rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2024-3144RLROLBrpcardio-3144Research ArticleORIGINAL STUDIESОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯСardiac interoception and its link with psychological characteristics in patients with symptomatic and asymptomatic premature ventricular contractionsИнтероцепция сердца и ее связь с психологическими характеристиками у пациентов с симптомным и бессимптомным течением желудочковой экстрасистолииhttps://orcid.org/0000-0003-1500-3696ЛимоноваА. С.LimonovaA. S.

Лимонова Алена Сергеевна

Москва

Alena S. Limonova

Moscow

limonova-alena@yandex.ruhttps://orcid.org/0000-0003-3131-9770МиненкоИ. А.MinenkoI. A.

Миненко Ирина Алексеевна

Москва

Irina A. Minenko

Moscow

minenko.irina98@yandex.ruhttps://orcid.org/0000-0001-5218-7012СукмановаА. А.SukmanovaA. A.

Сукманова Анастасия Александровна

Москва

Anastasiia A. Sukmanova

Moscow

chariot7@yandex.ruhttps://orcid.org/0000-0003-3788-3997ДавтянК. В.DavtyanK. V.

Давтян Карапет Воваевич

Москва

Karapet V. Davtyan

Moscow

KDavtyan@gnicpm.ruhttps://orcid.org/0000-0001-7989-0760ЕршоваА. И.ErshovaA. I.

Ершова Александра Игоревна

Москва

Alexandra I. Ershova

Moscow

alersh@mail.ruhttps://orcid.org/0000-0002-4453-8430ДрапкинаО. М.DrapkinaO. M.

Драпкина Оксана Михайловна

Москва

Oksana M. Drapkina

Moscow

ODrapkina@gnicpm.ruНациональный медицинский исследовательский центр терапии и профилактической медицины Минздрава РоссииРоссияNational Medical Research Center for Therapy and Preventive MedicineRussian FederationНациональный медицинский исследовательский центр терапии и профилактической медицины Минздрава России; Центр нейроэкономики и когнитивных исследований, Институт когнитивных нейронаук, Национальный исследовательский университет "Высшая школа экономики"РоссияNational Medical Research Center for Therapy and Preventive Medicine; National Research University Higher School of EconomicsRussian Federation202428112024206610617Copyright © Limonova A.S., Minenko I.A., Sukmanova A.A., Davtyan K.V., Ershova A.I., Drapkina O.M., 20252025Лимонова А.С., Миненко И.А., Сукманова А.А., Давтян К.В., Ершова А.И., Драпкина О.М.Limonova A.S., Minenko I.A., Sukmanova A.A., Davtyan K.V., Ershova A.I., Drapkina O.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpcardio.online/jour/article/view/3144Aim

Aim. To explore cardiac interoception (probed by interoceptive accuracy in the mental tracking task) and its association with psychological characteristics in groups of patients with symptomatic and asymptomatic premature ventricular contractions (PVC) and controls.

Material and methods

Material and methods. The study included 34 patients with PVC [17 individuals formed the group with symptomatic PVC (median age: 43 years) and 17 — formed the group with asymptomatic PVCs (median age: 42 years)] and 17 healthy subjects without cardiovascular diseases (median age: 40 years) in the control group. All study participants underwent 24-hour blood pressure and Holter monitoring. Interoception was assessed by interoceptive accuracy probed by behavioral test — mental tracking task. Participants completed questionnaires to assess levels of depression, anxiety, alexithymia and body perception.

Results

Results. Patients with symptomatic PVC had significantly higher levels of personal (p<0.001) and situational (p=0.011) anxiety compared to controls (p<0.001). The total alexithymia index was elevated in both symptomatic (p=0.004) and asymptomatic patients (p=0.028) compared to controls. Body perception (supradiaphragmatic scale of the Body Perception Questionnaire) was significantly higher in the group with symptomatic PVC compared to both the asymptomatic group (p=0.003) and the control group (p<0.001). A trend towards higher interoceptive accuracy was found in the group with symptomatic PVC (p=0.021; after correction p=0.064). No correlation was found between the level of interoception and psychological characteristics.

Conclusion

Conclusion. Our findings suggest a possible role of cardiac interoception in the development of PVC symptoms, which may serve as a basis for the development of non-invasive and non-pharmacological treatment methods aimed at reducing the intensity of PVC symptoms, taking into account patients’ levels of anxiety, alexithymia and body perception.  

