time scales. It can combine experimental neuroscience (HEPs, fMRI), ecological measures (EMA), and patient perspectives (PPI), to move toward translational tools that connect with both science and lived experience. Although neuroscience prides itself on rigor, we can do better to truly reach the people whose lives we hope to improve.

Refernces

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