Interoceptive awareness and beliefs about health and the body as predictors of the intensity of emotions experienced at the beginning of the pandemic

The ecological background of the study–the context of the pandemic

This study was run during the beginning of the COVID-19 pandemic in Poland, from 27 March until 15 April 2020. The severity of the pandemic at that time can be described by the following indicators: on 27 March 1,389 cases of COVID-19 had been diagnosed and 16 patients had died, whereas on 15 April, 7,582 cases were diagnosed, there had been 286 fatalities and 668 had recovered. During that period, the government implemented many restrictions limiting ordinary social activities. From 1 April, the government announced a ban on movement to reduce the rate of spread of the epidemic. The “lockdown” strategy was used for the first time in Poland. It can be said that the study was conducted during a period of significant restrictions on civil liberties and a serious growth of the pandemic; additionally, the novelty of the situation could have provoked increased stress. A pandemic is a stressful event, which significantly influences individuals’ emotional states.

In the current study, we would like to focus on the subject’s declared emotional state during the first stage of the pandemic, and to verify the factors that may modify this state. Interoceptive awareness is related to emotional experience (e.g., Barrett et al., 2004; Hanley, Mehling & Garland, 2017), and therefore it should modify emotional reactions to threatening circumstances. At the same time, exposure to a serious, contagious disease involves a fear for one’s health (Person et al., 2004). Accordingly, beliefs about health and the body were also included in the study design as a factor influencing emotional state during the first stage of the COVID-19 pandemic.

The pandemic situation can be highly stressful. Folkman & Lazarus (1985) defined stress as a type of relationship between humans and the environment when resources are exceeded. An individual experiencing an overloading situation might feel the threat of potential harm or loss, which is a stress component (Folkman & Lazarus, 1985). It is the perception of the situation in terms of a threat, not a challenge, that causes a negative emotional response (Dienstbier, 1989). Importantly, research demonstrated that threat perception is associated with cardiac and vascular reactivity (Tomaka et al., 1993). This is not the only manifestation of stress at the physiological level. The meta-analysis conducted by Dickerson & Kemeny (2004) revealed that acute psychological stressors are related to an increase in cortisol level; however, the reaction varied across conditions. In addition, stress also has a significant impact on mental health. Several meta-analyses confirmed the association between stress and depression (e.g., Kessler, 1997; Mazure, 1998; Monroe & Hadjiyannakis, 2002; Paykel, 2003). Essentially, there is evidence confirming the linear connection between the severity and amount of stressful events and vulnerability to depression (Kendler, Karkowski & Prescott, 1998).

Data on the current pandemic confirm that people presently experience more stress than before. Research done in January and February 2020 in China confirmed that 54% of respondents perceived the psychological impact of disruption caused by the COVID-19 pandemic as severe or moderate, 29% declared experiencing moderate or serious anxiety symptoms and 17% indicated a depressive reaction (Cullen, Gulati & Kelly, 2020). If we look at data describing past epidemics, we can conclude that this type of phenomenon is inherently a large emotional burden. In a paper about the psychological consequences of the influenza pandemic, Perrin (2009) indicated that although people do indeed address fear and new, unknown health dangers, the severity of anxiety experienced and the type of coping strategies are determined by individual differences and might evolve during the epidemic. There are many examples in the empirical literature illustrating the influence of epidemics on mental health and emotional state. For example, during an outbreak of Legionnaires Disease in Japan, 17.6% of respondents reported feeling stressed, 13.7% reported anxiety and insomnia and 3.3% reported severe depression. Moreover, 3–4 months after the breakout, some patients still demonstrated mental health problems (Tsuruta et al., 2005). Similarly, in 18% of the study population, severe acute respiratory syndrome (SARS) in Hong Kong was associated with anxiety, post-traumatic stress disorder and depression symptoms (Wu, Chan & Ma, 2005). Taking into account the above empirical data, it can be seen that a pandemic is associated with various emotions and might cause a distress response with serious consequences for mental health. So, the question is, what kind of emotions are presently people experiencing, during the COVID-19 pandemic? To answer this question, we first need to define appropriate dimensions to describe emotions.

