Interoception of breathing and its relationship with anxiety

• Published in: Neuron (Cambridge, Mass.) Mass.), 2021-12, Vol.109 (24), p.4080-4093.e8
• Main Authors: Harrison, Olivia K., Köchli, Laura, Marino, Stephanie, Luechinger, Roger, Hennel, Franciszek, Brand, Katja, Hess, Alexander J., Frässle, Stefan, Iglesias, Sandra, Vinckier, Fabien, Petzschner, Frederike H., Harrison, Samuel J., Stephan, Klaas E.
• Format: Article
• Language: English
• Subjects: Anxiety; Anxiety Disorders; breathing; Heart Rate; Humans; inspiratory resistance; Interoception; Life Sciences; Neurons and Cognition; Respiration
• ISSN: 0896-6273; 1097-4199
• DOI: 10.1016/j.neuron.2021.09.045

Interoception, the perception of internal bodily states, is thought to be inextricably linked to affective qualities such as anxiety. Although interoception spans sensory to metacognitive processing, it is not clear whether anxiety is differentially related to these processing levels. Here we investigated this question in the domain of breathing, using computational modeling and high-field (7 T) fMRI to assess brain activity relating to dynamic changes in inspiratory resistance of varying predictability. Notably, the anterior insula was associated with both breathing-related prediction certainty and prediction errors, suggesting an important role in representing and updating models of the body. Individuals with low versus moderate anxiety traits showed differential anterior insula activity for prediction certainty. Multi-modal analyses of data from fMRI, computational assessments of breathing-related metacognition, and questionnaires demonstrated that anxiety-interoception links span all levels from perceptual sensitivity to metacognition, with strong effects seen at higher levels of interoceptive processes. •A novel trial-by-trial breathing-related interoception task during fMRI at 7 T•Anxiety relates to differences in breathing perception, metacognition, and learning•Anterior insula activity reflects respiratory predictions and prediction errors•Anterior insula activity during interoceptive predictions differs with anxiety Measuring brain activity while manipulating breathing resistance, Harrison et al. demonstrate that activity in the anterior insula reflects breathing-related predictions and prediction errors. Furthermore, prediction-related brain activity is altered with anxiety, along with sensitivity of and insight into breathing perceptions. These findings elucidate the link between breathing perception and anxiety.