The impact of cardiac perception on emotion experienceand cognitive performance under mental stress

Nicole K. Kindermann • Natalie S. Werner

Received: May 29, 2013 / Accepted: March 21, 2014

� Springer Science+Business Media New York 2014

Abstract Mental stress evokes several physiological

responses such as the acceleration of heart rate, increase of

electrodermal activity and the release of adrenaline.

Moreover, physiological stress responses interact with

emotional and behavioral stress responses. In the present

study we provide evidence that viscero-sensory feedback

from the heart (cardiac perception) is an important factor

modulating emotional and cognitive stress responses. In

our study, we compared participants with high versus low

cardiac perception using a computerized mental stress task,

in which they had to respond to rapidly presented visual

and acoustic stimuli. Additionally, we assessed physio-

logical responses (heart rate, skin conductance). Partici-

pants high in cardiac perception reported more negative

emotions and showed worse task performance under the

stressor than participants low in cardiac perception. These

results were not moderated by physiological responses. We

conclude that cardiac perception modulates stress respon-

ses by intensifying negative emotions and by impairing

cognitive performance.

Keywords Cardiac perception � Interoception �Mental stress � Emotion � Cognitive performance

Introduction

‘‘Faster, higher, further’’ is the slogan of the modern

achievement-oriented society. There are however heavy

costs that come with the benefits of such a mentality for

both the individual as well as for society as a whole. The

European Agency for Safety and Health at Work reports

that up to 40 million Europeans complain about stress at

work, which leads to costs of 20 billion Euros in both lost

time and health care (EU-OSHA, 2003). Among the costs

for the individual, stress is associated with an increased risk

for physiological and psychological disorders (Jones &

Bright, 2007). In particular the cardiovascular system has

become a crucial concern in this context. Chronic life

stressors can lead to more cardiovascular reactivity, which

over time may lead to the development of arteriosclerosis

(Low et al., 2009). In the current study we were interested

in the perception of cardiovascular responses as an influ-

encing factor on cognitive and emotional responses under

mental stress.

The ability to perceive cardiovascular responses is

referred to as cardiac perception. A variety of methods for

the quantification of cardiac perception have been devel-

oped. The two principal types are tracking and discrimi-

nation paradigms. In tracking paradigms, participants have

to press a button or tap a finger in time with the rhythm of

their heart rate (McFarland, 1975) or they are asked to

count their heartbeats (Carroll & Whellock, 1980; Dale &

Anderson, 1978; Schandry, 1981). In discrimination para-

digms, participants have to judge whether a series of

externally presented stimuli (e.g. tones) matches their heart

rate (Brener, 1974; Brener & Kluvitse, 1988; Katkin et al.,

1982; Whitehead et al., 1977). The ability to perceive

cardiac signals varies among individuals. Factors such as

gender, percentage of body fat and physical fitness are

suggested as influences upon cardiac perception (Cameron,

2001; Jones, 1994; Katkin, 1985; Schandry & Bestler,

1995; Vaitl, 1996). Accordingly, on average men perform

better in a cardiac perception test (Harver et al., 1994;

Katkin et al., 1981), which may be primarily due to their

N. K. Kindermann (&) � N. S. Werner

Department Psychologie, Ludwig-Maximilians-Universitaet,

Leopoldstr. 13, 80802 Munich, Germany

e-mail: Nicole.Kindermann@psy.lmu.de

123

J Behav Med

DOI 10.1007/s10865-014-9564-7

lower percentage of body fat (Rouse et al., 1988). Fur-

thermore, physically fit individuals achieve higher scores in

cardiac perception tests than unfit individuals (Jones &

Hollandsworth, 1981; Montgomery et al., 1984). It is

supposed that physical fitness results in an enlargement of

the left cardiac ventricle, which in turn leads to an

increased stroke volume. An increased stroke volume can

result in a stronger cardiac signal and thus a better per-

ception of heartbeats (see Schandry et al., 1993). Some

authors also consider increased autonomic reactivity to be

related to cardiac perception (Herbert et al., 2010; Pollatos

et al., 2007b, c). However, the evidence is inconsistent

(Eichler & Katkin, 1994; Hantas et al., 1982; Werner et al.,

2009a, b). Critchley et al. (2004) and Pollatos et al. (2007a)

identified neural structures associated with cardiac per-

ception: the insula, the somatomotor and anterior cingulate

cortex. In particular, better performance in a heartbeat

perception task was positively associated with enhanced

activity in the right insular cortex (Critchley et al., 2004).