Types of emotions–valence and origin components

To discuss the nature of the dimensions of emotion, it is first necessary to briefly define the concept of emotion. Some authors define emotions as a response (physiological, psychological and behavioural) (Frijda, 2007) to the evaluation of stimuli (Jarymowicz & Imbir, 2015) which might address both biological aspects (Damasio, 2010) and the cognitive interpretation of the ongoing situation from the perspective of an individual’s goals and standards (Clore & Ortony, 2010). Consecutively, Moors & Fischer (2019) consider emotions as a product of a goal-directed mechanism, referring to adaptability. Emotions express a tendency to action directed towards the achievement of a goal. The appraisal theories of emotions emphasise the relevance of the stimulus in reference to goals (Moors et al., 2013). The appraisal of stimulus is a type of verification of the congruence of stimulus with goals and controllability of this goal, thus it influences behaviour. The proposed view on emotions is in line with an alternative approach to dual-processes in the action and emotion domain proposed by Moors, Boddez & De Houwer (2017). The goal-oriented processes are considered a default (instead of stimuli-driven); moreover, these processes are not limited to the regulation of emotion, but are expected to strongly affect the formulation of action tendencies. The goal-oriented approach emphasises the role of possible control of aversive stimuli–when an individual is facing a choice between a fight or flight reaction; the choice is dependent on the expected utility of both reactions (Moors et al., 2019).

Taking into account the multitude of definitions and the variety of approaches (sometimes partially or completely contradictory to each other), one can get the impression that the construct of emotions still arouses some controversy, and the outlining of an unambiguous definition accepted by most researchers seems to be instinctive, albeit difficult to achieve.

To get deeper into the concept of emotions it is useful to address the key dimensions of this phenomenon. One of the basic dimensions of emotions is valence, a factor defined as the pleasantness or unpleasantness of experiences (Barrett, 1998; Lazarus, 1991). Valence results from appraisal the of stimuli as positive, negative or neutral, thus reflecting the basic biological tendency of approaching and avoiding. This elementary dimension enables the description of the emotional state in terms of positive and negative emotions, thus responding to the basis of the need to define feelings experienced in terms of comfort and discomfort. It is common to both the theoretical scientific approach and the common typology of emotions.

While the dimension of valence is fundamental in most research on emotion, there are still limited data about the origin dimension. This dimension refers to the broader heart-mind dichotomy rooted in classical philosophy. Based on the origin typology proposed by Jarymowicz & Imbir (2015), emotions can be divided into those resulting from automatic (“heart”) evaluative processes that do not need explicit cognition to appear and those following reflective (“mind”) evaluative processes that are based on extended cognition (Jarymowicz & Imbir, 2015). Automatic emotions result from internal drives and needs; they also refer to external incentives that play a crucial role in social and physical survival. They are thus related to the concept of biological value (Damasio, 2010), an automatic criterion of evaluation that gives an organism the sense of what is good for survival (i.e., pleasant) or bad (i.e., unpleasant). Automatic emotions are regulated by affect (Zajonc, 1980) and thus have a diffusive, holistic and homogeneous character (Jarymowicz & Imbir, 2015). The automaticity and reflectiveness in this approach are related to different degrees of cognition; automatic emotions need a minimal level of cognition to occur, in contrast to reflective ones. Nevertheless, the automaticity is not understood synonymously as absolute spontaneity. Reflective emotions are driven by intellectual, “mind” principles; their evaluation has a verbalised nature (Reykowski, 1989; Strack & Deutsch, 2004, 2014). They are relatively heterogeneous and precise. The criteria of evaluation develop over the entire lifespan and are based on reflections concerning what is good or bad (Jarymowicz, 2012; Jarymowicz & Imbir, 2015).