 

 

Цель

Цель. Изучить интероцепцию сердца с помощью точности ощущения сердцебиения (ТОС) с применением теста с подсчетом сердечных сокращений и оценить наличие и характер связи сердечной интероцепции с психологическими характеристиками у пациентов с симптомным и бессимптомным течением желудочковой экстрасистолии (ЖЭС).

Материал и методы

Материал и методы. В исследование были включены 34 пациента с ЖЭС: группы симптомного (n=17, медиана возраста — 43 года) и бессимптомного течения ЖЭС (n=17, медиана возраста — 42 года). Лица без сердечно-сосудистых заболеваний (n=17, медиана возраста — 40 лет) составили контрольную группу. Всем участникам исследования проведено суточное мониторирование артериального давления и электрокардиограммы. Интероцепция оценена с помощью ТОС в тесте с подсчетом числа сердечных сокращений. Участники заполняли опросники, направленные на оценку уровня депрессии, тревоги, алекситимии и восприятия тела.

Результаты

Результаты. У пациентов с симптомной ЖЭС выявлен более высокий уровень личностной (р<0,001) и ситуативной (р=0,011) тревожности по сравнению с контрольной группой (р<0,001). Общий индекс алекситимии оказался повышенным как у пациентов с симптомной (р=0,004), так и бессимптомной ЖЭС (р=0,028), по сравнению с контрольной группой. Балл по опроснику восприятия тела (наддиафрагмальная шкала) в группе с симптомной ЖЭС значимо выше как по сравнению с бессимптомной группой (р=0,003), так и с контрольной группой (р<0,001). Тенденция к более высокой интероцепции по показателю ТОС выявлена в группе с симптомной ЖЭС (р=0,021; после поправки р=0,064). Корреляции между уровнем интероцепции и психологическими характеристиками не обнаружено.

Заключение

Заключение. Полученные данные свидетельствуют о возможной роли интероцепции сердца в формировании симптомов при ЖЭС, что может стать основной для разработки неинвазивных и немедикаментозных методов лечения, направленных на снижение интенсивности симптомов ЖЭС, с учетом уровней тревожности, алекситимии и восприятия тела у пациентов.

