Interoceptive aberrations in major depressive disorder: Neural mechanisms, clinical correlates, and targeted interventions

Table 2 Evidence for interventions with potential relevance to interoceptive dysfunction in major depressive disorder

Intervention	Evidence base	Key findings	Evidence appraisal	Ref.
Cardiac-musical synchronization	Single-session study in 24 healthy adults	Improved cardiac interoceptive performance; lower HR and negative affect; higher HRV	Small healthy sample; indirect relevance to MDD	[60]
Aerobic exercise	RCT in inactive young adults without MDD	Improved HCT performance and confidence; reduced depressive/anxiety symptoms	Nonclinical sample; HCT-based outcome	[59]
Osteopathic manipulative treatment	Pilot and sham-controlled studies; RCT protocol in chronic low back pain	Improved body awareness/heartbeat tracking; altered interoceptive-region activity	Direct interoceptive evidence outside MDD; depression evidence preliminary	[61,62,67]
Functional electrical stimulation	Uncontrolled pilot in 10 patients with MDD	Reduced depressive symptoms; interoception not assessed	Feasibility evidence in MDD; mechanism untested	[63]
Mindfulness-based interventions	Clinical and controlled studies in depression/anxiety or nonclinical samples	Changes in anterior insula activity and selected MAIA dimensions	Heterogeneous evidence; mainly neural/self-report outcomes	[57,58,64]
Deep brain stimulation	Small mechanistic/longitudinal studies in treatment-resistant MDD	Altered limbic/insula connectivity; HEP increase linked to faster response	Direct neural evidence; very small samples; no performance-based IAc	[65,66]

HCT: Heartbeat counting task; HEP: Heartbeat-evoked potential; HR: Heart rate; HRV: Heart rate variability; IAc: Interoceptive accuracy; MAIA: Multidimensional Assessment of Interoceptive Awareness; MDD: Major depressive disorder; RCT: Randomized controlled trial.