The proposed theoretical conceptualisation of automaticity and reflectiveness in terms of emotion deliver an interesting framework; however, its postulates might draw some contraventions. For example, Moors & De Houwer (2006) question defining a concept of automaticity through categories such as unintentionality, uncontrollability, autonomy, stimulus dependency, goal independence, efficiency and high speed. Researchers indicate the overlapping character of these components and suggest investigating each feature separately. Moreover, based on theoretical analysis, authors conclude that the features mentioned have rather a dimensional nature, therefore cognitive and emotional processes should be located somewhere on a continuum.

Nevertheless, in the current study we used Jarymowicz & Imbir’s (2015) view on emotions, treating automaticity and reflectiveness as opposite ends of a scale representing the engagement of explicit deliberation towards stimulation, leading to interpretation of the situation. In our opinion, this approach might offer a promising theoretical framework to investigate the possible diversity of emotions reported during the pandemic.

Factors related to psychological attitude towards the body affecting emotional state

In the context of the pandemic, stress, which is naturally experienced within the body, seems to be strongly associated with concern about the condition of one’s body, in other words, about one’s health. Therefore, we might assume that an individual’s perception and awareness of their body might influence their currently self-reported emotional state. One such factor might be cognitive beliefs about the body resulting from perception and evaluation of the body. A Health Beliefs Model delivers a kind of theoretical support for the importance of individuals’ beliefs, health and behaviour (Hochbaum, 1985; Rosenstock, 1966, 1960; Rosenstock, Strecher & Becker, 1988). This model was initially designed to explain the failures of prevention programmes relating to health, and then it was expanded to explain reactions to symptoms and diagnosed diseases. The model refers to value-expectancy theory and includes the perceived severity of illness, the perceived benefits, or action taken to reduce the threat of illness and promote health and perceived barriers referring to cost-benefit analysis if the actions taken involved any sacrifices (Rosenstock, Strecher & Becker, 1994). The role of beliefs in the approach to disease conceptualised in the model was empirically verified (see, for example, the meta-analysis conducted by Harrison, Mullen & Green (1992)). Furthermore, research proved that optimistic self-beliefs enhance health-protecting behaviour through setting goals, taking actions and building motivations (Schwarzer, 1994). Finally, the relationship between emotional state and beliefs can be addressed with the ABC model constituting one of the foundations in CBT and RET therapies. Based on the model, cognition mediates emotional reaction (Ellis, 1991).

By describing how people experience their bodies, a distinction can be made between the perceived sensations and the declared state. When a person suffers from the disease, the observed physiological dysfunctions are associated with symptoms reported by this person (Pezzulo et al., 2019). However, some fluctuations in this relationship can be noticed. To explain why the relationship between objective disease parameters and symptoms reported by patients may vary significantly, Pezzulo and colleagues (2019) proposed a new predictive processing coding perspective. In this conceptualization, the experience of symptoms is the product of not only interoceptive perception but also predictions of the brain about detected interoceptive signals. We can therefore conclude that the perception process is not independent of the previously encoded meanings. Apart from perception (defined as predictive coding), the model also includes the level of action understood as an active interference. The role of pre-existing (prior) information in the construction of newly occurring representation expresses some similarity to the influence of cognitive beliefs on the formulation of emotional response.

To discuss further the role of related factors in shaping emotional state, we going to describe the concept of interoceptive awareness. The interoception is currently one of the major topics in mental health and body-mind based interventions (Mehling et al., 2018). Recent approaches put a strong emphasis on the beneficial influence of the enhancement of body awareness, especially in individuals who are professionally involved in mind-body therapies like yoga, tai chi or meditation (Mehling et al., 2009, 2012, 2011). Moreover, some indicate that an increase of interoceptive awareness observed in mindful awareness in body-oriented therapy (MABT) has a beneficial influence on an individuals’ emotional state. It supports the ability to adequately detect and classify physiological sensations, therefore it enables an adequate reaction to stressful stimuli and appropriate regulation (Price & Hooven, 2018). Considering the literature cited, we drew a conclusion that interoceptive awareness should play a crucial role in explaining the emotions experienced. For a broader discussion of the topic of interoceptive awareness, some definitions will first be presented, and then the relationship between interoceptive awareness and emotions will be described.

