From Interoception to Anxiety, Empathic Distress and Emotion Perception: The Meditating Role of Intolerance of Uncertainty and Alexithymia

Navigating daily life involves dealing with uncertainty, including both external events and internal bodily sensations. While uncertainty often triggers anxiety, individuals differ significantly in their sensitivity towards uncertain situations, a trait known as Intolerance of Uncertainty (IU). This study investigates the mediating roles of IU and alexithymia, i.e., the difficulty in recognizing and describing emotions, in the relationships between interoceptive sensibility (awareness and regulation of internal bodily sensations), anxiety, and social cognition. Using online questionnaires, we collected data from two studies (N = 142, N = 153), assessing interoceptive sensibility, alexithymia, IU, anxiety, and empathic traits. Additionally, participants performed an emotion recognition task with ambiguous facial expressions, analysed through Drift Diffusion Modelling (DDM). Results showed that higher anxiety levels are linked to increased IU and alexithymia, along with heightened maladaptive attention towards bodily sensations accompanied by negative interpretations. Importantly, both IU and alexithymia significantly mediated the relationship between interoceptive sensibility and anxiety, highlighting their critical roles in emotional regulation. In social contexts, IU and alexithymia mediated the relationship between interoceptive traits and empathic distress. Unexpectedly, individuals with higher IU displayed enhanced recognition of positive emotional expressions, supported by DDM analyses indicating more efficient perceptual processing. These findings illustrate the complex interplay between interoceptive sensibility, IU, alexithymia, anxiety, and social cognition, suggesting targeted approaches addressing aversive uncertainty sensitivity and emotional awareness could improve emotional well-being and social interactions. This research highlights IU’s potential impact on anxiety-related disorders and empathic interactions, providing novel insights into social functioning under uncertainty.