Somatic Symptoms and Its Association With Anxiety and Interoception

Venie Viktoria Rondang Maulina; Hideki Ohira

doi:10.24123/aipj.v39i2.6327

Venie Viktoria Rondang Maulina Nagoya University & Universitas Katolik Indonesia Atma Jaya
Hideki Ohira Nagoya University

DOI: https://doi.org/10.24123/aipj.v39i2.6327

Abstract Views: 111 times

PDF - Full Text Downloads: 54 times

Keywords: somatic symptoms, health concerns, trait anxiety, interoception, heart rate variability (HRV)

Abstract

In Somatic Symptom Disorder, individuals may misinterpret their symptoms as signs of disease. Meanwhile, interoception refers to an individual’s perception to sense internal body sensations. Interoception may play a role in the regulation of state and trait anxiety. Anxiety, in turn, is associated with somatic symptoms. A comprehensive study regarding somatic symptoms is still required to fill the knowledge gap regarding its relationships with other variables. In this study, 101 university students from Nagoya, Japan, fulfilled four questionnaires related to the study variables. The participants also completed the heartbeat counting task (HCT) to assess interoceptive accuracy and heart rate variability (HRV) measurement. The results showed that health concerns and trait anxiety are associated with somatic symptoms. In addition, the sub-scales Attention Regulation and Self-Regulation determined trait anxiety in an inverse correlation. These results suggest that interoception, particularly interoceptive sensibility, is negatively associated with trait anxiety regarding somatic symptoms. The inverse relationship could be expected, as interoceptive sensibility is a set of positive beliefs about aspects of the individual’s abilities and the tendency to consciously sense signals originating from inside their body.

Downloads

Download data is not yet available.

References

American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders, fifth edition. American Psychiatric Association (APA) Publishing. https://doi.org/10.1176/appi.books.9780890425596

Barrett, L. F., & Simmons, W. K. (2015). Interoceptive predictions in the brain. Nature Reviews Neuroscience, 16(7), 419-429. https://doi.org/10.1038/nrn3950

Bogaerts, K., Millen, A., Li, W., De Peuter, S., Van Diest, I., Vlemincx, E., Fannes, S., & Van den Bergh, O. (2008). High symptom reporters are less interoceptively accurate in a symptom-related context. Journal of Psychosomatic Research, 65(5), 417-424. https://doi.org/10.1016/j.jpsychores.2008.03.019

Calì, G., Ambrosini, E., Picconi, L., Mehling, W. E., & Committeri, G. (2015). Investigating the relationship between interoceptive accuracy, interoceptive awareness, and emotional susceptibility. Frontiers in Psychology, 6: 1202. https://doi.org/10.3389/fpsyg.2015.01202

Chalmers, J. A., Quintana, D. S., Abbott, M. J. -A., & Kemp, A. H. (2014). Anxiety disorders are associated with reduced heart rate variability: A meta-analysis. Frontiers in Psychiatry, 5: 80. https://doi.org/10.3389/fpsyt.2014.00080

Chang, H. -A., Fang, W. -H., Wan, F. -J., Tzeng, N. -S., Liu, Y. -P., Shyu, J. -F., Chang, T. -C., Huang, S. -Y., & Chang, C. -C. (2020). Attenuated vagally-mediated heart rate variability at rest and in response to postural maneuvers in patients with generalized anxiety disorder. Psychological Medicine, 50(9), 1433-1441. https://doi.org/10.1017/S0033291719001302

Craig, A. D. (2002). How do you feel? Interoception: The sense of the physiological condition of the body. Nature Reviews Neuroscience, 3(8), 655-666. https://doi.org/10.1038/nrn894

Craig, A. D. (2009). How do you feel-now? The anterior insula and human awareness. Nature Reviews Neuroscience, 10(1), 59-70. https://doi.org/10.1038/nrn2555

Craig, A. D., & Bushnell, M. C. (1994). The thermal grill illusion: Unmasking the burn of cold pain. Science, 265(5169), 252-255. https://doi.org/10.1126/science.8023144

Desmedt, O., Corneille, O., Luminet, O., Murphy, J., Bird, G., & Maurage, P. (2020). Contribution of time estimation and knowledge to heartbeat counting task performance under original and adapted instructions. Biological Psychology, 154: 107904. https://doi.org/10.1016/j.biopsycho.2020.107904