Interoception can be defined as a process reflected in nervous system activity by which signals both from and within the body are detected, interpreted and integrated (Mehling et al., 2018), and which is also understood as a body-to-brain axis related to the state of the inner body and visceral organs (Cameron, 2001). Quadt, Critchley & Garfinkel, (2018) emphasise a basic function of interoception, which is keeping the body alive through the afferent channel of the brain and body interaction oriented to maintenance of homeostasis. Tsakiris & Critchley (2016) described interoception as a process of detecting and sensing internal states through the processing of inner body sensation. Considering the definition thus noted, it is worth emphasising, however, that awareness of the state of the inner body and visceral organs (Cameron, 2001) differs from detection, followed by interpretation and integration (Mehling et al., 2018). The understanding proposed by Mehling is a wider concept and seems to refer both to awareness of bodily psychological sensations and to the appraising interpretation occurring with such awareness (Mehling, 2016; Mehling et al., 2012). This type of understanding corresponds with the four (4) dimensions of interoception theory, based on which, the following stages of interoception can be designated: occurrence of afferent signals (1); encoding, integration and generation of representation (2); influence on cognitive and behavioural processes (3), a conscious expression of representation of inner bodily signals (4) (Quadt, Critchley & Garfinkel, 2018). Generally, people differ in terms of their ability to detect and properly report inner body signals. Thus, the question arises of how to assess interoceptive awareness? The concept of interoceptive awareness understood as an ability to detect, interpret and integrate inner bodily sensations is the foundation of the self-reported measurement tool, the Multidimensional Interoceptive Awareness Questionnaire developed by Mehling and coworkers (Mehling et al., 2018, 2012). The questionnaire was applied in the current study as it is enables individuals to make a self-description in terms of interoceptive awareness linked with emotions, consciousness and behaviour (Mehling et al., 2013). The tool is built of eight scales addressing such components of interoceptive awareness as: Noticing; Not-Distracting; Not-Worrying; Attention Regulation; Emotional Awareness; Self-Regulation; Body Listening; and Trusting. The use of self-reported measurements also has some limitations. Recent research indicates that people express a limited ability to accurately reason about their inner bodily states, such as current cardiac activity (Iodice et al., 2019).

A more detailed description of the questionnaire is provided in the Materials & Methods section.

After the definitions of interoception have been outlined, we would like to discuss the relationship between interoceptive awareness and emotions. Firstly, the role of interoception understood in the narrow sense as a perception of the physiological circumstances of the body, will be discussed. Interoception is the basis of subjective emotional experience (Calì et al., 2015). Many theories of emotion accentuate the role of perception and interpretation of interoceptive signals (Damasio, 1994; Schachter & Singer, 1962). The exploration of the relationship between emotions and interoception became a topic of frequent interest to researchers (Calì et al., 2015). For instance, Damasio and colleagues emphasised the role of the representation of bodily experience in the brain, which is associated with specific emotions, subsequently affecting a decision making process (Damasio, 1998, 1994; Damasio et al., 2000). It was empirically demonstrated that individuals who are more sensitive interoceptively experience emotions more intensively (Montoya, Schandry & Miiller, 1993; Pollatos, Kirsch & Schandry, 2005; Pollatos, Gramann & Schandry, 2007; Wiens, Mezzacappa & Katkin, 2000). For example, research has shown that individuals highly aware of cardiac activity demonstrate a significantly stronger cardiac reaction to pleasant and unpleasant stimuli compared to less aware individuals (Pollatos & Schandry, 2008). Interestingly, interoceptive awareness seems to be associated with perception and appraisal of the arousal dimension (see e.g., Barrett et al., 2004; Dunn et al., 2010). Moreover, higher interoceptive awareness was associated with greater recognition of affectively stimulating pictures, which might prove that individuals characterised by higher interoceptive awareness process emotionally arousing materials in a more conscious way (Pollatos & Schandry, 2008). Calì et al. (2015) suggested that interoception might influence emotional processing through a trait called emotional susceptibility, understood as a vulnerability and propensity to experience discomfort in response to emotionally charged stimuli. The proposed mechanism explaining the relationship between interoception and emotional experience seems to be supported by growing evidence of the role of the insula in interoceptive and emotional processes (e.g., Ernst et al., 2013; Zaki, Davis & Ochsner, 2012). Taking into account the data quoted, it is not surprising that, in psychopathology body awareness was initially linked with excessive attention towards bodily sensations (or even symptoms) resulting in somatisation, rumination and catastrophic beliefs (Cioffi, 1991).

