From Symptoms to Cardiac Perception: Interpretive Bias in Heartbeat Perception Among Generalized Anxiety Disorder

Patients with generalized anxiety disorder (GAD) frequently report distressing palpitations, yet it remains unclear whether this reflects enhanced cardiac perception or interpretive processes. This study compared 40 GAD patients and 38 matched healthy controls on the Heartbeat Tracking Task (HTT) assessing interoceptive accuracy (HPS), and the Cardiovascular Signal Detection Task (CVSDT) measuring perceptual sensitivity (d′) and response bias (β). Self-report questionnaires assessed interoceptive sensibility and anxiety. No significant group differences were found in HPS or d′; Bayesian analyses provided anecdotal-to-moderate evidence favoring the null hypothesis. However, GAD patients reported heightened interoceptive sensibility with greater attention to bodily sensations and lower trust. An exploratory Group × Somatic Anxiety interaction emerged for HPS: in GAD, somatic anxiety correlated positively with HPS and negatively with β, indicating a relatively more liberal response bias; the opposite pattern was observed in controls. Findings suggest GAD is not characterized by enhanced cardiac perception. Rather, palpitation experiences reflect a dissociation between normal accuracy and negative subjective sensibility, with somatic anxiety associated with a shift in response bias, a pattern consistent with predictive coding accounts. Clinically, these preliminary findings suggest that targeting cognitive-interpretive processes rather than perceptual accuracy may be indicated.