Desmedt, O., Luminet, O., & Corneille, O. (2018). The heartbeat counting task largely involves non-interoceptive processes: Evidence from both the original and an adapted counting task. Biological Psychology, 138, 185-188. https://doi.org/10.1016/j.biopsycho.2018.09.004

Domschke, K., Stevens, S., Pfleiderer, B., & Gerlach, A. L. (2010). Interoceptive sensitivity in anxiety and anxiety disorders: An overview and integration of neurobiological findings. Clinical Psychology Review, 30(1), 1-11. https://doi.org/10.1016/j.cpr.2009.08.008

Dunn, B. D., Stefanovitch, I., Evans, D., Oliver, C., Hawkins, A., & Dalgleish, T. (2010). Can you feel the beat? Interoceptive awareness is an interactive function of anxiety- and depression-specific symptom dimensions. Behaviour Research and Therapy, 48(11), 1133-1138. https://doi.org/10.1016/j.brat.2010.07.006

Ferentzi, E., Drew, R., Tihanyi, B. T., & Köteles, F. (2018). Interoceptive accuracy and body awareness - Temporal and longitudinal associations in a non-clinical sample. Physiology & Behavior, 184, 100-107. https://doi.org/10.1016/j.physbeh.2017.11.015

Freeston, M. H., Rhéaume, J., Letarte, H., Dugas, M. J., & Ladouceur, R. (1994). Why do people worry? Personality and Individual Differences, 17(6), 791-802. https://doi.org/10.1016/0191-8869(94)90048-5

Fujino, H. (2019). Further validation of the Japanese version of the Multidimensional Assessment of Interoceptive Awareness. BioMed Central (BMC) Research Notes, 12(1): 530. https://doi.org/10.1186/s13104-019-4556-x

Garfinkel, S. N., & Critchley, H. D. (2013). Interoception, emotion and brain: New insights link internal physiology to social behaviour. Commentary on: “Anterior insular cortex mediates bodily sensibility and social anxiety” by Terasawa et al. (2012). Social Cognitive and Affective Neuroscience, 8(3), 231-234. https://doi.org/10.1093/scan/nss140

Garfinkel, S. N., Seth, A. K., Barrett, A. B., Suzuki, K., & Critchley, H. D. (2015). Knowing your own heart: Distinguishing interoceptive accuracy from interoceptive awareness. Biological Psychology, 104, 65-74. https://doi.org/10.1016/j.biopsycho.2014.11.004

Hipwell, A. E., Keenan, K., & Marsland, A. (2009). Exploring psychophysiological markers of vulnerability to somatic illnesses in females. Journal of Pediatric Psychology, 34(9), 1030-1039. https://doi.org/10.1093/jpepsy/jsp010

Huang, W. -L., Liao, S. -C., Yang, C. C. H., Kuo, T. B. J., Chen, T. -T., Chen, I. -M., & Gau, S. S. -F. (2017). Measures of heart rate variability in individuals with somatic symptom disorder. Psychosomatic Medicine, 79(1), 34-42. https://doi.org/10.1097/PSY.0000000000000362

Järvelin-Pasanen, S., Sinikallio, S., & Tarvainen, M. P. (2018). Heart rate variability and occupational stress-Systematic review. Industrial Health, 56(6), 500-511. https://doi.org/10.2486/indhealth.2017-0190

Kabir, R. S. (2019). Interoceptive attention tendencies predict trait anxiety in undergraduate students and hospital nurses participating in stress management programs. Bulletin of the Graduate School of Education Part III, 68, 111-120. https://doi.org/10.15027/48517

Khalsa, S. S., Adolphs, R., Cameron, O. G., Critchley, H. D., Davenport, P. W., Feinstein, J. S., Feusner, J. D., Garfinkel, S. N., Lane, R. D., Mehling, W. E., Meuret, A. E., Nemeroff, C. B., Oppenheimer, S., Petzschner, F. H., Pollatos, O., Rhudy, J. L., Schramm, L. P., Simmons, W. K., Stein, M. B., Stephan, K. E., Van der Bergh, O., Van Diest, I., van Leupoldt, A., Paulus, M. P., & Interoception Summit 2016 Participants. (2018). Interoception and mental health: A roadmap. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 3(6), 501-513. https://doi.org/10.1016/j.bpsc.2017.12.004