To date research on cardiac perception has mainly

focused on emotional experience. Psychophysiological

theories of emotions have suggested that somatic processes

impact upon emotional experience (Bechara & Naqvi,

2004; Cacioppo et al., 1992; Damasio, 1994; James, 1884;

Thayer & Lane, 2000). William James (1884) was one of

the first who postulated that feedback from the body is

closely related to emotional experience. Damasio (1994)

extended this approach in his somatic marker hypothesis.

According to this theory, situational somatic processes,

called ‘somatic markers’, occur depending on the conse-

quences of an event, and evoke certain emotional pro-

cesses. In similar situations these somatic markers are

reactivated and guide emotional and behavioral responses.

In accordance with these theories, it has been repeatedly

shown that high cardiac perception is related to more

intense emotional experience (e.g. Barrett et al., 2004;

Hantas et al., 1982; Pollatos et al., 2005, 2007c, Schandry,

1981, 1983; Wiens et al., 2000).

Although stress can provoke strong emotional and phys-

iological responses, to date there are only a few studies

considering the relationship between cardiac perception and

stress. Eichler and Katkin (1994) demonstrated that partici-

pants high in cardiac perception compared to participants

low in cardiac perception showed greater left ventricular

contractility as well as greater shortening of pre-ejection

period during a mental arithmetic task. In a study of Herbert

et al. (2010), participants high in cardiac perception also

showed a greater shortening of pre-ejection period, a greater

left ventricular contractility as well as a greater increase in

mean heart rate when performing a mental arithmetic test.

The authors concluded that high cardiac perception is asso-

ciated with greater sympathetic reactivity in response to a

mental stressor. Two recent studies investigated the emo-

tional impact of cardiac perception in socially stressful sit-

uations. When confronted with a public speaking situation

participants high in cardiac perception reported significantly

less anxiety as compared to participants low in cardiac per-

ception (Werner et al., 2009a). Likewise when confronted

with a social exclusion situation, participants high in cardiac

perception showed a smaller increase in negative affect as

well as a smaller decrease of positive affect (Werner et al.,

2013). On the first view, these two studies seem to contradict

previous studies on emotion experience as participants high

in cardiac perception reported less intensive negative emo-

tions in the socially stressful situations. We assume however,

that everyday situations such as social exclusion or public

speaking are probably familiar to the participants and that

these situations reactivated somatic markers. Accordingly,

individuals high in cardiac perception, who have a better

access to somatic markers, were familiar with the physio-

logical arousal evoked and thus were able to deal with the

socially stressful situations more effectively. However, in

new and unfamiliar situations as in laboratory situations

somatic markers are not available and first have to be

established. Therefore, individuals with better access to

somatic processes may experience more arousal which in

turn may intensify emotions as proposed by physiological

emotion theories (Damasio, 1994; James, 1884).

According to the Competition of Cues Theory of

Pennebaker (1982) the elaboration of internal stimuli, such

as cardiovascular stimuli, may interfere with the simulta-

neous elaboration of external stimuli. Thus, Pennebaker

postulated that cognitive capacity is limited and that the

elaboration of internal stimuli shares the same cognitive

resources as the elaboration of external stimuli. For this

reason, internal and external stimuli compete for the same

limited cognitive resources and interference may occur if

attention is bonded by external or internal stimuli. As

individuals high in cardiac perception have better access to

their cardiovascular signals as compared to individuals low

in cardiac perception, these processes might interfere with

the elaboration of external stimuli.

