Interoceptive accuracy and cognitive reappraisal modulate affective and physiological reactivity to social stress

Background: Accurate detection of bodily signals may facilitate spontaneous emotion regulation (ER) outcomes, when effective ER strategies are available. We tested whether interoceptive accuracy (IAcc) and Cognitive Reappraisal jointly predict affective and physiological responses to social stress. Methods: A total of 83 participants underwent a modified version of the Trier Social Stress Test (mTSST). IAcc was measured with the heartbeat counting task and Cognitive Reappraisal was measured with the Emotion Regulation Questionnaire (ERQ). State anxiety, heart rate (HR), and skin conductance level (SCL) were recorded. Results: The mTSST increased HR, SCL, and state anxiety. Changes in state anxiety were predicted by an interaction of IAcc × Cognitive Reappraisal: among individuals with lower habitual use of Cognitive Reappraisal, higher IAcc was associated with a stronger increase in state anxiety, whereas at average or higher levels of reappraisal, IAcc was not reliably related to changes in state anxiety. Further, higher IAcc was associated with a smaller increase in HR during the mTSST. Changes in SCL were not related to IAcc, Cognitive Reappraisal, nor their interaction. Discussion: Higher IAcc could increase the salience of bodily arousal during social stress, potentially leading to greater distress when habitual use of Cognitive Reappraisal is below average. From a predictive coding perspective, this pattern could reflect unresolved high-precision prediction errors that amplify negative affect. In addition, the negative association between IAcc and HR reactivity during social stress may indicate an autonomic counter-regulatory process buffering against excessive cardiac stress responses. • Interoceptive accuracy (IAcc) might support emotion regulation (ER) outcomes • However, this should only be the case if appropriate ER strategies are available • Accordingly, IAcc amplified distress after social stress when reappraisal was low • Whereas, higher IAcc was associated with smaller increases in heart rate • Findings delineate when high interoceptive precision becomes maladaptive