интероцепция сердцажелудочковая экстрасистолиясимптомысердцебиениетест с подсчетом числа сердечных сокращенийалекситимиятревожностьвосприятие телаcardiac interoceptionpremature ventricular contractionssymptomspalpitationsmental tracking taskalexithymiaanxietybody perceptionИсследование выполнено за счет гранта Российского научного фонда № 22-15-00507, https://rscf.ru/project/22-15-00507.This research was funded by the Russian Science Foundation, grant number 22-15-00507, https://rscf.ru/project/22-15-00507.ReferencesVan den Bergh O, Witthöft M, Petersen S, et al. Symptoms and the body: Taking the inferential leap. Neurosci Biobehav Rev. 2017;74(Pt A):185-203. DOI:10.1016/j.neubiorev.2017.01.015.Van den Bergh O, Witthöft M, Petersen S, et al. Symptoms and the body: Taking the inferential leap. Neurosci Biobehav Rev. 2017;74(Pt A):185-203. DOI:10.1016/j.neubiorev.2017.01.015.Parshall MB, Schwartzstein RM, Adams L, et al.; American Thoracic Society Committee on Dyspnea. An Official American Thoracic Society Statement: Update on the Mechanisms, Assessment, and Management of Dyspnea. Am J Respir Crit Care Med. 2012;185(4):435-52. DOI:10.1164/rccm.201111-2042ST.Parshall MB, Schwartzstein RM, Adams L, et al.; American Thoracic Society Committee on Dyspnea. An Official American Thoracic Society Statement: Update on the Mechanisms, Assessment, and Management of Dyspnea. Am J Respir Crit Care Med. 2012;185(4):435-52. DOI:10.1164/rccm.201111-2042ST.Janssens T, Verleden G, De Peuter S, et al. Inaccurate perception of asthma symptoms: A cognitive — affective framework and implications for asthma treatment. Clin Psychol Rev. 2009;29(4):317-27. DOI:10.1016/j.cpr.2009.02.006.Janssens T, Verleden G, De Peuter S, et al. Inaccurate perception of asthma symptoms: A cognitive — affective framework and implications for asthma treatment. Clin Psychol Rev. 2009;29(4):317-27. DOI:10.1016/j.cpr.2009.02.006.Müllerová H, Lu C, Li H, Tabberer M. Prevalence and Burden of Breathlessness in Patients with Chronic Obstructive Pulmonary Disease Managed in Primary Care. PLoS One. 2014;9(1):e85540. DOI:10.1371/journal.pone.0085540.Müllerová H, Lu C, Li H, Tabberer M. Prevalence and Burden of Breathlessness in Patients with Chronic Obstructive Pulmonary Disease Managed in Primary Care. PLoS One. 2014;9(1):e85540. DOI:10.1371/journal.pone.0085540.Ehlers A, Mayou RA, Sprigings DC, Birkhead J. Psychological and Perceptual Factors Associated With Arrhythmias and Benign Palpitations. Psychosom Med. 2000;62(5):693-702. DOI:10.1097/00006842-200009000-00014.Ehlers A, Mayou RA, Sprigings DC, Birkhead J. Psychological and Perceptual Factors Associated With Arrhythmias and Benign Palpitations. Psychosom Med. 2000;62(5):693-702. DOI:10.1097/00006842-200009000-00014.Barsky AJ, Cleary PD, Brener J, Ruskin JN. The Perception of Cardiac Activity in Medical Outpatients. Cardiology. 1993;83(5-6):304-15. DOI:10.1159/000175986.Barsky AJ, Cleary PD, Brener J, Ruskin JN. The Perception of Cardiac Activity in Medical Outpatients. Cardiology. 1993;83(5-6):304-15. DOI:10.1159/000175986.Barsky AJ, Delamater BA, Clancy SA, et al. Somatized psychiatric disorder presenting as palpitations. Arch Intern Med. 1996;156(10):1102-8.Barsky AJ, Delamater BA, Clancy SA, et al. Somatized psychiatric disorder presenting as palpitations. Arch Intern Med. 1996;156(10):1102-8.Jonsbu E, Dammen T, Morken G, et al. Cardiac and psychiatric diagnoses among patients referred for chest pain and palpitations. Scand Cardiovasc J. 2009;43(4):256-9. DOI:10.1080/14017430902946749.Jonsbu E, Dammen T, Morken G, et al. Cardiac and psychiatric diagnoses among patients referred for chest pain and palpitations. Scand Cardiovasc J. 2009;43(4):256-9. DOI:10.1080/14017430902946749.Carnlöf C, Iwarzon M, Jensen-Urstad M, et al. Women with PSVT are often misdiagnosed, referred later than men, and have more symptoms after ablation. Scand Cardiovasc J. 2017;51(6):299-307. DOI:10.1080/14017431.2017.1385837.Carnlöf C, Iwarzon M, Jensen-Urstad M, et al. Women with PSVT are often misdiagnosed, referred later than men, and have more symptoms after ablation. Scand Cardiovasc J. 2017;51(6):299-307. DOI:10.1080/14017431.2017.1385837.Dilaveris PE, Kennedy HL. Silent atrial fibrillation: epidemiology, diagnosis, and clinical impact. Clin Cardiol. 