In order to clarify the relation between cardiac percep-

tion and stress responses, we investigated whether and how

the perception of cardiac signals affects emotional expe-

rience and cognitive functioning under mental stress in the

current study. According to the data based on cardiac

perception and emotion experience we hypothesized that

individuals high in cardiac perception report more negative

emotions under mental stress compared to individuals low

in cardiac perception. With regard to cognitive perfor-

mance previous studies have shown enhanced decision

making, emotional memory and attention processes in

individuals with high cardiac perception (Matthias et al.,

2009; Pollatos & Schandry, 2008; Werner et al., 2009c,

2010). As however stress evokes strong somatic and

J Behav Med

123

emotional responses, which may interfere with cognitive

responses according to Pennebaker’s (1982) attention the-

ory, individuals more sensitive to somatic processes are

probably more distracted by the internal signals. Thus, we

hypothesized that individuals high in cardiac perception

show worse cognitive performance under stress compared

to individuals low in cardiac perception.

Methods

Participants

Fifty participants took part in the study (26 men, 24

women). The mean age was 23.92 years (SD = 3.01). All

participants had a university-entrance diploma. Forty-six

were university students and 4 were in the workforce. The

sample consisted of 25 participants with high cardiac per-

ception and 25 participants with low cardiac perception

(for assignment of participants to the two cardiac percep-

tion groups see next section). To be included, potential

participants had to be free of any history of cardiac or

cardiovascular diseases or any axis one disorders, as

defined by the Diagnostic and Statistical Manual of Mental

Disorders (DSM-IV, American Psychiatric Association,

1994). Additionally, participants included in the study did

not take any medication affecting the cardiac or respiratory

system. We screened participants’ health status using the

Stamm-Screening Questionnaire (SSQ, Wittchen &

Perkonig, 1996). All participants gave written informed

consent and received a financial remuneration of 12 €.

Assessment of cardiac perception

The participants were assigned to the high versus low

cardiac perception group according to their performance in

the heartbeat detection task (Schandry, 1981). In this task

participants were instructed to count their heartbeats

silently without taking their pulse or attempting any other

physical manipulations, which could facilitate the detection

of heartbeats. First, participants had to relax during a 5-min

rest period. Afterwards, three counting phases followed.

These lasted for 25, 35, and 45 s, which were separated by

rest periods of 30 s. Start and stop signals for counting

were given by the investigator. An individual heartbeat

perception score was calculated by relating the reported to

the actual heartbeats according to the following formula:

Heartbeat perception score ¼1=3

Xð1� ðjactual heartbeats � reported heartbeatsjÞ=

actual heartbeatsÞ

The heartbeat perception score ranges from 0 to 1.

Large differences between reported and actual heart-

beats result in low scores and indicate low cardiac

perception, whereas small differences between reported

and actual heartbeats result in high scores and indicate

high cardiac perception. In accordance with previous

studies, we used a cut-off score of .85 to assign par-

ticipants to the high versus low cardiac perception

group (e.g. Montoya et al., 1993; Pollatos et al., 2005;

Schandry et al., 1986).

In our study, the high cardiac perception group had

significantly higher heartbeat perception scores (M = 0.95,

SD = 0.04) as compared to the low cardiac perception

group (M = 0.67, SD = 0.12) [t(48) = 10.70, p \ .001].

The groups with high and low cardiac perception did not

differ regarding gender (per group 13 men and 12 women).

The groups did also not differ either in their mean age (high

cardiac perception: M = 24.12, SD = 2.83; low cardiac

perception: M = 23.72, SD = 3.22; t(48) = 0.47, p = .64)

or in their body mass index (high cardiac perception:

M = 22.13, SD = 2.29; low cardiac perception:

M = 22.42, SD = 2.50; t(48) = 0.42, p = .68). The dis-

tribution of participants according to graduation and pro-

fession was comparable: All participants had a university-

entrance diploma. In the high cardiac perception group, 22

participants were university students and three were in the

workforce. In the low cardiac perception group, 24 par-

ticipants were university students and one was in the

workforce. The groups did not differ significantly regard-

ing their profession (v2 = 3.58, p = .36).

