Abstract
IN THIS FEATURE, we will try to describe the characteristics of current cyberpsychology research in Europe. In particular, CyberEurope aims at describing the leading research groups and projects running on the other side of the Ocean.
Interoception: The Foundation of Psychophysical Well-Being
Interoception is defined as the sense of the physiological condition of the entire body. The interoceptive system is crucial for maintaining the body’s homeostasis and overall well-being and is composed of a complex neural network that connects the organs to the brain. This system transmits signals through small-diameter afferent Aδ and C fibers, which end in the dorsal horns of the spinal cord in the lamina I system. These fibers convey information about various physiological states, including mechanical, thermal, chemical, metabolic, immunological, and hormonal conditions. 1
Interoceptive signals travel to the brain through specific neural pathways, reaching areas such as the insula, the somatosensory cortex, and the anterior cingulate cortex. Among these, the insula serves as a hub for gathering and sorting body information, playing a crucial role in representing the internal bodily state. The insula relates to different brain structures, suggesting that interoception is involved not only in homeostasis but also in cognition, affect, and self-awareness. Notably, the bodily representations within the interoceptive cortex are the biological substrate of the bodily states’ meta-representation that is linked to the subjective awareness of “feeling oneself.”1,2
Interoception is a complex construct that can be analyzed and explored not only at the cortical, autonomic but also behavioral and cognitive levels. Recent evidence from literature identified three dimensions of interoceptive perception at the conscious level: interoceptive accuracy (the ability to accurately perceive internal body sensations), interoceptive sensitivity (the self-perceived tendency to be aware of body signals), and interoceptive awareness (the metacognitive ability to accurately perceive body sensations). These dimensions help explain how internal body experiences influence self-perception, well-being, and physical and psychological health, also suggesting that interoceptive information can be integrated into conscious processes and lead to the foundation of high-level cognitive functions in everyday life and human well-being. 3
A Virtual Reality Paradigm to Enhance Interoceptive Awareness and Well-Being
Virtual reality (VR) holds significant potential for enhancing well-being in both healthy individuals and clinical populations. This technology can create dynamic environments where individuals can engage in simulated multisensory experiences that can enhance the possibilities of real-life scenarios. Over the past two decades, immersive VR systems have evolved into powerful tools for inducing a broad array of experiences and simulations.
Various studies support its clinical efficacy for treating conditions such as anxiety disorders, depression, eating disorders, pain management, and others.4,5 Notably, VR can be also used to access the interoceptive system and promote well-being. One example of using VR to modulate interoceptive bodily experience is the heartbeat-enhanced immersive VR (HEVR) paradigm. This involves integrating heart signals synchronized with the participant’s visual perceptive channel in a virtual environment. HEVR leverages a realistic visual representation of a participant’s body part (e.g., the hand) flashing in sync with the real-time detected heartbeat. In a study involving patients with complex regional pain syndrome, 6 HEVR was shown to improve heart rate variability (HRV), a marker connected to physiological well-being, as well as patients’ clinical symptoms.
HEVR utilizes virtual reality to heighten interoceptive perceptions by synchronizing the patient’s heartbeat with visual pulsations in a virtual body part, creating an enhanced sensory experience. A possible explanation for the effectiveness of this technological intervention could be related to an increase in the patient’s internal body awareness (i.e., interoceptive awareness). This heightened interoceptive awareness could therefore contribute to higher levels of overall well-being.
Possible Application to Promote Well-Being in Healthy and Clinical Populations
The HEVR paradigm offers a promising approach to promoting well-being in healthy individuals. By implementing interventions that focus on interoceptive processes through VR, it is possible to enhance HRV, which is a key indicator of physiological well-being, coherence, and adaptability. Improved HRV is associated with better overall well-being, suggesting that the HEVR paradigm could significantly promote the well-being of healthy individuals by fostering greater physiological balance and adaptation in various contexts.
Moreover, this intervention can also be applied to a variety of clinical conditions characterized by altered interoceptive processing and low autonomic (e.g., HRV) balance such as anxiety, depression, eating disorders, and chronic pain, as demonstrated by Solcà et al. Specifically, as chronic pain is defined as a pain that persists or recurs for more than 3 months, its nature is extremely varied, and this diverse etiopathogenesis complicates the development of effective therapeutic solutions. Pain medications are often ineffective, due to drug resistance, dependency, and pharmacological interactions, which make it difficult to continue therapies, while maintaining unchanged effectiveness.
Therefore, the possibility of developing innovative VR interoceptive technologies and treatments 7 that adopt a holistic approach aimed at promoting the overall well-being of patients suffering from this condition is of extreme interest. 8
The Objective of the Enhanced-Beat Project
The Enhanced-Beat project aims to develop and implement a VR protocol based on an HEVR approach. The project will extend and improve the framework proposed by Solcà, also integrating heart and respiratory signals synchronized with the participant’s visual experience to create a sensory illusion that enhances interoceptive bodily awareness in different domains. It is expected that this method will improve HRV and autonomic well-being; moreover, the project will also explore if this new approach will be able to enhance interoceptive awareness and if and how virtually enhanced interoceptive awareness is connected to well-being in healthy and clinical populations.
The project will be conducted at the Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, with the support of the Humane Technology Lab, Università Cattolica del Sacro Cuore, both located in Milan, Italy. This project represents a promising exploration of the therapeutic benefits of new interoceptive technologies and includes three studies.
During the prescreening meeting, sociodemographic and medical information will be collected. Psychological well-being will be assessed using measures of anxiety (STAI), depression (BDI-II), and stress (DASS-21 stress subscale). Physiological measures such as HRV and indicators of sympathetic and parasympathetic autonomic response will also be collected. Moreover, as an exploratory outcome, dimensions of interoceptive awareness (accuracy, sensitivity, and metacognition) will be collected before and after the intervention to evaluate if and how the Enhanced-Beat interoceptive virtual technology can modulate interoceptive awareness in healthy participants.
Conclusions
The Enhanced-Beat project aims to investigate the role of interoceptive VR interventions in promoting well-being in both healthy individuals and people with chronic pain. The project will also investigate the effectiveness of interoceptive VR in modulating interoceptive awareness both in healthy and clinical participants. By using an innovative approach that combines synchronized cardiac and respiratory signals with visual experiences in VR, the project seeks to understand how interoceptive awareness contributes to well-being and to develop targeted interventions to enhance it. The expected outcomes could lead to new therapeutic interventions based on VR, capable of significantly improving overall well-being and possibly interoceptive awareness.
Interoception, and particularly interoceptive awareness, plays a fundamental role in the processes that regulate and underpin the global well-being of an individual. The ability to perceive and be mentally aware of the interactions between the brain and the internal body is a core element of several cognitive and emotional processes. This usually happens adaptively, favoring the overall well-being of the individual, but sometimes it can occur maladaptively, with negative consequences for health and well-being. Interoceptive dysfunctions are increasingly recognized as factors present in various disorders.
Discovering an intervention that improves interoceptive awareness would therefore allow for addressing not only chronic pain but also a wide range of other disorders, including mood and anxiety disorders, autism, addiction disorders, eating disorders, as well as neurological and neurodegenerative disorders, and somatic symptom disorders. In conclusion, this project aims to provide a significant advancement in the research for innovative solutions to improve well-being and quality of life in both healthy individuals and those with clinical conditions.
Footnotes
Author Disclosure Statement
No competing financial interests exist.
Funding Information
No funding was received for this article.