Is alexithymia characterised by impaired interoception? Further evidence, the importance of control variables, and the problems with the Heartbeat Counting Task
Open accessAbstract
Interoception, the perception of one's internal state, is commonly quantified using the heartbeat counting task (HCT) - which is thought to be a measure of cardiac interoceptive sensitivity (accuracy). Interoceptive sensitivity has been associated with a number of clinical traits and aspects of higher order cognition, including emotion processing and decision-making. It has been proposed that alexithymia (difficulties identifying and describing one's own emotions) is associated with impaired interoceptive sensitivity, but new research questions this association. Problematically, much evidence attesting to the absence of this association has been conducted using the HCT, a measure affected by various physiological and psychological factors. Here, we present novel data (N = 287) examining the relationship between alexithymia and HCT performance, controlling for a number of potential confounds. Inclusion of these control measures reveals the predicted negative relationship between alexithymia and HCT performance. Results are discussed with regard to difficulties quantifying interoceptive sensitivity using the HCT.
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The extent to which beliefs about heartbeat affect interoceptive accuracy estimates in the heartbeat counting task may depend on the task instructions given.
“The extent to which beliefs about heart beat affect interoceptive accuracy estimates in the heartbeat counting task may depend on the task instructions given; whilst early instructions encouraged participants to ‘estimate’ if they could not feel their heartbeat (Brener and Ring, 2016; Schandry, 1981) more recent approaches advocate a response of zero in this instance (Murphy, Brewer, et al., 2018)”
From Atypical interoception as a common risk factor for psychopathology: A review (2021) · cites this paper as Murphy, Brewer, et al., 2018
Increased alexithymia is associated with decreased interoceptive accuracy, specifically less accurate heartbeat detection.
“Some evidence suggests that increased alexithymia was associated with decreased interoceptive accuracy; specifically that those with higher levels of alexithymia were less accurate at detecting their heartbeat (Herbert et al., 2011; Murphy, Brewer, et al., 2018; Näring and van der Staak, 1995; Shah, Hall, Catmur, and Bird, 2016).”
From Atypical interoception as a common risk factor for psychopathology: A review (2021) · cites this paper as Murphy, Brewer, et al., 2018
Performance on cardiac interoceptive tasks appears influenced by external factors such as beliefs about heart rate, time estimation, and task instruction, which may confound observed effects.
“Performance on these tasks appears influenced by external factors such as beliefs about heart rate, time estimation, and task instruction, which may confound observed effects [67, 72].”
From Neural correlates of altered interoception in depressive and anxiety disorders: a systematic review and meta-analysis (2026) · cites this paper as [72]
Commonly used cardiac interoceptive measures, particularly heartbeat perception tasks, show issues concerning validity and reliability.
“Related to task variability, commonly used cardiac interoceptive measures, particularly heartbeat perception tasks, show issues concerning validity and reliability.”
From Neural correlates of altered interoception in depressive and anxiety disorders: a systematic review and meta-analysis (2026) · cites this paper as [72]
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References 80 · Cited by 180
Research works printed but not linked: 4
- Khalsa, S. S., Kuplicki, R., Hung-wen, Y., Clary, K., Feinstein, J. S., Simmons, K., & Paulus, M. P. (2017). Interoceptive dysfunction across psychiatric disorders: preliminary results from a large-scale naturalistic study. The American College of Neuropsychopharmacology (ACNP) conference.
- Lovibond, S. H. (1993). In P. F. Lovibondc (Ed.). Manual for the depression anxiety stress scales (DASS). Psychology Foundation Monograph. MATLAB and Statistics Toolbox Release 2014a The MathWorks, Inc., Natick, Massachusetts, United States.
- Pollatos, O., Herbert, B. M., Mai, S., & Kammer, T. (2016). Changes in interoceptive processes following brain stimulation. Transactions of the Royal Society of London.
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- Authors
- Murphy, J., Brewer, R., Hobson, H., Catmur, C., & Bird, G.
- Affiliations
- King's College London (GB)
- Royal Holloway University of London (GB)
- University of Greenwich (GB)
- Corresponding author
- Murphy, Jennifer
- Venue
- Biological Psychology
- Publisher
- Elsevier BV
- Published
- 2018-07
- Volume
- 136
- Pages
- 189-197
- ISSN
- 0301-0511 (ISSN-L)
- OpenAlex
- W2804770118
- Cited by
- 180
- References
- 80
- Citations by year
- 2026: 13 · 2025: 21 · 2024: 18 · 2023: 21 · 2022: 25 · 2021: 29 · 2020: 21 · 2019: 24 · 2018: 8
- FWCI
- 16.08
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Biological Psychology (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Greenwich Academic Literature Archive (University of Greenwich) (acceptedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (submittedVersion)
- Research Portal (King's College London) (submittedVersion, cc-by-nc-nd)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion, other-oa)
- Funders
- Economic and Social Research Council (1599941, ES/J500057/1)
- Baily Thomas Trust
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- alexithymia, interoception, heartbeat counting task, emotional awareness, confounding variables
- MeSH terms
- Adolescent, Adult, Affective Symptoms, Aged, Aged, 80 and over, Cognition, Decision Making, Emotions, Female, Heart Rate, Humans, Male, Middle Aged, Perception, Self Concept, Young Adult, Interoception
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