Mental stress induction

In order to induce mental stress, participants had to conduct

the Determination Test (Vienna Testsystem, SCHUFRIED

GmbH, Modling, Austria). This test assesses the ability to

react under pressure. During the test, participants had to

respond simultaneously to visual stimuli (red, green, yel-

low, blue and white dots on a computer screen) and

acoustic signals (two tones of different pitches presented

via speakers) by pressing a button. The response panel

consisted of five colored buttons (red, green, yellow, blue

and white), each associated with the correspondingly col-

ored dot presented on the computer screen. There was also

one light grey button and one dark grey button. The former

had to be pressed when the high tone was presented, and

the latter had to be pressed when the low tone was pre-

sented. The stimuli were presented continuously and rap-

idly with fixed time limits. The stress test consisted of three

stress periods with different time limits (1,583, 948 and

1,078 ms).

J Behav Med

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Assessment of emotional experience and cognitive

performance

Emotional experience was assessed using the Multidi-

mensional Mood Questionnaire (Steyer et al., 1997). This

questionnaire consists of three bipolar dimensions that

describe the current emotional state of an individual: (1)

good versus bad mood, (2) wakefulness versus sleepiness

and (3) calmness versus restlessness. Participants had to

judge 24 adjectives on 5-point Likert scales (1 = definitely

not, 5 = very much). Low sum scores on the dimensions

indicate bad mood, wakefulness and restlessness. Cron-

bach’ s Alpha for the subscales is between .86 and .94

(Steyer et al., 1997).

Cognitive performance was assessed by several outcome

variables of the Determination Test: (1) the number of

correct reactions, (2) the number of incorrect reactions and

(3) the number of omitted reactions. In order to intensify

the participants’ stress experience, participants were

instructed to work as fast as possible and to make as few

mistakes as possible. Additionally, they were told that their

financial remuneration would depend on their test perfor-

mance.

Assessment of control variables

To control for the impact of third variable effects, we

additionally assessed trait anxiety, since this variable has

been associated with cardiac perception (Pollatos et al.,

2007a, b, 2009) and stress responses (Gonzalez-Bono et al.,

2002; Wilken et al., 2000). Trait anxiety was assessed with

the items for trait anxiety of the German adaptation of the

State-Trait-Anxiety Inventory (STAI, Laux et al., 1981).

The items describe how one feels in general and are

answered along 4-point Likert scales (1 = almost never,

4 = almost always).

Furthermore, we assessed performance motivation in

order to ensure that differences in emotional experience

during stress periods were not affected by current effort.

Performance motivation was controlled with two items,

which participants had to judge on 10-point Likert scales

(0 = not at all, 9 = very much). First, participants

answered how important it was for them to perform well on

the Determination Test (performance motivation) and

second, how important it was for them to win a lot of

money (financial motivation).

As fitness can also affect physiological processes (e.g.

Forcier et al., 2006), we asked the participants to answer

two items, which assessed how much exercise they do (in

minutes per week) and what kind of exercise they do

(power and/or endurance training).

Procedure

Upon arrival at the laboratory, participants were given

written information about the experiment and informed

consent was obtained. Thereafter, they were seated on a

chair and were fitted with electrodes to measure heart rate

and skin conductance. The experiment began with a 10-min

rest period, followed by the heartbeat perception task.

Subsequently, the Determination Test was carried out,

beginning with a short practice period to ensure compre-

hension of the task. The Determination Test lasted for

8 min. The Multidimensional Mood Questionnaire was

completed immediately after the rest period and the

Determination Test. Questionnaires assessing the control

variables were completed at the end of the Determination

Test.

