A Longitudinal Study of Interoception Changes in the Times of COVID-19: Effects on Psychophysiological Health

Background: Interoception - the processing of the internal state of the body - has been consistently tied to well-being and mental health, which in turn have been severely challenged by the COVID-19 pandemic. Moreover, the fact that symptoms of COVID-19 (high temperature, shortness of breath, fatigue, and even gastro-intestinal problems) directly alter interoceptive signals has fueled people's tendency to constantly check their internal bodily state. To the best of our knowledge, no evidence at the moment supports this idea.Objectives: In this longitudinal study we tested for changes in interoception and psychophysiological well-being during different stages of the pandemic in 2020 and for their potential association.Methods: 245 Italian participants who had completed the Multidimensional Assessment of Interoceptive Awareness (MAIA-2) prior to the onset of the pandemic, repeated the questionnaire during the first national lockdown in Italy, and three months after restrictions. Participants also completed survey measures of depression (PHQ-9), anxiety (STAI), and sleep disturbance (PSQI). A sub-sample of 28 participants, who had completed the heartbeat counting task (HCT) and a measure of heart rate variability (HRV), was tested again remotely, in the same temporal windows, using phone applications and photoplethysmography.Results: While performance in the HCT remained unvaried, MAIA-2 scores consistently increased from before the pandemic to the national lockdown and remained largely unvaried after four months. The national lockdown was associated with the least well-being, as evidenced by a decrease in HRV compared to before the pandemic and by higher scores in self-reported depression, anxiety, and sleep disturbance compared to four months after the lockdown. Interestingly, psychophysiological well-being was predicted by specific regulatory components of interoception (e.g., the ability to regulate distress by attention to body sensations and the experience of one’s body as safe and trustworthy).Conclusions: Our results suggest an increased attention towards visceral signals during the COVID-19 pandemic and highlight the positive role of specific components of interoception in contributing to well-being, suggesting that novel interventions aimed at increasing interoception might be developed to protect against stressful life events such as COVID-19.Funding Information: The study was supported by European Research Council (ERC) Advanced Grant (eHONESTY, Prot. 789058) to SMA.Declaration of Interests: No conflicts of interest, financial or otherwise, are declared by the authors.Ethics Approval Statement: The study was approved by the Ethics Committee of the IRCCS Santa Lucia Hospital in Rome and was conducted in accordance with the 1964 declaration of Helsinki. Participants were paid for their participation.