When considering interoceptive awareness in the wide sense, it is worth mentioning the study by Calì et al. (2015) once again. Research revealed that of the dimensions of the MAIA questionnaire (Attention Regulation, Trusting, Not-Worrying and Emotional Awareness) predicting emotional susceptibility (Calì et al., 2015), only Emotional Awareness is positively correlated with emotional susceptibility, whereas the rest of the scales are negatively correlated. A mindful, accepting experience of bodily sensations is a fundamental aspect of embodiment (Carruthers, 2008; Fogel, 2009). Many studies have shown that there is a link between mindfulness and interoception (Farb et al., 2015; Hölzel et al., 2011; Mehling et al., 2012; Tang, Hölzel & Posner, 2015). In essence, both concepts can be theoretically and functionally treated as intertwined (Farb et al., 2015; Hölzel et al., 2011): mindfulness offers practices directly engaging interoceptive awareness and is based on the interoception mechanism as an intervention (Bornemann & Singer, 2017; Farb et al., 2015; Hölzel et al., 2011). Research has revealed that both IA and dispositional mindfulness predict psychological well-being (Hanley, Mehling & Garland, 2017).

Summing up the empirical data cited, the conclusion is that both beliefs about health and body and interoceptive awareness are associated with emotional experience. The relationship seems to be rather complex and further research in this area seems necessary.

Aim and hypothesis

The current study seeks to address the understanding of the nature of the relationship between the types of variables: a self-reported emotional state classified on the valence and origin scales, dimensions of interoceptive awareness (Mehling et al., 2012, 2018) and negative beliefs about health and body.

At first, the investigation was narrowed down to dimensions of interoceptive awareness and all types of emotions: negative automatic and reflective, positive automatic and reflective.

Therefore, we predicted that there is an association between two sets of variables: (I) all types of emotions and (II) the level of interoceptive awareness (H1). To examine multivariate networks of association between interoceptive awareness and different types of emotions, a canonical correlation analysis was planned.

Secondly, the aim of the study was to verify the relationship between negative beliefs and the emotions experienced. We expected that negative beliefs are positively associated with negative automatic and negative reflective emotions (Neg. Aut. Emo.; Neg. Refl. Emo.) (H2a). By contrast, negative beliefs are predicted to be negatively related to both automatic and reflective positive emotions (H2b).

We predicted also that there is generally a negative association between the MAIA scales and negative beliefs (H3).

Finally, the aim of the study was to demonstrate multiple distinct associations between all variables investigated. Research indicates that interoception might predict the intensity of emotional experience (see e.g., Dunn et al., 2010; Pollatos, Kirsch & Schandry, 2005; Terasawa et al., 2014). Analogically, taking into account the ABC Ellis (Ellis, 1991) model used in cognitive or REBT therapy, the type and intensity of emotions experienced can to some extent be explained by referring to the subjective beliefs of the individual. Accordingly, based on the current state of knowledge, we assumed that the direction of the relationship runs from negative beliefs and MAIA scales to emotions. In other words, both MAIA scales and Neg. beliefs were expected to predict the intensity of Neg. Aut. Emo, Neg Refl. Emo, Pos. Aut. Emo and Pos. Refl. Emo (H4).

