Interoception in anxiety and depression

Abstract

We review the literature on interoception as it relates to depression and anxiety, with a focus on belief, and alliesthesia. The connection between increased but noisy afferent interoceptive input, self-referential and belief-based states, and top-down modulation of poorly predictive signals is integrated into a neuroanatomical and processing model for depression and anxiety. The advantage of this conceptualization is the ability to specifically examine the interface between basic interoception, self-referential belief-based states, and enhanced top-down modulation to attenuate poor predictability. We conclude that depression and anxiety are not simply interoceptive disorders but are altered interoceptive states as a consequence of noisily amplified self-referential interoceptive predictive belief states.

Fig. 1

Proposed alterations in brain circuitry (top) and the resulting process abnormalities in anxiety and depression. Briefly, “noisy” afferent interoceptive information results combined belief-based associations lead to an attempt of the cognitive control apparatus to differentiate predictive from non-predictive signals. The resulting experience (bottom) consists of amplified interoceptive afferents that are associated with carry poor differentiation of stimuli that carry predictive outcomes and create constant uncertainty for the future. More details are described in the text