Helmholtz Lecture Katerina Fotopoulou, October 31: Embodied Mentalisation from Development to the Clinic: The Social Origins of Interoception and its Treatment  

Helmholtz lecture Katerina Fotopoulou (Dep. of Clinical., Educational and Health Psychology, University College London)

Location: Ruppert building room Paars (Purple), Leuvenlaan 21 3584 CE Utrecht

Abstract:

Embodied Mentalisation from Development to the Clinic: The Social Origins of Interoception and its Treatment  

Introduction: Interoception, the ability to perceive and interpret internal bodily signals, plays a crucial role in emotional regulation and overall well-being, particularly during childhood when foundational affective skills are developing. Not surprisingly, disruptions in interoception have emerged as a transdiagnostic pathogenic mechanism for several disorders at the mental-physical health interface, such as eating, functional or somatic symptom disorders. However, the interdisciplinary expertise required to identify and therapeutically target psychophysiological mechanisms, spanning physiological variables to metacognitive beliefs, has limited the efficacy of related therapeutic endeavours (Heim et al., 2024).  In this talk, I will present the first steps of two novel interdisciplinary approaches progressing in parallel towards the common goals of understanding the development of adaptive and maladaptive interoceptive inferences (embodied mentalisation), and of treating them by social biofeedback.  

Methods: First, in order to provide the first, direct evidence of parental inferences of opaque interoceptive child states, I present the development and validation of two novel methodologies, namely Parental Interoception Questionnaire (PIQ) testing parental interoceptive sensibility (based on two independent samples of 601 and 511 parents of young children) and the Parental Interoception Task (PIT), testing parental interoceptive sensitivity or accuracy, based on a adult, cardiac interoception task (Galvez-Pol, Antoine, Li, and Kilner, 2022), using first a group of 54 adults and then an independent sample of 64 parents and their children. Second, based on prior computational psychiatry studies on patients with anorexia nervosa revealing maladaptive interoceptive inferences at the metacognitive level and following co-design with users, we have developed and tested the efficacy and mechanisms of action of a novel, interdisciplinary (psychophysiological) therapeutic module (InMe) in 100 individuals with low interoception awareness, stratified for subclinical disorder eating or somatisation symptoms. In a two-arm parallel group randomised controlled trial (RCT) comparing InMe intervention to an active control intervention (imagery training without biofeedback). INME uses cardiac biofeedback during guided respiration exercises to train individuals to down-regulate their own heartrate under different conditions of stress, while also enhancing related metacognitive beliefs. 

Results and Discussion: Parental studies revealed direct relationships between parental own interoception and ‘reading’ the body of children, and the ability to differentiate between the two as predictive of affective regulation in both parent and child. RCT biofeedback results showed effects on primary measure of interoception only at follow-up for INME than for the control intervention.  Taken together, these findings provide evidence on the role of social biofeedback and embodied mentalisation in the development of adaptive and maladaptive interoception, and its treatment. 

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