Participants

The participants were volunteers recruited from different types of Facebook groups: groups associating local communities such as the inhabitants of big cities (Warsaw, Cracow, Trójmiasto and others), smaller cities and villages (like Mińsk Mazowiecki, Legnica, Ząbki and others) and regions (for example, masovian voivodeship, lubelskie voivodeship, świętokrzyskie voivodeship); groups of different university students (for example, the University of Warsaw, Warsaw Medical University, the Economic University in Cracow); and groups dedicated to different hobbies, like sport, health, self-development and psychology (but not addressed to professional psychologists). Group selection was designed to maximise sample diversification and avoid testing only the student population.

All Facebook groups are public and open to new members; however, some of them require filling in an additional survey to join the group. Members of the groups were asked to fill in an online survey consisting of several tools. The data was collected from 27 March to 15 April. During that time, about 50 posts were published with announcements encouraging individuals to take part in the study. This resulted in the receipt of more than 300 fully completed surveys. There was no remuneration for participation in the study.

The survey was completed by 327 Polish adults. The criteria applied to prepare the dataset were to exclude the responses wherein time of completion of the whole set of questionnaires differed by more than two standard deviations from the mean (M = 7.92 min; SD = 3.76; the time range for completing the study was from 2.68 min to 28.13 min). Based on that, 28 subjects’ responses were removed. The final participant number was N = 299 (236 women, 62 men and 1 other), aged between 18 and 67 years old (M = 30.41; SD = 10.96).

No personal data was collected that would allowing us to identify participants. The demographic characteristics of the sample are included in Appendix 1.

Design

The study was held in a correlational schema. There were three variables measured: (1) emotions experienced; (2) interoceptive awareness; and (3) negative beliefs about health and body.

Materials

Procedure

The data was collected from 27 March to 15 April. The recruitment procedure consisted of publishing announcements encouraging individuals to take part in the study. The message contained information about the expected time needed to complete the survey, the general purpose of the study, information about the anonymous nature of the study and appeals encouraging people to participate in the study. The only excluding criterion was age: the study was only addressed to adult participants. No data that would allow us to identify participants was collected during the study. The study was approved by Ethics Committee of the Faculty of Psychology in the University of Warsaw.

The study consisted of informed consent to participate in the study and several questionnaires, ordered as follows: measurement of emotions experienced; MAIA; beliefs about health and body in relation to the ongoing epidemic; a demographic survey. The informed consent included detailed information about who obtains the data and for what purpose, information that the data is anonymously analysed for academic purposes only and that there are no data permitting identification of the participants. Additionally, the consent contained a request to fill out the questionnaires honestly and carefully, as there are no right or wrong answers. To confirm consent to participate in the study, participants were asked to click the “Go further” button. The consent was part of an online study; therefore it was given as an online approval, not in writing.

The study was conducted via the Qualtrics platform. Each tool was displayed on a separate screen. The first part was the assessment of emotional reaction. Participants were asked to evaluate on a seven-degree Likert scale (where 1 = not much, and 7 = very much) how much they currently experience each emotion. There were 20 emotions in total, all described above in the section on tools. Then participants filled out the MAIA questionnaire. Afterwards, participants were asked to assess how much they agree with the statements describing some beliefs about health and the body in the epidemic context. There were 10 statements for assessment. The last part was the demographic survey. The following data were collected via this survey: age, gender, place of residence, education and financial status (i.e., if someone has a stable source of income and their perception of their financial status); state of health (i.e., if someone suffers from a serious illness); and experiences related to the COVID-19 pandemic, like knowing someone who has had the disease and having the virus oneself. The demographic survey contained nine questions in total, most of which were closed.