2017;40(6):413-8. DOI:10.1002/clc.22667.Dilaveris PE, Kennedy HL. Silent atrial fibrillation: epidemiology, diagnosis, and clinical impact. Clin Cardiol. 2017;40(6):413-8. DOI:10.1002/clc.22667.Chen WG, Schloesser D, Arensdorf AM, et al. The Emerging Science of Interoception: Sensing, Integrating, Interpreting, and Regulating Signals within the Self. Trends Neurosci. 2021;44(1):3-16. DOI:10.1016/j.tins.2020.10.007.Chen WG, Schloesser D, Arensdorf AM, et al. The Emerging Science of Interoception: Sensing, Integrating, Interpreting, and Regulating Signals within the Self. Trends Neurosci. 2021;44(1):3-16. DOI:10.1016/j.tins.2020.10.007.Garfinkel SN, Seth AK, Barrett AB, et al. Knowing your own heart: Distinguishing interoceptive accuracy from interoceptive awareness. Biol Psychol. 2015;104:65-74. DOI:10.1016/j.biopsycho.2014.11.004.Garfinkel SN, Seth AK, Barrett AB, et al. Knowing your own heart: Distinguishing interoceptive accuracy from interoceptive awareness. Biol Psychol. 2015;104:65-74. DOI:10.1016/j.biopsycho.2014.11.004.Coll MP, Hobson H, Bird G, Murphy J. Systematic review and meta-analysis of the relationship between the heartbeat-evoked potential and interoception. Neurosci Biobehav Rev. 2021;122:190-200. DOI:10.1016/j.neubiorev.2020.12.012.Coll MP, Hobson H, Bird G, Murphy J. Systematic review and meta-analysis of the relationship between the heartbeat-evoked potential and interoception. Neurosci Biobehav Rev. 2021;122:190-200. DOI:10.1016/j.neubiorev.2020.12.012.Locatelli G, Matus A, James R, et al. What is the role of interoception in the symptom experience of people with a chronic condition? A systematic review. Neurosci Biobehav Rev. 2023;148:105142. DOI:10.1016/j.neubiorev.2023.105142.Locatelli G, Matus A, James R, et al. What is the role of interoception in the symptom experience of people with a chronic condition? A systematic review. Neurosci Biobehav Rev. 2023;148:105142. DOI:10.1016/j.neubiorev.2023.105142.Lee CS, Chu SH, Dunne J, et al. Body listening in the link between symptoms and self-care management in cardiovascular disease: A cross-sectional correlational descriptive study. Int J Nurs Stud. 2024;156:104809. DOI:10.1016/j.ijnurstu.2024.104809.Lee CS, Chu SH, Dunne J, et al. Body listening in the link between symptoms and self-care management in cardiovascular disease: A cross-sectional correlational descriptive study. Int J Nurs Stud. 2024;156:104809. DOI:10.1016/j.ijnurstu.2024.104809.Van den Bergh O, Bogaerts K, Van Diest I. Symptom Perception, Awareness and Interpretation. In: Wright JD (editor). International Encyclopedia of the Social & Behavioral Sciences (Second Edition). Elsevier; 2015:866-72. DOI:10.1016/B978-0-08-097086-8.14137-6.Van den Bergh O, Bogaerts K, Van Diest I. Symptom Perception, Awareness and Interpretation. In: Wright JD (editor). International Encyclopedia of the Social & Behavioral Sciences (Second Edition). Elsevier; 2015:866-72. DOI:10.1016/B978-0-08-097086-8.14137-6.Klewer J, Springer J, Morshedzadeh J. Premature Ventricular Contractions (PVCs): A Narrative Review. Am J Med. 2022;135(11):1300-5. DOI:10.1016/j.amjmed.2022.07.004.Klewer J, Springer J, Morshedzadeh J. Premature Ventricular Contractions (PVCs): A Narrative Review. Am J Med. 2022;135(11):1300-5. DOI:10.1016/j.amjmed.2022.07.004.Zeppenfeld K, Tfelt-Hansen J, de Riva M, et al.; ESC Scientific Document Group. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J. 2022;43(40):3997-4126. DOI:10.1093/eurheartj/ehac262.Zeppenfeld K, Tfelt-Hansen J, de Riva M, et al.; ESC Scientific Document Group. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J. 2022;43(40):3997-4126. DOI:10.1093/eurheartj/ehac262.Limonova AS, Minenko IA, Sukmanova AA, et al. Exploring the Link between Interoception and Symptom Severity in Premature Ventricular Contractions. J Clin Med. 2024;13(24):7756. DOI:10.3390/jcm13247756.Limonova AS, Minenko IA, Sukmanova AA, et al. Exploring the Link between Interoception and Symptom Severity in Premature Ventricular Contractions. J Clin Med. 2024;13(24):7756. DOI:10.3390/jcm13247756.