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Multimodal MRI Protocol to Study Interoception in SchizophreniaHow Schizophrenia Changes the Body’s Inner Signals

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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.

Why the Body’s Inner Voice Matters in Schizophrenia

Imagine feeling your heart race but not knowing why. Or feeling disconnected from your own body, like you’re watching yourself from the outside. For many people with schizophrenia, this is a daily reality.

Schizophrenia is often thought of as a disorder of the mind. But new research suggests it’s also a disorder of the body’s internal signals.

This study explores a concept called interoception—your brain’s ability to sense and interpret signals from inside your body, like hunger, heartbeat, or breath. When this system breaks down, it can lead to emotional confusion and a lost sense of self.

What Is Interoception, and Why Does It Matter?

Interoception is like your body’s internal messaging system. It tells your brain when you’re cold, full, or anxious. It helps you understand your emotions and connect with the world around you.

For people with schizophrenia, this system may be disrupted. They might struggle to feel their heartbeat or understand what their body is telling them. This can make emotions feel confusing or overwhelming.

Current treatments focus on hallucinations and delusions. But they often miss the emotional and bodily struggles that make daily life so hard.

A New Way to Look at Schizophrenia

Researchers used to focus mainly on the brain’s thinking circuits. But this study looks at the body’s role in schizophrenia.

The old way saw schizophrenia as a “brain-only” problem. The new way sees it as a whole-body issue. This shift could change how we understand and treat the condition.

How the Brain and Body Connect

Think of the brain and body like a two-way radio. The brain sends commands, but it also listens to the body’s signals. In schizophrenia, this radio might be tuned to the wrong frequency.

The study focuses on key brain areas that process body signals:

  • The insula, which helps you feel your heartbeat.
  • The cingulate cortex, which links body signals to emotions.
  • The thalamus, which acts as a relay station for body information.

If these areas aren’t working together, it could explain why people with schizophrenia feel disconnected from their bodies.

The Study at a Glance

This study will include 30 people with schizophrenia and 30 healthy adults. They’ll complete tasks to measure how well they sense their heartbeat and fill out questionnaires about their body awareness.

They’ll also undergo MRI scans to look at brain structure and activity. The goal is to see how body signals and brain circuits connect in schizophrenia.

What Researchers Expect to Find

The team expects to find that people with schizophrenia have trouble sensing their heartbeat and understanding their body’s signals. They also expect to see differences in brain areas that process body information.

These differences may link to how severe their symptoms are and how well they think and function in daily life.

Here’s the Catch

This is a protocol paper, meaning it outlines the study plan. The actual results aren’t ready yet. The study is ongoing, and findings will be published later.

This research could help bridge the gap between the mind and body in schizophrenia. By understanding how body signals go wrong, doctors might develop new therapies that target interoception.

For example, mindfulness or biofeedback could help people with schizophrenia reconnect with their bodies and regulate their emotions.

This study is still in progress. It’s too early to change treatment plans. But it highlights an important area of research that could lead to better care in the future.

If you or a loved one has schizophrenia, talk to your doctor about how body awareness might play a role in symptoms.

This study is small and focuses on a specific group of people. It’s also a protocol, so the results aren’t final. More research is needed to confirm these findings.

The study is registered and underway. Results are expected in the coming months. If the findings are promising, they could pave the way for larger trials and new treatments focused on interoception.

This is just the beginning of understanding how the body and mind connect in schizophrenia.

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.
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