Statistical procedure

The statistical approach was aimed at verifying the relationship between three sets of variables: interoceptive awareness measured with the MAIA questionnaire, a negative belief about health and body operationalised with ten statements and four types of emotions based on the valence-origin division. For this purpose, a canonical correlation analysis (CCA) was applied to examine the multivariate structure of the association between the components of interoceptive awareness and different types of emotions experienced (automatic negative emotions, reflective negative emotions, positive automatic emotions, reflective automatic emotions). To illustrate the relationship between all variables investigated, a path analysis was also run. This type of analysis enables one to build a model including various dependencies between variables.

Additionally, some preliminary analyses were performed, such as a t-Student comparison based on the demographic factors, correlation analysis and regression analysis.

Canonical correlations: the relationship between the MAIA scales and automatic and reflective emotions

To investigate the multivariate shared association between two sets of variables–the components of the MAIA questionnaire and variables based on the valence and origin types of emotions–a canonical correlation analysis was conducted. The full model was statistically significant using Wilk’s λ =.63, F(32, 1,060.00) = 4.41, p < 0.001., and explained 41% of the shared variance between the two sets of variables (see Fig. 1). Four functions were investigated using squared canonical correlations corresponding to respectively: (1) Rc2 = 0.27, (2) Rc2 = 0.11, (3) Rc2 = 0.03, (4) Rc2 = 0.01. However, only two of them were statistically significant. The first [27%; F(31, 1,060) = 4.41, p < 0.001] and second [11%; F(21, 827.53) = 2.16, p = 0.002] functions explained a substantial portion of shared variance. In the first function, two scales of the MAIA questionnaire, Self-Regulation and Trusting, were principally associated with three types of emotions: Neg. Aut. Emo., Neg. Refl. Emo., Pos. Aut. Emo. The sign of the correlation index for the Self-Regulation and Trusting scales was positive, the same as the correlation index in the case of the Pos. Aut. Emo., and contrary to Neg. Aut. Emo and Neg. Refl. Emo. In the second function, two scales of the MAIA questionnaire, Noticing and Not-Worrying, were primarily related with Pos. Refl. Emo. The correlation index for the Noticing scale and for Pos. Refl. Emo was minus, whereas the correlation index for the second scale, Not-Worrying, obtained a positive sign. All standardised canonical coefficients were reported in Fig. 1.

Relationship between all types of emotions, negative beliefs about health and the body and the MAIA scales

The relationships between the study variables were analysed with the use of path analysis based on the maximum likelihood method. The preliminary model is depicted in Fig. 2.

The preliminary model differed significantly from the data that was analysed, χ²(13) = 87.06, p < 0.001. The values of fit indices were NFI = 0.91; CFI = 0.92, RMSEA = 0.14. In order to improve the fit of the model, statistically insignificant paths were removed, and statistically significant paths were added. The addition of paths was based on the values of modification indices with a threshold value of 4. The path that was statistically insignificant was the path between Attention Regulation and Emo. Pos. Refl., B = 0.12, p > 0.05. The only directional relationship involving Attention Regulation was the path between Attention Regulation and Emo. Pos. Refl. Therefore, Attention Regulation was excluded from the model. In the next three consecutive steps correlations between Emo. Neg. Aut. and Emo. Pos. Aut., between Emo. Neg. Refl. and Emo. Pos. Aut. and a path between Trusting and Emo. Pos. Refl. were added. After these four modifications the final model depicted in Fig. 3 did not differ significantly from the data that was analysed, χ²(6) = 9.70, p > 0.05. The values of fit indices were NFI = 0.99; CFI = 0.99, RMSEA = 0.05.

Table 5 presents the values of the correlation coefficients. Table 6 presents the values of the regression coefficients.

Not-Worrying was positively correlated with Self-Regulation, Self-Regulation was positively correlated with Trusting and Trusting was positively correlated with Not-Worrying. Negative beliefs correlated negatively with both Trusting and Not-Worrying. The indicators of positive emotions showed a positive correlation with each other. The indicators of negative emotions also showed a positive correlation with each other. The indicators of positive emotions and the indicators of negative emotions correlated negatively with each other.

