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Anti-anxiety treatment hopes for autism

Training patients to tune into their own heartbeats may reduce symptoms

Mark Gould

Monday, 17 December 2018

Clinical trials are about to commence on pioneering therapy aimed at lowering anxiety by getting participants to tune into their own heartbeat. The treatment, known as interoception-directed therapy, is being tested on 120 autistic people, for whom anxiety is a common problem.

The trials follow many years of research by Professor Sarah Garfinkel, a psychologist at the University of Sussex, into the ways that interactions between the heart and the brain influence emotions and behaviour. The trials, funded by the mental health charity MQ: Transforming Mental Health, aims to turn these insights into a therapy.

Sophie Dix, the director of research at MQ, said: “This project has so much potential to inform treatments and further understanding of anxiety in autistic people. Research like this provides hope for better treatments for mental health kindled by our increased understanding of the link between the mind and the body.”

Professor Garfinkel says there is emerging evidence that interoception - the ability to tune into the activity of our internal organs - is linked to how well a person is able to identify their own emotional state and to empathise with others.

Garfinkel believes that altered interoception may be a factor in why autistic people experience the world differently. Her work has shown that autistic people tend to find it far harder to detect their own heartbeats – and the worse they are at this task, the greater their anxiety tends to be.

The 120 trial participants are being asked to complete eight training sessions over several weeks. During training, their heartbeat is tracked using a pulse oximeter and they are asked to “listen in” to their heart and count how many beats occur in a set time period. They are then given the correct answer and the exercise is repeated.

A pilot study involving participants without autism showed the training improved people’s interoceptive awareness and significantly reduced anxiety levels.

Garfinkel’s interest was sparked after reading a scientific paper on autism and empathy, “I found within this paper an almost buried graph showing that if you measure the bodily response of someone with autism to seeing someone in pain, it’s actually greater,” said Garfinkel.

“They have a heightened bodily response to the pain of others.”

This finding runs counter to the idea that autistic people “lack empathy”, she said.

“Early accounts of autism sometimes said they didn’t have empathy and for me that’s really not true at all,” she said.

However, autistic people can feel disconnected from their own emotions and struggle to assess what people around them are feeling.

“It made me wonder, if they’re having this very heightened bodily response, is there something altered about their interoception, their capacity to sense and use these signals?”

One hypothesis is that, in autistic people, empathetic responses are occurring at the brain’s fast, instinctive level, reflected by changes in heartbeat. However, the brain may be less adept at interpreting these signals and so having these constant unexplained increases in heart rate could potentially leave people feeling under threat, causing anxiety.

Garfinkel hopes the latest trial could provide further insights into whether the hypothesis, which is under active debate in the field, is correct. The participants will also have brain scans before and after training to look for any potential changes in a brain area called the insula, which picks up signals from the heart and is also involved in emotion.

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