Physiological recording

Heart rate and mean skin conductance level were assessed

during the rest and the stress periods using the Biopac MP

150 (Biopac Systems, Inc., Goleta, CA). An electrocar-

diogram (ECG) was recorded with nonpolarizable Ag–

AgCl electrodes, which were attached to the right mid

clavicle and lower left rib cage. ECG activity was digitized

at a sampling rate of 500 Hz. R-waves were detected

automatically and converted into heart rate. For skin con-

ductance recording, electrodes filled with an isotonic gel

were attached to the thenar and hypothenar of the non-

dominant hand. Skin conductance was sampled at 250 Hz.

Mean heart rate and mean skin conductance level were

analyzed using the software Biopac AcqKnowledge 3.9.1

(BIOPAC Systems, Inc., Goleta, CA) for the rest period

and the stress period.

Data analysis

Differences between the cardiac perception groups in

emotional experience, heart rate and skin conductance

level were assessed using repeated measurement ANOVAS

with experimental condition (rest period vs. stress period)

as within-subject factor and cardiac perception group (high

vs. low cardiac perception) as between-subject factor.

Degrees of freedom were adjusted according to Green-

house and Geisser where appropriate. We carried out fol-

low-up contrasts for differences between cardiac

perception groups.

As the variables of cognitive performance were not

normally distributed and in order to compare the three

cognitive parameters, we z-standardized (1) the number of

correct reactions, (2) the number of incorrect reactions and

(3) the number of omitted reactions. We used the z-values

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123

to indicate differences between participants high and low in

cardiac perceptions regarding cognitive performance using

a MANOVA procedure.

Pearson correlation coefficients were calculated for the

relation between the heartbeat perception score and the

mean of negative emotions as well as the three z-stan-

dardized cognitive performance parameters (correct reac-

tions, incorrect reaction, omitted reactions).

Furthermore, we used t tests to indicate group differ-

ences in trait anxiety, performance motivation, financial

motivation and the time per week the participants spend

exercising. Pearson’s Chi square test was conducted in

order to analyze differences between participants high and

low in cardiac perception with respect to current exercise

activity (power and/or endurance training).

Results

Emotional experience

The repeated measurement ANOVA for the dimension good

versus bad mood revealed a significant main effect of

experimental condition [F(1, 48) = 91.49, p \ .001,

gp2 = .66] with a lower good mood score during the stress

period compared to the rest period. The main effect of

cardiac perception group on the dimension good versus bad

mood was not significant [F(1, 48) = 2.72, p = .11,

gp2 = .05]. But there was a significant interaction effect

between experimental condition and cardiac perception

group [F(1, 48) = 4.44, p = .04, gp2 = .09]. While the

groups did not differ during the rest period (high cardiac

perception: M = 35.11, SD = 3.43; low cardiac percep-

tion: M = 35.38, SD = 1.84; t(48) = 0.35, p = .73), par-

ticipants high in cardiac perception showed a lower good

mood score (M = 27.92, SD = 5.92) as compared to par-

ticipants low in cardiac perception (M = 30.79, SD = 3.74)

during the stress period [t(48) = 2.05, p = .047] (see

Fig. 1).

For the dimension wakefulness versus sleepiness, the

repeated measurement ANOVA did not reveal a main

effect of experimental condition [F(1, 48) = 0.52, p = .47,

gp2 = .01] nor did it show a main effect of cardiac per-

ception group [F(1, 48) = 0.04, p = .84, gp2 \ .01].

Finally, there was no interaction effect between experi-

mental condition and cardiac perception group [F(1,

48) = 0.32, p = .58, gp2 \ .01].

The repeated measurement ANOVA for the dimension

calmness versus restlessness revealed a significant main

effect of experimental condition [F(1, 48) = 306.00,

p \ .001, gp2 = .86] with a lower calmness score during

the stress period (M = 20.31, SD = 5.67) compared to the

rest period (M = 35.88, SD = 2.65). There was no main

effect of cardiac perception group [F(1, 48) = 0.46,

p = .50, gp2 \ .01], nor was there any interaction effect

between experimental condition and cardiac perception

group [F(1, 48) \ 0.01, p = .97, gp2 \ .001].

