Attention to interoceptive signals: an experience sampling study

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Attention to interoceptive signals: an experience sampling study

Rationale

It has recently been suggested that individual differences in interoception, the perception of the body’s internal state, can be considered across four broad categories; objective interoceptive accuracy, subjective interoceptive accuracy, objective interoceptive attention and subjective interoceptive attention (1). Despite methods to quantify subjective facets of interoception (both beliefs regarding accuracy and beliefs regarding attention) and one’s objective interoceptive accuracy, there remains no objective method to quantify the extent to which internal signals are the object of one’s attention. Given previous research that suggests atypical attention to internal signals is observed across certain clinical conditions (e.g., anxiety; (2)), coupled with a growing need to test theoretical models of the structure of interoceptive abilities (e.g., (1,3)), the development of such a task is an urgent research goal.

Previous theoretical papers have suggested that experience sampling methods may be used to quantify the extent to which internal signals are the object of one’s attention, thereby providing an objective measure of attention to internal signals. The aim of this project is therefore to develop an experience sampling method to quantify the extent to which internal signals are the object of one’s attention and use this method to examine both the structure of interoceptive abilities and the novel measures relationship with mental health.

Methods

Participants : All data will be collected online using Qualtrics or smartphone applications. Participants will be recruited via Prolific. Participants will be able to take part in this survey if they are between 18-60 years of age and have no visual or hearing problems (as noted by Prolific’s screeners). Ethical approval has already been obtained from Royal Holloway University of London.

Study 1

Aim(s): Study 1 aims to: 1) examine whether reporting on one’s attention to internal signals (vs. reporting on one’s attention to auditory signals) alters one’s beliefs regarding one’s general attention to, and accuracy of perceiving, internal signals. 2) identify the extent to which objectively measured attention to internal signals is related to wellbeing measures such as depression, anxiety and alexithymia and 3) determine the extent to which objectively measured attention to internal signals is related to one’s mood and if this varies as a function of depression, anxiety or alexithymia.

Measures and protocol:

This protocol has already been piloted in a sample of 40 individuals.

  • Part 1. Participants will first complete questionnaire measures of attention to internal signals (the interoceptive attention questionnaire; (4)) and accuracy of perceiving internal signals (the interoceptive accuracy scale; IAS (3)) via Qualtrics. Here they will also provide demographic information and complete questionnaires about their mental health (the Depression, Anxiety and Stress Scale; DASS-21; Toronto Alexithymia Scale; TAS-20; (5–7)).
  • Part 2. Participants will then be randomly assigned to one of the experience sampling surveys, attention to internal signals or attention to auditory signals, implemented via a smartphone application (the PIEL survey). Participants will be asked to complete these ratings 6 times per day for 2 weeks. On each day, a prompt will be sent randomly within the following time points: 10-11am; 12-1pm; 2-3pm; 4-5pm; 6-7pm; 8-9pm. Participants will be sent a reminder to complete the survey 10 minutes after the first notification. After the first notification, participants will have 30 minutes to answer the survey.
  • Part 3. After the experience sampling procedure is complete, participants will complete the same questionnaire measures of interoception as in part 1 and a debrief survey about their experience.

Study 2

Aim(s): Will use the experience sampling method to test the model proposed by Murphy et al., (2019; (1)).

Measures and protocol :

  • Participants will complete questionnaire measures of attention to internal signals (IATS; (4)) and accuracy of perceiving internal signals (IAS; (3)) via Qualtrics.
  • Participants will complete the experience sampling procedure that assesses one’s attention to internal signals implemented via a smartphone application.
  • Participants will complete an objective measure of cardiac interoceptive accuracy implemented via a smartphone application (Phase Adjustment Task; PAT; (8)).

Analysis and sample size rationale

Sample size for Study 1 has been determined a priori based on previously reported effect sizes. As a 2 (experience sampling task: internal vs auditory) x 2 (beliefs regarding attention scores: pre-task vs. post-task) mixed ANOVA with the first factor between-subjects will be used to analyse the key data, power analyses are based on this analysis. Given that the test re-test of measures of attention to internal signals (the porges body perception questionnaire; BPQ; (9)) is reportedly r=.684 (3) a sample size of at least 88 participants (44 in each group) will provide >80% power to detect even small effect sizes (f=.10). Such a sample size provides >80% power to detect even small effect sizes for the model including the IAS given that the test-retest for this measure is slightly higher (r=.754; (3)). However, as part of the aim of this study is to examine the relationship between the subjective and objective measures of one’s attention to internal signals, a minimum of 70 participants will be included in each group. Such a sample size provides >80% to detect a correlation of r=.30 (one-tailed) between the objective and subjective measures of attention. As such, total sample size for test stage 1 will be 140 participants.

Study 2 will recruit a minimum of 100 participants. Such a sample size provides >80% power to detect correlations of r=.25 (one-tailed).

Full analysis plans can be found on the pre-registration.

Study costs

Study 1: 140 participant x 2.5 hours = £3,675.00

Study 1: Bonus for full completion: £10 x 140 participants = £1,400

Study 2: 100 participants x 2 hours = £2,100

Study 2: Bonus for full completion: £10 x 100 participants = £1,000

Slush fund for replacing incomplete datasets: £1,825

Pre-registration

Both studies have been pre-registered on the Open Science Framework (OSF).

Open science

All study materials, analysis code and results (as a pre-print) will be made available on the Open Science Framework.

References

  1. Murphy, J., Catmur, C., & Bird, G. (2019). Classifying individual differences in interoception: Implications for the measurement of interoceptive awareness. Psychonomic bulletin & review, 26 (5), 1467-1471.

  2. Khalsa, S. S., & Lapidus, R. C. (2016). Can interoception improve the pragmatic search for biomarkers in psychiatry?. Frontiers in psychiatry, 7 , 121.

  3. Murphy, J., Brewer, R., Plans, D., Khalsa, S. S., Catmur, C., & Bird, G. (2020). Testing the independence of self-reported interoceptive accuracy and attention. Quarterly Journal of Experimental Psychology, 73 (1), 115-133.

  4. Gabriele, E., Spooner, R., Brewer, R., & Murphy, J. (2020). Dissociations between interoceptive accuracy and attention: Evidence from the interoceptive attention scale. Pre-print: https://psyarxiv.com/vjgh6/

  5. Bagby, R. M., Parker, J. D., & Taylor, G. J. (1994). The twenty-item Toronto Alexithymia Scale—I. Item selection and cross-validation of the factor structure. Journal of psychosomatic research, 38 (1), 23-32.

  6. Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour research and therapy, 33 (3), 335-343.

  7. Antony, M. M., Bieling, P. J., Cox, B. J., Enns, M. W., & Swinson, R. P. (1998). Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychological assessment, 10 (2), 176-181.

  8. Plans, D., Ponzo, S., Bird, G., Ring, C., Morelli, D., Keating, C. T., … & Catmur, C. (2020). Measuring Interoception: The Phase Adjustment Task. Pre-print: https://psyarxiv.com/sa953

  9. Cabrera, A., Kolacz, J., Pailhez, G., Bulbena‐Cabre, A., Bulbena, A., & Porges, S. W. (2018). Assessing body awareness and autonomic reactivity: Factor structure and psychometric properties of the Body Perception Questionnaire‐Short Form (BPQ‐SF). International journal of methods in psychiatric research, 27 (2), e1596.