An insula hierarchical network architecture for active interoceptive inference
Open accessAbstract
In the brain, the insular cortex receives a vast amount of interoceptive information, ascending through deep brain structures, from multiple visceral organs. The unique hierarchical and modular architecture of the insula suggests specialization for processing interoceptive afferents. Yet, the biological significance of the insula's neuroanatomical architecture, in relation to deep brain structures, remains obscure. In this opinion piece, we propose the Insula Hierarchical Modular Adaptive Interoception Control (IMAC) model to suggest that insula modules (granular, dysgranular and agranular), forming parallel networks with the prefrontal cortex and striatum, are specialized to form higher order interoceptive representations. These interoceptive representations are recruited in a context-dependent manner to support habitual, model-based and exploratory control of visceral organs and physiological processes. We discuss how insula interoceptive representations may give rise to conscious feelings that best explain lower order deep brain interoceptive representations, and how the insula may serve to defend the body and mind against pathological depression.
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Fermin et al. proposed a three-tiered insula model in which the granular insula first receives interoceptive afferent signals and informs lower-order innate interoceptive representations; resulting prediction errors are projected to the mid-dorsal insula, which facilitates preemptive adjustments to the visceral system through model-based adaptive behavior, before information is forwarded onto the
“Recently, Fermin et al. attempted to expand upon this framework, proposing a three-tiered insula model [49]. The granular insula first receives interoceptive afferent signals and uses these to inform lower-order innate interoceptive representations. Resulting prediction errors are projected to the mid-dorsal insula, which facilitates preemptive adjustments to the visceral system through model-”
From Neural correlates of altered interoception in depressive and anxiety disorders: a systematic review and meta-analysis (2026) · cites this paper as [49]
In “Insula hierarchical modular adaptive interoception control” (page unavailable), the paper describes afferents reaching the granular insula, prediction errors passing to the dysgranular insula, and model-based predictions that may adjust visceral systems before a disturbance. It does not describe the granular insula’s representations as innate: it locates innate first-order autonomic predictions in brainstem and subcortical systems and describes granular-insula predictions as habitual. (LLM, conf=0.84)
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Flagged first, then by citations
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Cited by
Sorted by citations
Bednarek, L., Harrison, B. J., Davey, C. G., Steward, T., & Jamieson, A. J. (2026) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-026-02201-5 · Cited by 1 · see citing works
- Authors
- Fermin, A. S. R., Friston, K., & Yamawaki, S.
- Affiliations
- Hiroshima University (JP)
- Wellcome Centre for Human Neuroimaging (GB)
- Corresponding author
- Fermin, Alan S. R.
- Venue
- Royal Society Open Science
- Publisher
- The Royal Society
- Published
- 2022-06
- Volume
- 9
- Issue
- 6
- Pages
- 220226-220226
- ISSN
- 2054-5703 (ISSN-L)
- PMC
- PMC9240682
- OpenAlex
- W4283707164
- Cited by
- 101
- References
- 329
- Citations by year
- 2026: 31 · 2025: 22 · 2024: 28 · 2023: 16 · 2022: 2 · 2021: 1 · 2020: 1
- FWCI
- 2.93
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Royal Society Open Science (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- Wellcome Centre for Human Neuroimaging (205103/Z/16/Z)
- Canada-UK Artificial Intelligence Initiative (ES/T01279X/1)
- Japan Agency for Medical Research and Development (JP19dm0107093)
- Center of Innovation Program (JPMJCA2208, JPMJCE1311)
- Japan Society for the Promotion of Science (20309202, 20K07723, JPMJMS2296)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Life Sciences › Neuroscience › Cognitive Neuroscience › Embodied and Extended Cognition
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Keywords
- insula, interoception, prefrontal cortex, striatum, model-based control, depression
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