A Change of Heart: Differentiating Interoceptive Metacognition Across State and Trait Anxiety using the Heart Rate Discrimination Task

Research suggests that interoception – the ability to sense internal bodily signals – plays a role in anxiety, though the specific interoceptive processes involved are unclear. Some studies suggest anxiety is linked to improved detection of bodily signals (interoceptive accuracy), while others highlight impairments in higher-order thinking about these signals (interoceptive metacognition). Here, we employed the newly developed Heart Rate Discrimination task to address how anxiety symptoms relate to interoceptive accuracy and metacognition. Participants judged whether feedback tones were faster or slower than their heart rate, with a Bayesian psychophysical staircase calculating two metrics of interoceptive accuracy: heart rate estimation and uncertainty. Using a signal detection approach, trial-by-trial confidence ratings allowed us to quantify metacognitive bias (overall confidence) and metacognitive efficiency (the accuracy-confidence relationship). We predicted that individuals with higher anxiety symptoms would demonstrate greater accuracy in their heart rate estimations (H1) yet reduced metacognitive insight (H2). Using the State-Trait Anxiety Inventory (STAI-Y), we distinguished between state and trait anxiety symptoms in relation to interoceptive processing. Results revealed no significant differences in interoceptive accuracy across anxiety levels, but distinct metacognitive patterns in relation to bodily processing. Higher state anxiety was associated with greater interoceptive metacognitive efficiency, while higher trait anxiety was linked to lower confidence in these interoceptive judgements. These findings advance our understanding of cognitive models of state-trait anxiety and suggest that targeted diagnostic tools and interventions could be developed based on these distinct interoceptive metacognitive abilities.