How Misreading Bodily Signals Causes Anxiety

[David Baxter PhD]

How Misreading Bodily Signals Causes Anxiety
by Nicholas Hobson, PhD, BrainBlogger.com
May 25, 2018

It’s 9 AM Monday morning. You’ve just pulled into work and are ready to pitch your presentation to the senior management team. Your PowerPoint slides are damn near perfect and you’ve gone over the script dozens of times. You’ve got this.

As everyone gathers in the room, you’re suddenly flooded with a hit of adrenaline. The bad kind. In a flash you become acutely aware of what your body is doing: beads of sweat forming on your brow, a dry mouth that no amount of water can fix, and a steadily increasing heart rate thumping inside your chest.

This ability to perceive the signals of your body is known as interoceptive accuracy (IAc). There are, as the example demonstrated, different psychosomatic cues that you pick up within yourself during states of anxiety. But above all, a beating heart is the hardest one to ignore.

It’s for this reason that heartbeat perception, as brain scientists call it, is a direct proxy for measuring people’s IAc and reported anxiety and stress levels.

IAc and a beating heart
Having the ability to accurately detect your own heartbeat is critical for reappraising your anxiety on a moment to moment basis. We know that anxiety is as much in the body as it is in the mind, and that a (mis)perception of a fast heart rate can easily contribute to the catastrophization of a panicked state.

It’s why some of the most effective anxiety-related therapies, like progressive muscle relaxation and deep breathing, tend to focus on muting a physiological response followed by a cognitive reappraisal technique.

Now in terms of IAc, the longstanding view was that it is an inherited trait, similar to eye color or height. Your IAc is immutable, unchanging. But now there’s new evidence suggesting that the situation matters just as much as the person: While some people may have inherently bad interoceptive ability, we can’t ignore the influence of the broader context. And this, if it turns out to be true, is a definite win for anyone looking to reverse a certain anxiety-based predisposition.

The study and findings
A team of researchers led by Martin F. Whittkamp out of the University of Luxembourg set out to investigate just how much of a role the environment plays in determining our ability to self-reflect on accurate biofeedback.

The researchers relied on two methods to measure IAc via heartbeat perception. The first, called the counting task is simply a comparison between actual measures of your heartbeat with your self-reported measures. Another method, called the heartbeat discrimination task, measures how accurately you can rate whether or not your heartbeat is in sync with an external stimulus such as a blinking light on a computer screen.

The team in this newest study compared the results of both a heartbeat counting task and discrimination task in two conditions: a resting state and a stress state. Mental stress was induced by having participants match the color of a flashing light bulb with a corresponding button as fast and accurately as possible. If this wasn’t stressful enough, the experimenter also chimed in with a few verbal cues urging the participant to perform better so as to not ruin the entire experiment.

In addition to comparing stress state IAc with resting state IAc, the researchers also designed a number of computational models. These models aimed to measure how much of one’s interoceptive accuracy is owed to individual ability versus the situation.

The results found that about 40% of a person’s IAc can be explained by his/her individual traits, while around 30% can be explained by the changing situation, leaving the remaining 30% to measurement error.

What this says is that your ability to detect and therefore modulate your bodily responses during an anxious state is not fixed. These signals are amenable to change. You can learn to more accurately perceive your beating heart in a high-stress environment. You can apply reappraisal techniques in mitigating your anxiety.

The findings of this study have the potential to inform research on stress and anxiety management. For example, having a general idea of how much your IAc is dependent on biological predisposition could provide leeway to pharmaceutical interventions to help combat debilitating responses to stressful situations.

For now there’s therapeutic power in knowing you can improve your IAc and work towards minimizing your anxiety.

References

• Feldman, G., Greeson, J., & Senville, J. (2010). Differential effects of mindful breathing, progressive muscle relaxation, and loving-kindness meditation on decentering and negative reactions to repetitive thoughts. Behaviour Research And Therapy, 48(10), 1002-1011. doi: 10.1016/j.brat.2010.06.006
• Knoll, J., & Hodapp, V. (1992). A Comparison between Two Methods for Assessing Heartbeat Perception. Psychophysiology, 29(2), 218-222. doi: 10.1111/j.1469-8986.1992.tb01689.x
• Richter, D., Manzke, T., Wilken, B., & Ponimaskin, E. (2003). Serotonin receptors: guardians of stable breathing. Trends In Molecular Medicine, 9(12), 542-548. doi: 10.1016/j.molmed.2003.10.010
• Wittkamp, M., Bertsch, K., Vögele, C., & Schulz, A. (2018). A latent state-trait analysis of interoceptive accuracy. Psychophysiology, 55(6), e13055. doi: 10.1111/psyp.13055

 

[David Baxter PhD]

Reading this article struck a special note with me because it perfectly mirrors my own experiences.

I was a shy child (unless I was performing¹) and as I grew older I was a nervous public speaker.

I started teaching and presenting papers at scientific conferences when I was a graduate student and this was a source of significant distress for me.

When it was only occasional, it was tolerable. But then I began my first regular teaching load - including teaching introductory psychology to a class of somewhere in the region of 300 students. No matter how much I prepared, I experienced a lot of anxiety, especially just before walking into class; it got somewhat better once the lecture was underway but it was still unpleasant. I longed for the day when I would have enough confidence to walk into that lecture hall without having near panic levels of anxiety.

And one day, about a third of the way through the lecture series, it happened. I got ready for my class - and I felt virtually no anxiety! I thought this was excellent. I had finally made it.

Off I went on my walk to the lecture hall, got the students settled down, and started into my prepared lecture.

And it was a disaster.

I was so flat and uninteresting that I was even boring myself.

In an act of mercy, I stopped after about 15-20 minutes and sent the students home with an apology.

I learned two things that day:

1. When I didn't feel at least some anxiety or nervousness before a lecture or public presentation, I sucked.
2. I had been confusing anxiety with adrenaline all along.

That burst of adrenaline I experienced before a class was my body preparing for a performance, preparing my brain to be alert and focused. Without the adrenaline, I meandered all over the place, lost my train of thought, distracted myself with things irrelevant to the topic at hand, and lacked the vitality needed to keep the audience interested for a 1-hour lecture or longer.

After that, I was able to look at the same feelings and physical experiences in an entirely new way - specifically, as an adrenaline boost instead of as a sign of weakness and lack of confidence. That adrenaline boost became my friend and ally instead of an enemy. I looked forward to it before public speaking because it was there to reassure me that I would be on top of my game.

¹ As an aside, I also realized quite early that when I was performing (school plays, later music and playing guitar) I didn't feel the same level of nervousness - perhaps recognizing that in that context it was excitement (adrenaline) rather than nervous. Later, after my teaching epiphany, I saw this as a reflection of another related phenomenon: When I knew what my role was, when I had a specific role to play and knew what to do, my shyness and lack of self-confidence disappeared - or at least was substantially reduced. This helped me in later life in unstructured social situations where I didn't have a clearly defined role and where I often experienced some social anxiety. The remedy was to construct a role for myself within that situation and play it out - comedy (being funny and making people laugh) was one of those roles for me.

It was also my introduction to cognitive behavior therapy (CBT) and cognitive reframing before I had ever heard of those terms: How you describe a situation or a feeling to yourself defines how you are going to experience it... either negative or positive, strength or weakness.