Cognitive performance

The MANOVA revealed no group differences regarding

the number of correct reactions [F(1, 48) = 0.25, p = .62,

gp2 = .01]. However, there was a significant difference

between participants high in cardiac perception and par-

ticipants low in cardiac perception regarding the number of

incorrect reactions [F(1, 48) = 12.59, p = .001,

gp2 = .21], with participants high in cardiac perception

showing more incorrect reactions than participants low in

cardiac perception. There was also a significant difference

Rest period Stress period0

10

20

30

40Good mood score

sum

sco

re

*

Rest period Stress period0

10

20

30

40Calmness score

sum

sco

re

Rest period Stress period0

10

20

30

40Wakefulness score

High cardiac perception Low cardiac perceptionsu

m s

core

High cardiac perception Low cardiac perception

High cardiac perception Low cardiac perception

Fig. 1 Mean values of emotional experience of participants high

versus low in cardiac perception during the rest period and the stress

period

J Behav Med

123

regarding the number of omitted reactions [F(1,

48) = 4.65, p = .04, gp2 = .09], with participants high in

cardiac perception showing less omitted reactions than

participants low in cardiac perception (see Fig. 2). To

analyze whether participants high and low in cardiac per-

ception differed in their sum errors, we calculated an error-

score by subtracting the z-standardized number of omitted

reactions from the z-standardized number of incorrect

reaction. Participants high in cardiac perception

(M = 0.75, SD = 1.12) showed significantly more errors

in the Determination Test than participants low in cardiac

perception (M = -0.74, SD = 1.36) (t (48) = 4.25,

p \ .001).

Relationship between cardiac perception and emotion

experience and cognitive performance

With regard to emotion experience, correlation analyses

revealed that cardiac perception correlated by trend nega-

tively with the dimension good versus bad mood for the

stress period (r = -.26, p = .07). However, there was no

significant correlation between cardiac perception and the

dimension wakefulness versus sleepiness (r = -.09,

p = .56) or the dimension calmness versus restlessness

(r = .01, p = .97) for the stress period. There was also no

significant correlation between cardiac perception and the

three emotional dimensions during the rest period (all rs

\.17, all ps [.23).

With regard to cognitive performance, correlation

analyses revealed that cardiac perception correlated posi-

tively with the number of incorrect reactions (r = .43,

p \ .01). However, there were no significant correlation

between cardiac perception and the number of correct

reactions (r = -.01, p = .97) or the number of omitted

reactions (r = -.23, p = .11).1

Impact of emotional experience on cognitive

performance

In order to clarify the impact of emotional experience and

cardiac perception on cognitive performance, a regression

analysis was computed with the good mood score during

rest and stress as well as the heartbeat perception score as

predictor variables and the error-index as the dependent

variable. Only the heartbeat perception score entered the

model as a significant predictor (R2 = .26; heartbeat per-

ception score: beta = .42, p = .003; good mood score

during rest: beta = .23, p = .13; good mood score during

stress: beta = -.21, p = .17). Multicollinearity did not

bias the model (heartbeat perception score: toler-

ance = .93, VIF = 1.08; good mood score during

rest = .77 VIF = 1.30; good mood score during stress:

tolerance = .72, VIF = 1.39).