Ханин Ю. Л. Краткое руководство к применению шкалы реактивной и личностной тревожности Ч. Д. Спилбергера. Ленинград: ЛНИ-ИТЕК, 1976.Hanin Y. A Brief Guide for the Spielberger C. D. State-Trait Anxiety Inventory. LNI-ITEK; 1976 (In Russ.)Spielberger C, Gorsuch R, Lushene R., et al. Manual for the State-Trait Anxiety Inventory. Palo Alto, CA Consulting Psychologists Press. 1983.Spielberger C, Gorsuch R, Lushene R., et al. Manual for the State-Trait Anxiety Inventory. Palo Alto, CA Consulting Psychologists Press. 1983.Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand. 1983;67(6):361-70. DOI:10.1111/j.1600-0447.1983.tb09716.x.Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand. 1983;67(6):361-70. DOI:10.1111/j.1600-0447.1983.tb09716.x.Cabrera A, Kolacz J, Pailhez G, et al. Assessing body awareness and autonomic reactivity: Factor structure and psychometric properties of the Body Perception Questionnaire-Short Form (BPQ-SF). Int J Methods Psychiatr Res. 2018;27(2):e1596. DOI:10.1002/mpr.1596.Cabrera A, Kolacz J, Pailhez G, et al. Assessing body awareness and autonomic reactivity: Factor structure and psychometric properties of the Body Perception Questionnaire-Short Form (BPQ-SF). Int J Methods Psychiatr Res. 2018;27(2):e1596. DOI:10.1002/mpr.1596.Старостина Е. Г., Тейлор Г. Д., Квилти Л. К. и др. Торонтская шкала алекситимии (20 пунктов): валидизация русскоязычной версии на выборке терапевтических больных. Социальная и клиническая психиатрия. 2010;20(4):31-8.Starostina ЕG, Taylor GD, Quilty L, et al. A new 20-item version of the Toronto Alexithymia scale: validation of the russian language translation in a sample of medical patients. Soc Clin psychiatry. 2010;20(4):31-8 (In Russ)Bagby RM, Parker JDA, Taylor GJ. The twenty-item Toronto Alexithymia scale — I. Item selection and cross-validation of the factor structure. J Psychosom Res. 1994;38(1):23-32. DOI:10.1016/0022-3999(94)90005-1.Bagby RM, Parker JDA, Taylor GJ. The twenty-item Toronto Alexithymia scale — I. Item selection and cross-validation of the factor structure. J Psychosom Res. 1994;38(1):23-32. DOI:10.1016/0022-3999(94)90005-1.Desmedt O, Luminet O, Corneille O. The heartbeat counting task largely involves non-interoceptive processes: Evidence from both the original and an adapted counting task. Biol Psychol. 2018;138:185-8. DOI:10.1016/j.biopsycho.2018.09.004.Desmedt O, Luminet O, Corneille O. The heartbeat counting task largely involves non-interoceptive processes: Evidence from both the original and an adapted counting task. Biol Psychol. 2018;138:185-8. DOI:10.1016/j.biopsycho.2018.09.004.Prentice F, Murphy J. Sex differences in interoceptive accuracy: A meta-analysis. Neurosci Biobehav Rev. 2022;132:497-518. DOI:10.1016/j.neubiorev.2021.11.030.Prentice F, Murphy J. Sex differences in interoceptive accuracy: A meta-analysis. Neurosci Biobehav Rev. 2022;132:497-518. DOI:10.1016/j.neubiorev.2021.11.030.Mayou R, Sprigings D, Birkhead J, et al. Characteristics of patients presenting to a cardiac clinic with palpitation. QJM. 2003;96(2):115-23. DOI:10.1093/qjmed/hcg017.Mayou R, Sprigings D, Birkhead J, et al. Characteristics of patients presenting to a cardiac clinic with palpitation. QJM. 2003;96(2):115-23. DOI:10.1093/qjmed/hcg017.Flaker GC, Belew K, Beckman K, et al; AFFIRM Investigators. Asymptomatic atrial fibrillation: Demographic features and prognostic information from the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. Am Heart J. 2005;149(4):657-63. DOI:10.1016/j.ahj.2004.06.032.Flaker GC, Belew K, Beckman K, et al; AFFIRM Investigators. Asymptomatic atrial fibrillation: Demographic features and prognostic information from the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. Am Heart J. 2005;149(4):657-63. DOI:10.1016/j.ahj.2004.06.032.Mavroudis G, Strid H, Jonefjäll B, Simrén M. Visceral hypersensitivity is together with psychological distress and female gender associated with severity of IBS-like symptoms in quiescent ulcerative colitis. Neurogastroenterol Motil. 