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Cited by 163Psychosomatic Disorders and Their TreatmentsEmbodied and Extended CognitionAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Interoception of breathing and its relationship with anxiety

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Harrison, Olivia K., Köchli, Laura, Marino, Stephanie, Luechinger, Roger, Hennel, Franciszek, Brand, Katja, Hess, Alexander J., Frässle, Stefan +5 more·2021·Neuron
DOI 10.1016/j.neuron.2021.09.045PMC PMC8691949

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Abstract

Interoception, the perception of internal bodily states, is thought to be inextricably linked to affective qualities such as anxiety. Although interoception spans sensory to metacognitive processing, it is not clear whether anxiety is differentially related to these processing levels. Here we investigated this question in the domain of breathing, using computational modeling and high-field (7 T) fMRI to assess brain activity relating to dynamic changes in inspiratory resistance of varying predictability. Notably, the anterior insula was associated with both breathing-related prediction certainty and prediction errors, suggesting an important role in representing and updating models of the body. Individuals with low versus moderate anxiety traits showed differential anterior insula activity for prediction certainty. Multi-modal analyses of data from fMRI, computational assessments of breathing-related metacognition, and questionnaires demonstrated that anxiety-interoception links span all levels from perceptual sensitivity to metacognition, with strong effects seen at higher levels of interoceptive processes.

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  • The perception of internal physical processes has the potential to amplify or modulate stress.

    “The perception of our internal physical processes has the potential to amplify or modulate stress.42”

    From Brief structured respiration practices enhance mood and reduce physiological arousal (2023) · cites this paper as [42]

    The Introduction (page unavailable) defines interoception as perceiving internal bodily states and says that perceiving signs of sympathetic arousal can induce anxiety. It does not establish that this perception amplifies or modulates stress specifically; the paper’s Conclusions likewise concern anxiety and breathing perception. (LLM, conf=0.81)

    Experimental — accuracy not yet measured

  • Controlled breathing can potentially reduce anxiety by decreasing anterior insula activity.

    “Thus, controlled breathing can potentially act in the opposite way and reduce anxiety by decreasing anterior insula activity.”

    From Brief structured respiration practices enhance mood and reduce physiological arousal (2023) · cites this paper as [42]

    The Abstract and Discussion (Conclusions; page numbers unavailable) link breathing-related processing, anxiety, and anterior insula activity. They do not show that controlled breathing decreases anterior insula activity or reduces anxiety through that mechanism. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • People with high anxiety and panic disorder have less tolerance for breathlessness and have heightened activity in the anterior insula.

    “People with high anxiety and panic disorder have less tolerance for breathlessness and have heightened activity in the anterior insula, a region central to interoception of visceral signals and central to the salience network.”

    From Brief structured respiration practices enhance mood and reduce physiological arousal (2023) · cites this paper as [42]

    The Introduction says aversive breathing symptoms are particularly prevalent in people with anxiety and panic disorder, and the Questionnaire results report greater breathing-related catastrophizing in the moderate-anxiety group. But the paper does not establish reduced tolerance for breathlessness or study a panic-disorder group. The Results (BLT results) report no overall anxiety-group effect on anterior-insula activity, only an interaction involving prediction certainty and threat valence, so the unqualified claim of heightened activity is not supported. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

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Authors
Harrison, O. K., Köchli, L., Marino, S., Luechinger, R., Hennel, F., Brand, K., Hess, A. J., Frässle, S., Iglesias, S., Vinckier, F., Petzschner, F. H., Harrison, S. J., & Stephan, K. E.
Affiliations
  • University of Zurich (CH)
  • University of Otago (NZ)
Corresponding author
Harrison, Olivia K.
ORCID
Venue
Neuron
Publisher
Elsevier BV
Published
2021-12
Volume
109
Issue
24
Pages
4080-4093.e8
ISSN
0896-6273 (ISSN-L)
DOI
10.1016/j.neuron.2021.09.045
PMC
PMC8691949
OpenAlex
W3206924380
Cited by
163
References
130
Citations by year
2026: 32 · 2025: 38 · 2024: 38 · 2023: 32 · 2022: 17 · 2021: 5 · 2020: 1
FWCI
16.50
Type
journal article
Language
en
Open access
Licence
Locations
  • Neuron (publishedVersion, cc-by)
  • bioRxiv (Cold Spring Harbor Laboratory) (acceptedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, cc-by)
  • HAL (submittedVersion, cc-by)
  • Repository for Publications and Research Data (ETH Zurich) (submittedVersion, cc-by)
  • Zurich Open Repository and Archive (University of Zurich) (submittedVersion, cc-by)
  • ETH Zürich Research Collection (cc-by)
  • Zurich Open Repository and Archive (University of Zurich)
Funders
  • European Commission (HORIZON2020, 793580)
  • Fondation pour la Recherche Médicale
  • Eidgenössische Technische Hochschule Zürich (793580, 2017-403)
  • Universität Zürich (793580, 2017-403)
  • Fondation Bettencourt Schueller
  • René und Susanne Braginsky Stiftung (2017-403, 793580)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Embodied and Extended Cognition
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
interoception, anxiety, breathing, anterior insula, prediction error, metacognition, inspiratory resistance, body model, computational modeling
MeSH terms
Anxiety, Anxiety Disorders, Heart Rate, Humans, Respiration, Interoception

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