Self-Regulation, Trusting and Not-Worrying were negatively related to Emo. Neg. Aut. and Emo. Neg. Refl. Negative beliefs were related to Emo. Neg. Aut. and Emo. Neg. Refl. positively. Self-Regulation and Trusting were positively related to Emo. Pos. Aut. and Emo. Pos. Refl. Negative beliefs were related to Emo. Pos. Aut. negatively. The final model explained 7.8% of Emo. Pos. Refl. Variance, 15.2% of Emo. Pos. Aut. variance, 25.8% of Emo. Neg. Refl. variance and 24.5% of Emo. Neg. Aut variance.

The relationship between different types of emotions and interoceptive awareness

The current study showed that there is a multivariate shared association between two sets of variables: MAIA components and different types of emotions: Neg. Aut. Emo., Neg. Refl. Emo, Pos. Aut. Emo., Pos. Refl. Emo. The model explained 41% of the shared variance between two sets of variables. Scales such as: Noticing, Not-Worrying, Self-Regulation, Trusting were primarily associated with emotions. The canonical correlation analysis delivered interesting data illustrating a multivariate association between automatic and reflective emotions and interoceptive awareness. The first function, explaining the majority of the common variance, indicated a strong relationship between the Self-Regulation and Trusting scales and emotions–with the increase of those dimensions in the function, the decrease of negative automatic and negative reflective emotions occurs, whereas positive automatic emotions escalate. An interesting pattern of relation between MAIA and emotions was investigated through the second function in canonical correlation analysis–there is an association between Noticing, Not-Worrying and positive reflective emotions. The increase of Noticing leads to an increase of positive reflective emotions, whereas an increase of Not-Worrying was associated with the opposite observation. The Noticing scale reflects the subject’s ability to detect inner body symptoms without psychological appraisal and integration; it refers to the elementary aspect of interoception (Quadt, Critchley & Garfinkel, 2018). The Not-Worrying scale contains statements expressing that the individual does not react with worry or upset on pain or discomfort. Only one statement refers directly to the ability to notice the sensations without concerns. Therefore, juxtaposing both scales, one can get the impression that some of them may express slightly opposite tendencies. However, the second function explains the minor part of the variance, therefore this result should rather be treated with caution.

The structure of associations between all types of emotions, negative beliefs about health and the body and MAIA scales

The model illustrating the multiple distinct associations between negative beliefs, MAIA components and four types of emotions: Neg. Aut. Emo., Neg Refl. Emo., Pos. Aut. Emo., Pos. Refl. Emo. revealed a good adjustment to data and brought some new insight.

Limitations

This study has its limitations. The data were collected from users of Facebook groups. In the sample, most participants were inhabitants of large cities and persons with higher education and which, therefore, constrained the representativeness of the sample. For that reason, the results may be a specific to the population, presenting relatively high levels of interoceptive awareness. Further studies on the general population are needed. The sample size can also be considered as a study limitation, especially when data is collected via the Internet. Due to specific time-related restrictions regarding movement, the only way to collect data was to conduct an online survey. This method excludes the use of objective measures of interoception, such as heartbeat tracking tasks, which in turn could deliver interesting information.

To understand more profoundly the character of the relationship between one’s bodily experience, negative beliefs about health and the body and emotional responses to threatening events, it seems useful to apply additional self-reported measurements, such as dispositional mindfulness, emotion regulation strategies and coping styles. In the study, only two dimensions of emotions were operationalised. The dimension of arousal was not included in the design due to the aim of the study (the purpose was to verify the relationship between the body related variable and the emotions based on variation in the valence and arousal dimensions). This direction of research seems to be interesting, as there is some evidence that highly interoceptively aware individuals perceive stimuli as more arousing (Barrett et al., 2004; Dunn et al., 2010). Moreover, there are varied approaches to emotions (e.g., Moors et al., 2019); possibly applying another theoretical framework could result in a new direction of research.