Anxiety linked to reduced insight into bodily sensations

A new study published in the European Journal of Neuroscience has found that moment-to-moment feelings of anxiety are related to reduced insight toward breathing-related bodily sensations, and that this link appears to be specific to women. The researchers found that while men and women had similar abilities to detect subtle changes in their breathing, greater anxiety was associated with lower confidence and reduced insight into performance accuracy—but only in women.

The study was motivated by growing evidence that anxiety is connected to interoception—the awareness of internal bodily states such as breathing, heartbeat, or hunger. Interoception is thought to play a central role in how the brain monitors and regulates physical and emotional states. Previous studies have suggested that people with anxiety may struggle with interoceptive awareness, particularly when it comes to how well they can evaluate or trust their perceptions of bodily signals. However, much of the earlier research was based on small samples, and few studies examined whether these relationships differ between men and women.

“Women have a much higher prevalence of anxiety than men, and the symptom presentation is often quite different,” said study author Olivia Harrison, a Rutherford Discovery Research Fellow and senior lecturer at University of Otago. “We are interested in how signals from within the body (interoception) are altered with anxiety differentially between men and women. We are also interested in whether this may be due to differences in early perceptual processing of these signals, or whether gender differences may only become apparent during metacognition – awareness and insight into one’s interoceptive processing.”

The researchers combined data from four study sites across Europe, bringing together a total of 175 participants, about half of whom were women. All participants were healthy adults and completed a battery of psychological questionnaires, including the Spielberger State–Trait Anxiety Inventory, which measures both current feelings of anxiety (state anxiety) and a person’s general tendency to experience anxiety over time (trait anxiety). Participants also completed a task designed to measure breathing-related interoception.

In the interoception task, participants breathed through a device that occasionally introduced a subtle resistance to inhaling, created by inserting filters into the breathing apparatus. These resistances were designed to be barely noticeable. After each trial, participants were asked to decide whether they thought a resistance had been added and rate how confident they were in that decision. The task was tailored to each person so that the difficulty remained consistent across participants.

Harrison and her colleagues analyzed several aspects of performance: sensitivity (how accurately someone could detect the resistance), decision bias (whether someone was more likely to say “yes” or “no”), metacognitive bias (how confident someone generally felt in their decisions), and metacognitive insight (how well someone’s confidence matched their actual accuracy).

Across all participants, higher levels of state anxiety were associated with lower metacognitive bias—meaning that anxious individuals tended to feel less confident in their judgments, even if their accuracy was unchanged. State anxiety was also linked to reduced metacognitive insight, or a weaker match between confidence and actual performance.

However, when the researchers examined this relationship by gender, they found something striking: the association between anxiety and reduced metacognitive insight was only present in women. For men, there was no significant link between how anxious they felt and how well their confidence reflected their performance. This gender-specific effect was statistically significant and appeared only for state anxiety, not for trait anxiety or depression.

Importantly, the average interoceptive abilities—such as sensitivity to breathing resistance and overall confidence—did not differ between men and women. This means the observed differences were not due to one gender being better or worse at the task, but rather how anxiety influenced their evaluation of their own performance. The researchers suggest that this might help explain inconsistent findings in previous studies, especially those with more female participants.

Harrison and her colleagues also found that trait anxiety and depression were linked to lower metacognitive insight in the group as a whole. However, unlike state anxiety, these relationships did not show a meaningful difference between men and women. This suggests that state anxiety, which reflects how a person feels in the moment, may have a more direct and gender-specific connection to interoceptive awareness than long-term anxiety tendencies or depressive symptoms.

“One of the main take-home messages of the study is that on average, men and women have the same levels of interoception and related insight towards breathing perceptions,” Harrison told PsyPost. “However, the relationship between state anxiety (i.e. in-the-moment anxiety) and interoceptive insight is different between men and women – lower anxiety is related to improved insight while greater anxiety is related to worsened insight only in women, while this relationship did not exist for men. Interestingly, this gender difference was not apparent for either trait (i.e. longer-term) anxiety nor depression.”

Despite the relatively large sample size for this kind of research, the authors acknowledge some limitations. Since the data came from four different sites with slightly different procedures, subtle inconsistencies could have influenced the results. To ensure the findings were not driven by differences across study locations or methods, the researchers conducted sensitivity analyses, which largely confirmed the main results.

The cross-sectional design also limits any conclusions about cause and effect. For example, it remains unclear whether anxiety disrupts metacognitive insight, or whether impaired interoceptive awareness contributes to feeling more anxious. The study also focused only on breathing-related interoception, and it’s not yet known whether similar patterns would be found for awareness of other bodily signals, such as heartbeats or stomach sensations.

The researchers hope their work will contribute to more personalized approaches to mental health. “We are aiming to both better understand anxiety behaviors as well as better target their treatment,” Harrison said. “In particular, we are interested in tailoring treatment options to each individual, to maximize the chances of success.”

The study, “Gender Differences in the Association Between Anxiety and Interoceptive Insight,” was authored by Olivia K. Harrison, Laura Köchli, Stephanie Marino, Lucy Marlow, Sarah L. Finnegan, Ben Ainsworth, Benjamin J. Talks, Bruce R. Russell, Samuel J. Harrison, Kyle T. S. Pattinson, Stephen M. Fleming, and Klaas E. Stephan.