Kleiger, R. E., Stein, P. K., & Bigger, J. T., Jr. (2005). Heart rate variability: Measurement and clinical utility. Annals of Noninvasive Electrocardiology (ANE), 10(1), 88-101. https://doi.org/10.1111/j.1542-474X.2005.10101.x

Koreki, A., Funayama, M., Terasawa, Y., Onaya, M., & Mimura, M. (2021). Aberrant interoceptive accuracy in patients with schizophrenia performing a heartbeat counting task. Schizophrenia Bulletin Open, 2(1): sgaa067. https://doi.org/10.1093/schizbullopen/sgaa067

Krautwurst, S., Gerlach, A. L., Gomille, L., Hiller, W., & Witthöft, M. (2014). Health anxiety - An indicator of higher interoceptive sensitivity? Journal of Behavior Therapy and Experimental Psychiatry, 45(2), 303-309. https://doi.org/10.1016/j.jbtep.2014.02.001

Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2002). The PHQ-15: Validity of a new measure for evaluating the severity of somatic symptoms. Psychosomatic Medicine: Journal of Biobehavioral Medicine, 64(2), 258-266. https://doi.org/10.1097/00006842-200203000-00008

Kvaal, S. A., & Patodia, S. (2000). Relations among positive affect, negative affect, and somatic symptoms in a medically ill patient sample. Psychological Reports, 87(1), 227-233. https://doi.org/10.2466/pr0.2000.87.1.227

LaMotte, R. H., Thalhammer, J. G., Torebjork, H. E., & Robinson, C. J. (1982). Peripheral neural mechanisms of cutaneous hyperalgesia following mild injury by heat. The Journal of Neuroscience, 2(6), 765-781. https://doi.org/10.1523/JNEUROSCI.02-06-00765.1982

Leventhal, E. A., Hansell, S., Diefenbach, M., Leventhal, H., & Glass, D. C. (1996). Negative affect and self-report of physical symptoms: Two longitudinal studies of older adults. Health Psychology, 15(3), 193-199. https://doi.org/10.1037//0278-6133.15.3.193

Light, A. R., & Perl, E. R. (2003). Unmyelinated afferent fibers are not only for pain anymore. The Journal of Comparative Neurology, 461(2), 137-139. https://doi.org/10.1002/cne.10691

Locatelli, G., Matus, A., James, R., Salmoirago-Blotcher, E., Ausili, D., Vellone, E., & Riegel, B. (2023). What is the role of interoception in the symptom experience of people with a chronic condition? A systematic review. Neuroscience & Biobehavioral Reviews, 148: 105142. https://doi.org/10.1016/j.neubiorev.2023.105142

Lovis-Schmidt, A., Bilz, L., Pahlke, K., & Rindermann, H. (2022). Physical health complaints in adolescents: Findings from the 2018 Brandenburg HBSC study. European Journal of Health Psychology, 29(3), 121-133. https://doi.org/10.1027/2512-8442/a000090

Malik, M., Bigger, J. T., Camm, A. J., Kleiger, R. E., Malliani, A., Moss, A. J., & Schwartz, P. J. (1996). Heart rate variability: Standards of measurement, physiological interpretation, and clinical use. European Heart Journal, 17(3), 354-381. https://doi.org/10.1093/oxfordjournals.eurheartj.a014868

Mallorquí-Bagué, N., Bulbena, A., Pailhez, G., Garfinkel, S. N., & Critchley, H. D. (2016). Mind-body interactions in anxiety and somatic symptoms. Harvard Review of Psychiatry, 24(1), 53-60. https://doi.org/10.1097/HRP.0000000000000085

Maulina, V. V. R. (2016). Health anxiety in young Indonesian adults: A preliminary study. The International Academic Forum (IAFOR) Journal of Psychology & the Behavioral Sciences, 2(1), 25-32. https://doi.org/10.22492/ijpbs.2.1.02

Mehling, W. E., Acree, M., Stewart, A., Silas, J., & Jones, A. (2018). The Multidimensional Assessment of Interoceptive Awareness, Version 2 (MAIA-2). PLoS ONE, 13(12): e0208034. https://doi.org/10.1371/journal.pone.0208034

Mehling, W. E., Price, C., Daubenmier, J. J., Acree, M., Bartmess, E., & Stewart, A. (2012). The Multidimensional Assessment of Interoceptive Awareness (MAIA). PLoS ONE, 7(11): e48230. https://doi.org/10.1371/journal.pone.0048230