Physiological response

Regarding mean heart rate, a repeated measurement

ANOVA revealed a significant main effect of experimental

condition [F(1, 45) = 71.91, p \ .001, gp2 = .62] with

higher heart rates during the stress period (M = 82.84,

SD = 11.08) than during the rest period (M = 73.87,

SD = 10.48). Participants high in cardiac perception did

High cardiac perception Low cardiac perception300

350

400

450

500

550

600Number of correct reactions

Mea

n nu

mbe

r

High cardiac perception Low cardiac perception0

2

4

6

8

10Number of incorrect reactions

Mea

n nu

mbe

r **

High cardiac perception Low cardiac perception0

2

4

6

8

10Number of omitted reactions

Mea

n nu

mbe

r

*

Fig. 2 Cognitive performance of participants high versus low in

cardiac perception during the stress period

1 Additionally we conducted correlation analyses between heart rate

and skin conductance level under stress and emotional experience as

well as cognitive performance. There was neither a significant cor-

relation between heart rate under stress and emotional experience (all

rs\.23, all ps[.12) nor between skin conductance level under stress

and emotional experience (all rs\.17, all ps[.24). There was also no

significant correlation between skin conductance level under stress

and cognitive performance (all rs \.12, all ps [.42). Only the cor-

relation between heart rate under stress and correct reactions (r =

-.29, p \ .05) as well as heart rate under stress and omitted reactions

(r = .29, p = .05) reached significance.

J Behav Med

123

not differ from participants low in cardiac perception

during the rest period (high: M = 73.63, SD = 13.86 vs.

low: 74.11, SD = 5.33) nor during the stress period (high:

M = 80.78, SD = 13.95 vs. low: 84.98, SD = 6.62; [F(1,

45) = 0.62, p = .43, gp2 = .02]. There was no significant

interaction between experimental condition and cardiac

perception group [F(1, 45) = 3.06, p = .09, gp2 = .06].

Regarding skin conductance level, the repeated mea-

surement ANOVA also revealed a significant main effect

of experimental condition [F(1, 48) = 192.75, p \ .001,

gp2 = .80], with higher skin conductance levels during the

stress period (M = 6.33, SD = 2.50) than during the rest

period (M = 3.33, SD = 2.37). Participants high in cardiac

perception did not differ in skin conductance level from

participants low in cardiac perception during the rest period

(high cardiac perception: M = 3.42, SD = 2.54 vs. low

cardiac perception: M = 3.25, SD = 2.23) nor during the

stress period (high cardiac perception: M = 6.08,

SD = 2.49 vs. low cardiac perception: M = 6.59,

SD = 2.54; F(1, 48) = 0.06, p = .80, gp2 \ .01). There

was no significant interaction between experimental con-

dition and cardiac perception group in skin conductance

level [F(1, 48) = 2.41, p = .13, gp2 = .05].

Control variables

Participants high and low in cardiac perception did not

differ with respect to trait anxiety (high cardiac perception:

M = 35.28, SD = 8.53 vs. low cardiac perception:

M = 32.92, SD = 5.76, t(48) = 1.15, p = .26), perfor-

mance motivation (high cardiac perception: M = 8.54,

SD = 0.66 vs. low cardiac perception: M = 8.40,

SD = 0.82, t(48) = 0.67, p = .51), financial motivation

(high cardiac perception: M = 6.67, SD = 2.14 vs. low

cardiac perception: M = 6.60, SD = 2.40, t(48) = 0.10,

p = .92) or the amount time per week they spent exercising

(high cardiac perception: M = 175.55 min, SD =

132.30 min vs. low cardiac perception: M = 200.22 min,

SD = 119.42 min, t(48) = 0.69, p = .49). They also did

not differ with respect to their frequency distribution

regarding power training (v2 = 3.00, p = .15) and endur-

ance training (v2 = 1.56, p = .32).

Discussion

Our study aimed at investigating whether and how cardiac

perception affects emotional experience and cognitive

performance during mental stress. In accordance with our

hypotheses, we found that participants high in cardiac

perception reported worse mood during mental stress and

made more reaction errors than participants low in cardiac

perception. Cognitive performance deterioration during

mental stress was not explained by worse mood but by

cardiac perception. The results were not moderated by

physiological responses, as the cardiac perception groups

did not differ in their heart rate or skin conductance level

during the rest and the stress period.

We see our finding on emotional experience in line with

emotion theories, which emphasize the importance of

somatic feedback for emotional processes (Bechara &

Naqvi, 2004; Cacioppo et al., 1992; Damasio, 1994; James,

1884; Thayer & Lane, 2000). According to James (1884)

and Damasio (1994), somatovisceral feedback is essential

for emotional experience. Accordingly, we assume that

individuals high in cardiac perception experience the

increase in heart rate during mental stress to a stronger

degree, which affects emotional experience. The result is

also in line with previous studies reporting stronger emo-

tional experience in individuals high in cardiac perception

compared to individuals low in cardiac perception (e.g.

