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The pathways of interoceptive awareness

Nature Neuroscience volume 12, pages 1494–1496 (2009)Cite this article

Abstract

A network of cortical brain regions, including the insula and anterior cingulate cortex (ACC), has been proposed as the critical and sole substrate for interoceptive awareness. Combining lesion and pharmacological approaches in humans, we found that the insula and ACC were not critical for awareness of heartbeat sensations. Instead, this awareness was mediated by both somatosensory afferents from the skin and a network that included the insula and ACC. Together, these pathways enable the core human experience of the cardiovascular state of the body.

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Figure 1: Schematic representing possible pathways of interoceptive awareness.
Figure 2: Brain damage in Roger.
Figure 3: Heart-rate response and on-line subjective dial ratings of interoceptive awareness changes induced by isoproterenol.

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Acknowledgements

We thank J. Bruss for figure assistance, S. Schubert and M. Bosch for isoproterenol administration, C. Sandesara, E. St. Louis, B. Olshansky and H. Shim for medical supervision, T. Grabowski for neurological expertise and J. Martins for safety monitoring. This work was supported by the US National Center for Complementary & Alternative Medicine (F31-AT003061), the US National Institute on Drug Abuse (R01-DA022549) and the US National Center for Research Resources, General Clinical Research Center Program (M01-RR-59).

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Author notes

  1. Sahib S Khalsa and David Rudrauf: These authors contributed equally to this work.

Authors and Affiliations

  1. Department of Neurology and Neuroscience Program, University of Iowa, Iowa City, Iowa, USA

    Sahib S Khalsa, David Rudrauf & Daniel Tranel

  2. Medical Scientist Training Program, University of Iowa, Iowa City, Iowa, USA

    Sahib S Khalsa

  3. Department of Psychology, University of Iowa, Iowa City, Iowa, USA

    Justin S Feinstein & Daniel Tranel

Authors
  1. Sahib S Khalsa
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  2. David Rudrauf
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  3. Justin S Feinstein
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  4. Daniel Tranel
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Contributions

S.S.K. and D.R. designed the study with help from J.S.F. S.S.K. collected the data. S.S.K. and D.R. analyzed the data. S.S.K. and D.R. wrote the paper with the help of J.S.F. and D.T.

Corresponding author

Correspondence to Sahib S Khalsa.

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Supplementary Figures 1 and 2, Supplementary Tables 1–3 and Supplementary Methods (PDF 774 kb)

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Khalsa, S., Rudrauf, D., Feinstein, J. et al. The pathways of interoceptive awareness. Nat Neurosci 12, 1494–1496 (2009). https://doi.org/10.1038/nn.2411

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