Research Article: Interoceptive deficits in patients with obsessive-compulsive disorder in the time course of cognitive-behavioral therapy

Date Published: May 24, 2019

Publisher: Public Library of Science

Author(s): Dana Schultchen, Michael Zaudig, Till Krauseneck, Götz Berberich, Olga Pollatos, Carles Soriano-Mas.

http://doi.org/10.1371/journal.pone.0217237

Abstract

Interoception is impaired in different psychiatric disorders and is also associated with emotions. Only one study could show a higher interoceptive accuracy (IAcc) in patients with obsessive-compulsive disorder (OCD). Based on the predictive coding system we assume contrary results, indicating a decreased IAcc in patients with OCD. So far, there is no study investigating the effect of cognitive-behavioral therapy on IAcc in patients with OCD. Therefore, we hypothesize that patients with OCD improve their IAcc during the time course of therapy compared to healthy controls. Twenty-six patients with OCD from the Psychosomatic Clinic in Windach were examined in the time course of cognitive-behavioral therapy. They were compared to 26 matched healthy controls. IAcc via the heartbeat perception task as well as questionnaire data (OCD-, depression- and anxiety symptoms) were assessed. Results showed that IAcc, OCD-, depression- and anxiety symptoms were attenuated in patients with OCD. Patients recovered in the time course of therapy regarding OCD-, depression- and anxiety symptoms. Interoceptive deficits did not change in the time course of cognitive-behavioral therapy. We demonstrated that IAcc is affected in patients with OCD and this deficit does not change during the time course of a standardized therapy. Future studies should investigate, whether an inaccuracy in perceiving one’s bodily signals constitutes a risk factor for relapse. Further, it could be examined if IAcc can be increased via self- and body focus interventions in patients with OCD.

Partial Text

Interoception is understood as the sensing and representation of signals concerning the internal state of the body [1,2]. There is a growing and ongoing interest in this construct because of the evidence that different mental disorders show impaired interoceptive processes and that mental processes are embodied (e.g., [3–8]). Consequently, an interplay between the mind and physiological states can be assumed.

All descriptive data of IAcc and OCD-, depression- and anxiety symptoms separated by patients and healthy controls are represented in Table 1. As shown in this table, OCD-, depression- and anxiety symptoms decrease during the time course of cognitive-behavioral therapy in the OCD sample. Furthermore, there is a descriptive increase in IAcc over time for patients with OCD. Moreover, patients have a decreased IAcc and more depressive- and anxiety symptoms in comparison to the healthy controls. These differences are significant for most group comparison at the different measurement points. Inferential statistic results will be described in more detail in the following sections.

To the best of our knowledge, these are the first empirical data demonstrating that IAcc is attenuated in OCD and that these interoceptive deficits do not change in the time course of cognitive-behavioral therapy. Nonetheless, there were definite improvements in OCD-, depression- and anxiety symptoms for patients with OCD. Additionally, we also showed negative associations between IAcc and OCD-, depression- and anxiety symptoms.

To conclude, our study highlighted a decreased IAcc in patients with OCD and the observation that these deficits do not seem to improve during the time course of cognitive-behavioral therapy. Future studies should use longer follow-ups and additionally examine more levels of interoceptive signal processing such as metacognitive confidence (i.e., interoceptive awareness) or subjective awareness (i.e., interoceptive sensibility). Besides, it could be interesting to differentiate between obsessive-compulsive thoughts and behaviors in future studies. It could also be useful to integrate another psychiatric control group (e.g., panic disorder) as in the setting of Yoris et al. [27]. Lastly, using methods in therapy that can improve IAcc (e.g., body scan; [58]) should be considered to be of high relevance.

 

Source:

http://doi.org/10.1371/journal.pone.0217237