2021;33(3):e13998. DOI:10.1111/nmo.13998.Mavroudis G, Strid H, Jonefjäll B, Simrén M. Visceral hypersensitivity is together with psychological distress and female gender associated with severity of IBS-like symptoms in quiescent ulcerative colitis. Neurogastroenterol Motil. 2021;33(3):e13998. DOI:10.1111/nmo.13998.Rief W, Barsky AJ. Psychobiological perspectives on somatoform disorders. Psychoneuroendocrinology. 2005;30(10):996-1002. DOI:10.1016/j.psyneuen.2005.03.018.Rief W, Barsky AJ. Psychobiological perspectives on somatoform disorders. Psychoneuroendocrinology. 2005;30(10):996-1002. DOI:10.1016/j.psyneuen.2005.03.018.Schulz A, Rost S, Flasinski T, et al. Distinctive body perception mechanisms in high versus low symptom reporters: A neurophysiological model for medically-unexplained symptoms. J Psychosom Res. 2020;137:110223. DOI:10.1016/j.jpsychores.2020.110223.Schulz A, Rost S, Flasinski T, et al. Distinctive body perception mechanisms in high versus low symptom reporters: A neurophysiological model for medically-unexplained symptoms. J Psychosom Res. 2020;137:110223. DOI:10.1016/j.jpsychores.2020.110223.Petersen S, Van Staeyen K, Vögele CC, et al. Interoception and symptom reporting: disentangling accuracy and bias. Front Psychol. 2015;6:732. DOI:10.3389/fpsyg.2015.00732.Petersen S, Van Staeyen K, Vögele CC, et al. Interoception and symptom reporting: disentangling accuracy and bias. Front Psychol. 2015;6:732. DOI:10.3389/fpsyg.2015.00732.Bonaz B, Lane RD, Oshinsky ML, et al. Diseases, Disorders, and Comorbidities of Interoception. Trends Neurosci. 2021;44(1):39-51. DOI:10.1016/j.tins.2020.09.009.Bonaz B, Lane RD, Oshinsky ML, et al. Diseases, Disorders, and Comorbidities of Interoception. Trends Neurosci. 2021;44(1):39-51. DOI:10.1016/j.tins.2020.09.009.Duschek S, Werner NS, Reyes del Paso GA, et al. The Contributions of Interoceptive Awareness to Cognitive and Affective Facets of Body Experience. J Individ Differ. 2015;36(2):110-8. DOI:10.1027/1614-0001/a000165.Duschek S, Werner NS, Reyes del Paso GA, et al. The Contributions of Interoceptive Awareness to Cognitive and Affective Facets of Body Experience. J Individ Differ. 2015;36(2):110-8. DOI:10.1027/1614-0001/a000165.Körmendi J, Ferentzi E, Petzke T, et al. Do we need to accurately perceive our heartbeats? Cardioceptive accuracy and sensibility are independent from indicators of negative affectivity, body awareness, body image dissatisfaction, and alexithymia. PLoS One. 2023;18(7):e0287898. DOI:10.1371/journal.pone.0287898.Körmendi J, Ferentzi E, Petzke T, et al. Do we need to accurately perceive our heartbeats? Cardioceptive accuracy and sensibility are independent from indicators of negative affectivity, body awareness, body image dissatisfaction, and alexithymia. PLoS One. 2023;18(7):e0287898. DOI:10.1371/journal.pone.0287898.Shah P, Hall R, Catmur C, Bird G. Alexithymia, not autism, is associated with impaired interoception. Cortex. 2016;81:215-20. DOI:10.1016/j.cortex.2016.03.021.Shah P, Hall R, Catmur C, Bird G. Alexithymia, not autism, is associated with impaired interoception. Cortex. 2016;81:215-20. DOI:10.1016/j.cortex.2016.03.021.de Houwer J, Hermans D (editors). Cognition and Emotion. Reviews of Current Research and Theories. Psychology Press; 2010. DOI:10.4324/9780203853054.de Houwer J, Hermans D (editors). Cognition and Emotion. Reviews of Current Research and Theories. Psychology Press; 2010. DOI:10.4324/9780203853054.Sancassiani F, Montisci R, Meloni L, et al. Why is it Important to Assess and Treat Alexithymia in the Cardiologic Field? An Overview of the Literature. Clin Pract Epidemiol Ment Heal. 2023;19:e174501792307140. DOI:10.2174/17450179-v19-230810-2022-HT15-4764-1.Sancassiani F, Montisci R, Meloni L, et al. Why is it Important to Assess and Treat Alexithymia in the Cardiologic Field? An Overview of the Literature. Clin Pract Epidemiol Ment Heal. 2023;19:e174501792307140. DOI:10.2174/17450179-v19-230810-2022-HT15-4764-1.

The authors declare that there are no conflicts of interest present.