Miu, A. C., Heilman, R. M., & Miclea, M. (2009). Reduced heart rate variability and vagal tone in anxiety: Trait versus state, and the effects of autogenic training. Autonomic Neuroscience: Basic & Clinical, 145(1-2), 99-103. https://doi.org/10.1016/j.autneu.2008.11.010

Mizuno, K., Tanaka, M., Yamaguti, K., Kajimoto, O., Kuratsune, H., & Watanabe, Y. (2011). Mental fatigue caused by prolonged cognitive load associated with sympathetic hyperactivity. Behavioral and Brain Functions (BBF), 7: 17. https://doi.org/10.1186/1744-9081-7-17

Muramatsu, K. (2014). An up‐to‐date letter in the Japanese version of PHQ, PHQ‐9, PHQ‐15 [Patient Health Questionnaire (PHQ-9, PHQ-15) Nihongoban oyobi Generalized Anxiety Disorder -7 Nihongoban -up to date-]. Niigata Seiryō University Clinical Psychological Research [Niigata Seiryō Daigaku Daigakuin Rinshō Shinrigaku Kenkyū], 7, 35-39. https://core.ac.uk/reader/70372800

Nolen-Hoeksema, S. (2020). Abnormal psychology (8th edition). McGraw-Hill Education. https://www.mheducation.co.uk/abnormal-psychology-ise-9781260569674-emea

Palser, E. R., Palmer, C. E., Galvez-Pol, A., Hannah, R., Fotopoulou, A., & Kilner, J. M. (2018). Alexithymia mediates the relationship between interoceptive sensibility and anxiety. PLoS ONE, 13(9): e0203212. https://doi.org/10.1371/journal.pone.0203212

Paulus, M. P., & Stein, M. B. (2010). Interoception in anxiety and depression. Brain Structure and Function, 214(5), 451-463. https://doi.org/10.1007/s00429-010-0258-9

Pennebaker, J. W. (2000). Psychological factors influencing the reporting of physical symptoms. In A. A. Stone, J. S. Turkkan, C. A. Bachrach, J. B. Jobe, H. S. Kurtzman, & V. S. Cain (Eds.), The science of self-report: Implications for research and practice (pp. 299-315). Lawrence Erlbaum Associates Publishers. https://psycnet.apa.org/record/1999-04118-017

Permadi, D., & Nurwianti, F. (2019). Mindfulness and coping skills as predictors of competitive anxiety amongst athletes in Indonesia. ANIMA Indonesian Psychological Journal, 33(4), 231-240. https://doi.org/10.24123/aipj.v33i4.1796

Pollatos, O., & Schandry, R. (2004). Accuracy of heartbeat perception is reflected in the amplitude of the heartbeat-evoked brain potential. Psychophysiology, 41(3), 476-482. https://doi.org/10.1111/1469-8986.2004.00170.x

Rahal, D., Tashjian, S. M., Karan, M., Eisenberger, N., Galván, A., Fuligni, A. J., Hastings, P. D., & Cole, S. W. (2023). Positive and negative emotion are associated with generalized transcriptional activation in immune cells. Psychoneuroendocrinology, 153: 106103. https://doi.org/10.1016/j.psyneuen.2023.106103

Rief, W., & Barsky, A. J. (2005). Psychobiological perspectives on somatoform disorders. Psychoneuroendocrinology, 30(10), 996-1002. https://doi.org/10.1016/j.psyneuen.2005.03.018

Salkovskis, P. M., & Warwick, H. M. C. (2001). Meaning, misinterpretations, and medicine: A cognitive-behavioral approach to understanding health anxiety and hypochondriasis. In V. Starcevic & D. R. Lipsitt (Eds.), Hypochondriasis: Modern perspectives on an ancient malady (pp. 202-222). Oxford University Press. https://psycnet.apa.org/record/2001-00239-009

Schandry, R. (1981). Heart beat perception and emotional experience. Psychophysiology, 18(4), 483-488. https://doi.org/10.1111/j.1469-8986.1981.tb02486.x

Schenk, L., Fischbach, J. T. M., Müller, R., Vögele, C., Witthöft, M., Van Diest, I., & Schulz, A. (2020). High blood pressure responders show largest increase in heartbeat perception accuracy after post-learning stress following a cardiac interoceptive learning task. Biological Psychology, 154: 107919. https://doi.org/10.1016/j.biopsycho.2020.107919

