The impact of unpredictability on dyspnea perception, anxiety and interoceptive error processing
Open accessAbstract
Dyspnea is a prevalent interoceptive sensation and the aversive cardinal symptom in many cardiorespiratory diseases as well as in mental disorders. Especially the unpredictability of the occurrence of dyspnea episodes has been suggested to be highly anxiety provoking for affected patients. Moreover, previous studies demonstrated that unpredictable exteroceptive stimuli increased self-reports and electrophysiological responses of anxiety such as the startle probe N100 as well as amplified the processing of errors as reflected by greater error-related negativity (ERN). However, studies directly examining the role of unpredictability on dyspnea perception, anxiety and error processing are widely absent. Using high-density electroencephalography, the present study investigated whether unpredictable compared to predictable dyspnea would increase the perception of dyspnea, anxiety and interoceptive error processing. Thirty-two healthy participants performed a respiratory forced choice reaction time task to elicit an interoceptive ERN during two conditions: an unpredictable and a predictable resistive load-induced dyspnea condition. Predictability was manipulated by pairing (predictable condition) or not pairing (unpredictable condition) dyspnea with a startle tone probe. Self-reports of dyspnea and affective state as well as the startle probe N100 and interoceptive ERN were measured. The results demonstrated greater dyspnea unpleasantness in the unpredictable compared to the predictable condition. Post-hoc analyses revealed that this was paralleled by greater anxiety, and greater amplitudes for the startle probe N100 and the interoceptive ERN during the unpredictable relative to the predictable condition, but only when the unpredictable condition was experienced in the first experimental block. Furthermore, higher trait-like anxiety sensitivity was associated with higher ratings for dyspnea unpleasantness and experimental state anxiety ratings. The present findings suggest that unpredictability increases the perception of dyspnea unpleasantness. This effect seems related to increased state and trait anxiety and interoceptive error processing, especially when upcoming dyspnea is particularly unpredictable, such as in early experimental phases. Future studies are required to further substantiate these findings in patients suffering from dyspnea.
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Although NIV can produce significant clinical improvement in COPD people, they often reject it or use it incorrectly, resulting in worse clinical outcomes and healthcare costs.
“Although NIV can produce a significant clinical improvement in COPD people, they often reject it or use it incorrectly, resulting in worse clinical outcomes and healthcare costs.”
From Promoting Acceptance and Adherence to Noninvasive Ventilation in Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial. (2022) · cites this paper as [23]
The Introduction (page unavailable) discusses the burden of dyspnea in COPD, but not noninvasive ventilation. Searches for NIV, treatment rejection or incorrect use, and associated clinical outcomes or healthcare costs found no passage addressing the claim. (LLM, conf=0.75)
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“Moreover, dyspnea during NIV is a complex problem:NIVaims to correct gaseous exchanges, but if it fails to relieve dyspnea—or worse, if dyspnea worsens during NIV—the combination of a life-threatening threat with a feeling of suffocation and thus lack of control leads to an aggravation of both dyspnea and anxiety, cre…”
BackgroundAffective traits, states, and breathlessness
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von Leupoldt, A., Ashoori, M., Jelinčić, V., Herzog, M., & Diest, I. V. (2021) · Psychophysiology · doi:10.1111/psyp.13807 · Cited by 10 · see citing works
Self-citationError Processing and Pain: A New Perspective
Traxler, J., Torta, D. M. E., von Leupoldt, A., & Vlaeyen, J. W. S. (2022) · Journal of Pain · doi:10.1016/j.jpain.2022.05.005 · Cited by 12 · see citing works
Self-citationJelinčić, V., Torta, D. M. E., Diest, I. V., & von Leupoldt, A. (2022) · Biological Psychology · doi:10.1016/j.biopsycho.2022.108267 · Cited by 10 · see citing works
