Author Response
interoceptive sensations, ’
CORTEX
Dear Professor Glasper,Thank you for your efforts in reviewing our manuscript entitled “Interoceptive Awareness of the Breath Preserves Dorsal Attention Network Activity amidst Widespread Cortical Deactivation: A Within-Participant Neuroimaging Study“, submitted for consideration in eNeuro.We appreciate your supportive synthesis of the paper, reviews, and response to reviews. We are grateful to the reviewers for their suggestions, which we believe have helped us to substantially improve the paper. We respond to each of the comments below.Overall Comments. The authors are encouraged to reduce, or remove, the many leading statements within the manuscript. Please see the following as examples and consider phrasing that mentions an association between 2 variables:1. Abstract - ‘attention towards...may lead to a low activity, high connectivity state’We have replaced this general statement with more specific language: “attention towards accessible body sensations such as the breath may lead to greater ACC-Dorsal Attention Network connectivity state in a context of widespread cortical deactivation.”2. Discussion - ‘Interoception led to increased connectivity in the frontoparietal dorsal attention network’We clarify that “Breath interoception led to increased connectivity between the ACC and the frontoparietal dorsal attention network”.Remaining ConcernsStatistics1. It is unclear why the authors used a global MAIA score instead of conducting analyses on the validates subscales. If a multiple comparison issue is of concern, this analysis could be included in the supplemental material to highlight “whether the observed brain-behavior relationships could be further refined”.We appreciate the suggestion to delve deeper than a blanket ‘sensibility’ description of the MAIA, and the reviewer is correct that we shouldn’t equivocate- we have revised the description of MAIA to be an assessment of subjective interoceptive awareness and attention tendency throughout the manuscript.We also agree that greater specificity of our findings could be supported by reviewing the interoceptive subscales. We initially created a second supplement to the paper (“Supplementary MAIA Analyses”), but learned that eNeuro does not allow supplemental materials, so we have placed extensive analyses within a document on the Open Science Framework for your reference (https://osf.io/d3uzw), with the highlights of these analyses added to the manuscript text.The supplement reviews the creation of the MAIA and its conceptual and empirical subfactors, and explains why we chose to use the single total score given limitations with the original version of the MAIA that was available at the time of data acquisition. We support this decision via exploratory factor analysis of the observed data, showing an optimal single-factor solution, and also that many of the subfactors show similar correlations with anterior cingulate cortex (ACC) region of interest (ROI).We did take to heart the need to go deeper than a blanket total score; we therefore explored each of the eight MAIA subfactors at both the TFCE familywise-error corrected and a more liberal threshold (p<.005, k{greater than or equal to}200), we now attach figures of these analyses as extended data to the MAIA analysis figure (The reviewer was correct that these analyses show more directly how whole-brain covariates might be supported by the subscales. The MAIA total score covariate map is similar to reduced- threshold maps for the subfactors of Emotion Awareness, Self-Regulation, Body Listening, and to a lesser extant Attention Regulation and Noticing. These whole brain analyses suggest a particular role of the “Mind-Body Integration” conceptual domain in supporting the covariation effect. Intriguingly, Attention Regulation implicated only the ACC component of the total score map, whereas Noticing implicated only language regions. By contrast the Not Distracting, Not Worrying, Trusting, and Noticing subfactors show little of this covariation effect, suggesting that self-reported integration/use of interoceptive information may be driving the total score finding. We make note of these ideas in the revised discussion section.2. 22 participants in a small N size, and not a ‘relatively small’ N like the author’s state. This should be explicitly emphasized in the revised manuscript and the authors should state that replication is needed given this small N.We appreciate the need to be clear about small sample size and have removed the word ‘relatively’ from the sentence, which now reads “We present unexpected and exploratory findings from a small sample; replication is therefore needed, especially given the paucity of studies in this area.” (p.32)Discussion1. It is suggested that the authors reconsider the “notion of MAIA scores simply as a measure of ‘interoceptive sensibility’ in the discussion”. The authors should focus on the most relevant subscale processes.We agree that the subscales add nuance, and also that ‘sensibility’ may not be the appropriate term for what the MAIA measures- we have revised the manuscript to emphasize ‘attention tendency’ rather than ‘sensibility’ per se, which seems to be a narrower term focusing on appraisal. As noted above, the suggested subscale analyses provide supporting evidence that these effects are driven primarily by the integration subscales (Emotion Awareness, Self-Regulation, and Body Listening), and we now dedicate a paragraph of the results and discussion to reviewing these findings, in addition to a more lengthy discussion of these findings in the MAIA Analysis Supplement found on the Open Science Framework (https://osf.io/d3uzw) as eNeuro will not allow supplemental materials beyond additional tables and figures.2. It is suggested that the authors reduce, or narrow, the respiratory interoceptive network inferences. The full extent to which these findings may apply to other interoceptive sensations was not studied.This suggestion is well-received given the multimodal nature of interoception. We have revised the manuscript language to be more specific about respiratory interoception / attention to the breath rather than implying that the findings generalize to interoception more broadly.We are grateful for the opportunity to improve our work and hope that the revisions satisfy the constructive suggestions offered by the editor and reviewers.Thank you for time and consideration. We look forward to your feedback!Best regards,