Scholz, O. B., Ott, R., & Sarnoch, H. (2001). Proprioception in somatoform disorders. Behaviour Research and Therapy, 39(12), 1429-1438. https://doi.org/10.1016/s0005-7967(00)00108-x

Shaffer, F., & Ginsberg, J. P. (2017). An overview of heart rate variability metrics and norms. Frontiers in Public Health, 5: 258. https://doi.org/10.3389/fpubh.2017.00258

Shiga, K., Izumi, K., Minato, K., Sugio, T., Yoshimura, M., Kitazawa, M., Hanashiro, S., Cortright, K., Kurokawa, S., Momota, Y., Sado, M., Maeno, T., Takebayashi, T., Mimura, M., & Kishimoto, T. (2021). Subjective well-being and month-long LF/HF ratio among deskworkers. PLoS ONE, 16(9): e0257062. https://doi.org/10.1371/journal.pone.0257062

Shimizu, H., & Imae, K. (1981). State-Trait Anxiety Inventory no nihongoban (daigakusei-yō) no sakusei [Development of the Japanese edition of the Spielberger State-Trait Anxiety Inventory (STAI) for university student use]. The Japanese Journal of Educational Psychology [Kyōiku Shinrigaku Kenkyū], 29(4), 348-353. https://doi.org/10.5926/jjep1953.29.4_348

Shimizu, H. (2016). An introduction to the statistical free software HAD: Suggestions to improve teaching, learning and practice data analysis [Furī no tōkei bunseki sofuto HAD: Kinō no shōkai to tōkei gakushū • kyōiku, kenkyū jissen ni okeru riyō hōhō no teian]. Journal of Media, Information and Communication [Media • Jōhō • Komyunikēshon Kenkyū], 1, 59-73. https://repository.tku.ac.jp/dspace/bitstream/11150/10815/1/JMIC01-05.pdf

Shoji, M., Mehling, W. E., Hautzinger, M., & Herbert, B. M. (2018). Investigating multidimensional interoceptive awareness in a Japanese population: Validation of the Japanese MAIA-J. Frontiers in Psychology, 9: 1855. https://doi.org/10.3389/fpsyg.2018.01855

Sloan, R. P., Shapiro, P. A., Bagiella, E., Boni, S. M., Paik, M., Bigger, J. T., Steinman, R. C., & Gorman, J. M. (1994). Effect of mental stress throughout the day on cardiac autonomic control. Biological Psychology, 37(2), 89-99. https://doi.org/10.1016/0301-0511(94)90024-8

Spielberger, C., Gorsuch, R., Lushene, R., Vagg, P., & Jacobs, G. (1983). Manual for the State-Trait Anxiety Inventory (Form Y1 - Y2). Consulting Psychologists Press.

Terasawa, Y., Shibata, M., Moriguchi, Y., & Umeda, S. (2013). Anterior insular cortex mediates bodily sensibility and social anxiety. Social Cognitive and Affective Neuroscience, 8(3), 259-266. https://doi.org/10.1093/scan/nss108

Toussaint, A., Murray, A. M., Voigt, K., Herzog, A., Gierk, B., Kroenke, K., Rief, W., Henningsen, P., & Löwe, B. (2016). Development and validation of the Somatic Symptom Disorder-B Criteria Scale (SSD-12). Psychosomatic Medicine, 78(1), 5-12. https://doi.org/10.1097/PSY.0000000000000240

Vig, L., Köteles, F., & Ferentzi, E. (2022). Questionnaires of interoception do not assess the same construct. PLoS ONE, 17(8): e0273299. https://doi.org/10.1371/journal.pone.0273299

Witthöft, M., Bräscher, A. -K., Jungmann, S. M., & Köteles, F. (2020). Somatic symptom perception and interoception: A latent-variable approach. Zeitschrift für Psychologie [Journal of Psychology], 228(2), 100-109. https://doi.org/10.1027/2151-2604/a000403

Witthöft, M., Fischer, S., Jasper, F., Rist, F., & Nater, U. M. (2016). Clarifying the latent structure and correlates of somatic symptom distress: A bifactor model approach. Psychological Assessment, 28(1), 109-115. https://doi.org/10.1037/pas0000150