# Electrophysiological Read-Out of Interoceptive Processing in the Insula

> **NIH NIH R21** · ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI · 2022 · $247,980

## Abstract

Project Summary / Abstract
Abnormal interoceptive processing is observed across psychiatric and neurological conditions wherein core
symptoms are motivated by diffuse bodily feeling: pervasive negative mood in Major Depression, compulsive
urge in Obsessive Compulsive Disorder, urge to tic in Tourette Syndrome, and craving in addiction. Despite the
prevalence of interoceptive abnormality, there is a scarcity of data on neurovisceral interactions in clinical
populations. This knowledge gap can be attributed in part to a need for objective, neural measures of
interoceptive processing. A candidate neural measure is the heartbeat evoked potential (HEP), a brain
electrophysiological signal that is time-locked to the heartbeat and thought to index baroreceptor sensation in
the chest cavity. While promising, basic characteristics of this signal are unknown, which limits its application to
mechanistic and clinical research. Cortical sources of the HEP have been identified in the insula, yet spatial
and temporal characteristics diverge across experimental paradigms. This suggests multiple functional
correlates and cortical sources of the HEP index, including the insula. An added challenge is that the insula
may be too deep for non-invasive recording and modulation, which necessitates invasive neural recording to
explain non-invasive measures. Aim 1 validates neural source generators of the HEP with simultaneous
invasive stereoelectroencephalography and dense array EEG on the scalp surface, while patients complete a
battery of interoceptive tasks. Aim 2 investigates neural network dynamics during interoceptive attention,
arousal and anticipation: theorizing that key clinical symptoms (e.g., tic, compulsions, negative mood) are
learned behaviors in response to interoceptive cues, we test the specific hypothesis that interoceptive activity
is a predictor of reward-based decisions, particularly when decision-making demands a go with your gut
strategy as reward outcomes are learned. Critically, Aim 3 then applies a deep breathing strategy to
strategically perturb cardiac dynamics and disambiguate functional correlates of the HEP signal. Outcomes
define properties of the HEP signal that must be known for this measurement strategy to inform and validate
models of abnormal interoceptive circuit dynamics involving maladaptive responses to bodily distress.

## Key facts

- **NIH application ID:** 10426540
- **Project number:** 1R21MH126968-01A1
- **Recipient organization:** ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
- **Principal Investigator:** Allison Candice Waters
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $247,980
- **Award type:** 1
- **Project period:** 2022-04-01 → 2024-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10426540

## Citation

> US National Institutes of Health, RePORTER application 10426540, Electrophysiological Read-Out of Interoceptive Processing in the Insula (1R21MH126968-01A1). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10426540. Licensed CC0.

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