Multimodal MRI Protocol to Study Interoception in Schizophrenia

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Frontiers in Medicine Published April 19, 2026 Medically reviewed April 25, 2026 DOI ↗ By Dr. Ji-eun Park, MD · Brain, Mind & Pain

Key Takeaway

Consider this planned multimodal MRI protocol as a hypothesis-generating approach to study interoception in schizophrenia.

This document is a protocol for a cross-sectional multimodal MRI study. It plans to enroll 30 individuals with schizophrenia and 30 age- and sex-matched healthy controls (total sample size 60). The protocol describes a behavioral interoceptive assessment using the heartbeat counting task and subjective questionnaires (Multidimensional Assessment of Interoceptive Awareness [MAIA], Body Perception Questionnaire [BPQ]). Clinical symptom ratings (PANSS, HAM-A, HAM-D) and cognitive testing (TMT, animal fluency, DSST) are included. Multimodal MRI scanning will include structural T1-weighted imaging, resting-state fMRI, and diffusion tensor imaging.

The planned primary outcome is not reported. Secondary outcomes include interoceptive accuracy, subjective interoceptive awareness, intrinsic neural activity and connectivity within interoception-related circuits (anterior insula, anterior cingulate cortex, amygdala, thalamus), structural abnormalities within thalamo-cortical pathways, correlations between interoceptive deficits and symptom severity, and correlations between interoceptive deficits and cognitive performance. The study is cross-sectional with no follow-up.

No results are reported. The authors do not present pooled effect sizes or findings, as this is a protocol. Safety data, including adverse events, serious adverse events, discontinuations, and tolerability, are not reported. Funding and conflicts of interest are not reported. The authors note that this is a protocol for a cross-sectional study; no causal inferences can be drawn from the planned methods.

Practice relevance is not reported. The protocol outlines an approach to test hypotheses about interoception and neural circuitry in schizophrenia, but it does not provide evidence to guide clinical decision-making. The study may inform future research, but findings remain to be established.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedApr 2026

View Original Abstract ↓

BackgroundInteroception—the perception and integration of internal bodily signals—is fundamental to emotion regulation, bodily self-awareness, and predictive coding. Emerging evidence suggests that interoceptive disturbances may contribute to core psychopathological features of schizophrenia. Our research group recently conducted a systematic review and meta-analysis demonstrating significant impairments in interoceptive accuracy and sensitivity among individuals with schizophrenia. However, the neural mechanisms underlying these deficits remain unclear.MethodsThis cross-sectional protocol will recruit 30 individuals with schizophrenia and 30 age- and sex-matched healthy controls. Participants will complete (1) behavioral interoceptive assessment using the heartbeat counting task; (2) subjective interoceptive questionnaires, including the Multidimensional Assessment of Interoceptive Awareness (MAIA) and the Body Perception Questionnaire (BPQ); (3) clinical symptom ratings (PANSS, HAM-A, HAM-D); and (4) cognitive testing (TMT, animal fluency, DSST). All participants will undergo multimodal MRI scanning, including structural T1-weighted imaging, resting-state fMRI, and diffusion tensor imaging. Neuroimaging data will be preprocessed and analyzed using DPABISurf, SPM12, and GRETNA. Expected Results: We anticipate that individuals with schizophrenia will show reduced interoceptive accuracy, altered subjective interoceptive awareness, and abnormal intrinsic neural activity and connectivity within interoception-related circuits, including the anterior insula, anterior cingulate cortex, amygdala, and thalamus. Structural abnormalities within thalamo-cortical pathways are also expected. Interoceptive deficits are hypothesized to correlate with symptom severity and cognitive performance.ConclusionsThis study will provide an integrated characterization of interoceptive dysfunction and its neural correlates in schizophrenia. Findings may advance understanding of bodily self-disturbance and emotional dysregulation and support the development of future interoception-focused therapeutic approaches.Clinical trial registrationhttps://www.chictr.org.cn/, identifier ChiCTR2500110551.