Contribution of Time Estimation and Knowledge to Heartbeat Counting Task Performance under Original and Adapted Instructions

https://doi.org/10.1016/j.biopsycho.2020.107904Get rights and content

Highlights

  • The Heartbeat Counting Task (HCT) is contaminated by time estimation and knowledge about heart rate under original task instructions.

  • Adapted instructions reduce the influence of estimation strategies on HCT performance.

  • Adapted instructions should be favored, complemented by statistical control of confounding variables.

Abstract

Interoceptive accuracy is frequently assessed using the Heartbeat Counting Task (HCT), requiring participants to count the number of times their heart beats. The HCT validity has been questioned, as participants may perform the task by estimating, rather than counting, their felt heartbeats. Participants could estimate the time or use their knowledge of their heart rate. Some research ruled out the contribution of time estimation in HCT performance. However, we believe these studies relied on a problematic analytic rationale. We revisited this question by relying on new analytic strategies, and by examining the role of estimation in HCT performance, while varying task instructions. The findings support the role of time and knowledge-based estimations under original instructions. They also highlight the critical impact of instructions on HCT validity. Given the many limitations of the HCT, we urge researchers to test the robustness of published effects and to reconsider the interpretation of replicable results.

Introduction

Interoception can be broadly defined as the processing of internal bodily stimuli by the nervous system (Cameron, 2001; Khalsa et al., 2017). Interoceptive accuracy (IAcc; Garfinkel, Seth, Barrett, Suzuki, & Critchley, 2015) is the term used to describe the objective capacity to detect these stimuli. Individual differences in IAcc are thought to play a central role in a variety of everyday abilities (e.g., adaptive responses, feelings, drives, emotions), and to predict mental (Khalsa et al., 2017; Paulus & Stein, 2010; Pollatos et al., 2008; Schaefer, Egloff, & Witthöft, 2012) and physical (Herbert & Pollatos, 2014; Verdejo-Garcia, Clark, & Dunn, 2012) health.

In order to test adequately the relationship between IAcc and any outcome variable, valid measures are required. The validity of the most frequently used measure of IAcc, the Heartbeat Counting Task (HCT; Dale & Anderson, 1978; Schandry, 1981), however, has been increasingly questioned (for a recent discussion, see Corneille, Desmedt, Zamariola, Luminet, & Maurage, 2020). In the HCT, participants are requested to count their heartbeats during various time intervals. Their reports are then compared to their objectively measured heartbeats. In the original description of the measure, participants were allowed to estimate their heartbeats (for a discussion see Brener & Ring, 2016; Schandry, 1981). For this task to be valid, however, performance should reflect the ability of participants to detect, rather than estimate, their heartbeats.

Contrary to this requirement, many studies have suggested that HCT performance reflects heart rate estimation rather than true detection (at least for some participants). Modifications of the instructions have been designed to limit the influence of estimation strategies. Specifically, while the original instructions ask participants to count or estimate their heartbeats (Schandry, 1981), adapted instructions ask them to only count their felt heartbeats (Desmedt, Luminet, & Corneille, 2018; Ehlers, Breuer, Dohn, & Fiegenbaum, 1995; Murphy, Brewer, Hobson, Catmur, & Bird, 2018). Importantly, previous research shows that results obtained using the HCT differ depending on which instructions are given (Desmedt et al., 2018; Ehlers et al., 1995).

In the present study, we investigated the contribution of time estimation strategies and knowledge about their heart rate (i.e., number of heartbeats per minute) to HCT performance, under both original and adapted instructions. In doing so, we also relied on more accurate analytic strategies. Below, we provide the theoretical and empirical background for our research question. Then, we report two studies that addressed this question. Finally, solutions to improve the HCT’s validity are discussed.

Section snippets

Interoceptive accuracy as measured by the HCT

The HCT is the most frequently used measure of IAcc (Dale & Anderson, 1978; Schandry, 1981). In the HCT, participants are asked to count their heartbeats during different time intervals (e.g., 25 s, 35 s and 45 s) without feeling their pulse using their hands. Smaller proportional absolute differences between the number of heartbeats reported by participants and objectively measured heartbeats result in higher HCT performance. Because of its ease of use, this task has been widely used during

Participants and Procedure

This study concerns a subset of a larger combined dataset from Murphy et al. (2018). This subset includes 69% of the participants included in the larger dataset for whom the raw data for both the HCT and the time estimation task were available. In this study, 198 volunteers (139 females, Mage = 44.9, SDage = 22.39) were recruited through local advertisements and recruitment databases, and compensated for their participation. Ethical approval was granted by the local ethics committee. All

Participants and Procedure

Data were from Desmedt et al. (2018). In this study, 123 healthy students (76 females, Mage = 22.3, SDage = 3.13) were recruited through advertisements on mailing lists and compensated for their participation. Ethical approval was granted by the local ethics committee. All participants gave informed consent and were fully debriefed upon task completion. Participants first completed the International Physical Activity Questionnaire – short form (IPAQ-SF; Craig et al., 2003). Then, they performed

Discussion

The past decade has been marked by a significant resurgence of interest in interoception. The most frequently used measure (HCT) of IAcc, however, suffers from considerable limitations impacting its validity (see Corneille et al., 2020). The use of an invalid task is likely to result in replicability issues (as past results could represent false positives) or in misleading conclusions, both of which have harmful consequences for theory and practice. The difficulty to replicate results coming

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgments

Olivier Desmedt (PhD student), Olivier Luminet (Research Director) and Pierre Maurage (Senior Research Associate) are funded by the Fund for Scientific Research – Belgium (FRS-FNRS). Jennifer Murphy was supported by a doctoral studentship from the Economic and Social Research Council [1599941; ES/J500057/1]. GB was supported by the Baily Thomas Trust.

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