Self-citationNorweg, A. M., Hofferber, B., Oh, C., Spinner, M., Stavrolakes, K., Pavol, M. A., DiMango, A. M., Raveis, V. H., Murphy, C., Allegrante, J. P., et al. (2023) · Contemporary Clinical Trials · doi:10.1016/j.cct.2023.107340 · Cited by 9 · see citing works
Hudson, A. L., Day, M.-E., Williams, M., & Harrison, O. K. (2025) · Respiratory Physiology & Neurobiology · doi:10.1016/j.resp.2025.104441 · Cited by 8 · see citing works
Willems, A. L., Jelinčić, V., Vlaeyen, J. W. S., von Leupoldt, A., & Torta, D. M. E. (2021) · Biological Psychology · doi:10.1016/j.biopsycho.2021.108177 · Cited by 8 · see citing works
Self-citationBodart, A., Invernizzi, S., Leener, M. D., Lefèbvre, L., & Rossignol, M. (2024) · Psychophysiology · doi:10.1111/psyp.14632 · Cited by 6 · see citing works
The epidemiology of breathlessness
Ekström, M. P., Johnson, M. J., Currow, D. C., & Svanes, C. (2022) · European Respiratory Society eBooks · doi:10.1183/2312508x.10012521 · Cited by 6 · see citing works
The effect of unpredictability on the perception of breathlessness: a narrative review
Pavy, F., Torta, D. M. E., & von Leupoldt, A. (2024) · Frontiers in Rehabilitation Sciences · doi:10.3389/fresc.2023.1339072 · Cited by 5 · see citing works
Self-citationPain by mistake: investigating a link between error-related negativity and pain avoidance behavior
Traxler, J., von Leupoldt, A., & Vlaeyen, J. W. S. (2021) · Pain · doi:10.1097/j.pain.0000000000002358 · Cited by 3 · see citing works
Self-citationNeurophysiological dynamics of visceral signals in emotion, self and bodily consciousness
Camara, C. F., Filippetti, M. L., & Sel, A. (2025) · Proceedings of the Royal Society B Biological Sciences · doi:10.1098/rspb.2024.2625 · Cited by 4 · see citing works
Bakshi, S., Puar, S., & Bose, P. P. (2024) · Journal of Asthma · doi:10.1080/02770903.2024.2387739 · Cited by 3 · see citing works
Higher Lifetime Stress and Symptom Burden Contribute to the Occurrence of Shortness of Breath
Shin, J., Kober, K. M., Yates, P. M., Wong, M. L., Cooper, B. A., Paul, S. M., Hammer, M. J., Conley, Y. P., Levine, J. D., Wright, F., et al. (2023) · Seminars in Oncology Nursing · doi:10.1016/j.soncn.2023.151471 · Cited by 3 · see citing works
Is uncertainty bad? Mixed findings and explanatory model of error processing under uncertainty
Yang, Q. K., & Yaqin, L. I. (2022) · Advances in Psychological Science · doi:10.3724/sp.j.1042.2023.00338 · Cited by 1 · see citing works
Dyspnea for the Critical Care Psychiatrist
Sole, J., Ha, J., & Sher, Y. I. (2025) · Psychiatric Annals · doi:10.3928/00485713-20250528-02 · Cited by 1 · see citing works
Lunge? Psyche? Reha! Gemeinsam stark gegen chronisch obstruktive Lungenerkrankung (COPD)
Schneeberger, T., Jarosch, I., Gloeckl, R., Leitl, D., Mießl, M., & Koczulla, A. R. (2024) · Zeitschrift für Pneumologie · doi:10.1007/s10405-024-00560-1
Gashi, A., Bastian, A., Günther, A., Grünewaldt, A., Held, M., Hetzel, M., Krüger, S., Randerath, W. J., Schlesinger, A., Sofianos, G., et al. (2026) · Pneumologie · doi:10.1055/a-2803-7306
- Authors
- Tan, Y., Van den Bergh, O., Qiu, J., & von Leupoldt, A.
- Affiliations
- Southwest University (CN)
- Corresponding author
- Qiu, Jiang
- ORCID
- Venue
- Frontiers in Physiology
- Publisher
- Frontiers Media SA
- Published
- 2019-05-03
- Volume
- 10
- Pages
- 535-535
- ISSN
- 1664-042X (ISSN-L)
- PMC
- PMC6509155
- OpenAlex
- W2943703086
- Cited by
- 22
- References
- 88
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 4 · 2023: 4 · 2022: 5 · 2021: 3 · 2020: 1 · 2019: 1
- FWCI
- 1.99
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Physiology (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Lirias (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- KU Leuven (METH/15/011, STRT/13/002, AKUL/13/07)
- China Scholarship Council (201606990047)
- Vlaamse regering (METH/15/011, AKUL/13/07)
- Herculesstichting (AKUL/13/07)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- dyspnea, unpredictability, anxiety, error-related negativity, anxiety sensitivity, cardiopulmonary disease, interoception
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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