Hantas et al., 1982; Pollatos et al., 2007a, c, 2005; Sch-

andry, 1981, 1983; Wiens et al., 2000). Moreover, our data

extend previous findings on cardiac perception and emo-

tional experience by demonstrating that individuals high in

cardiac perception report more negative emotions under

mental stress. This substantiates our earlier study where we

were able to demonstrate that individuals high in cardiac

perception reported more negative emotions during a

mental arithmetic task than individuals low in cardiac

perception (Kindermann & Werner, accepted). In the

present study we were able to replicate this finding by

using a different method for stress induction. We did not

however find differences between the groups on the mood

dimensions wakefulness versus sleepiness and calmness

versus restlessness for the stress period. As these latter

dimensions describe more general bodily states than spe-

cific emotional experience, it seems plausible that both

groups had a similar level of arousal during the mental

stress task. Furthermore, the items of these dimensions

describe general somatic symptoms such as e.g. ‘‘fresh’’ or

‘‘exhausted’’ and thus do not relate directly to cardiovas-

cular signals, which might affect individuals high in car-

diac perception to a stronger degree.

Our data also indicate that mental stress does not only

affect emotional responses in high cardiac perception but

also impairs cognitive performance. In the current study,

individuals high in cardiac perception showed more

incorrect reactions as well as a higher error-index in the

mental stress test than individuals low in cardiac percep-

tion. Incorrect reactions represent difficulty in inhibiting

irrelevant responses and hint at impairment in attention in

the Determination Test (Neuwirth & Benesch, 2007). As

cognitive performance was not related to mood but to

cardiac perception in our study, cognitive impairment does

J Behav Med

123

not seem to result from stronger emotional disturbances

during mental stress. Thus, we assume that the decreased

cognitive performance in high cardiac perception may be

explained by directing attention to cardiac signals, which

might interfere with directing attention to the task. We see

this in accordance with Pennebaker’ s (1982) Competition

of Cues Theory, which states that external and internal

stimuli share the same limited cognitive resources. Thus,

interference may occur if internal stimuli and external

stimuli compete for the same cognitive resources.

Accordingly, we assume that participants high in cardiac

perception had less cognitive resources for the Determi-

nation Test, because their better perception of internal

stimuli competed with the elaboration of external stimuli.

As a result, participants high in cardiac perception were

less accurate in the elaboration of external stimuli, which in

turn could have led to more errors. This reasoning is also in

line with a recent study demonstrating that individuals high

in cardiac perception show attention interference for

emotional words in an emotional Stroop task compared to

individuals low in cardiac perception (Werner et al., 2014).

At first glance, our results on cognitive functioning seem

to contradict studies showing a better cognitive functioning

for high cardiac perception as compared to low cardiac

perception. Former studies have shown benefits in decision

making, emotional memory and attention processes in high

cardiac perception (Matthias et al., 2009; Werner et al.,

2009c, 2010). However, these former studies investigated

the relationship between cardiac perception and cognitive

functioning under non-stress conditions. Regarding a

stressful condition, our study showed a negative effect of

cardiac perception on cognitive functioning. We assume

that, in stressful situations the resulting physiological

arousal is more distracting and requires more cognitive

resources for individuals more sensitive to interoceptive

processes and thus, leads to cognitive impairment.

Relating to the physiological variables, our results do

not show differences between individuals high and low in

cardiac perception. Nonetheless, both groups showed an

increase in heart rate and skin conductance level in the

stress condition, indicating that the Determination Test was

experienced as challenging. We reason that differences in

emotional experience or cognitive performance under

stress are not due to a stronger physiological arousal under

stress in participants high in cardiac perception as com-

pared to participants low in cardiac perception. Instead, we

hold that these differences are due to a better perception of

somatovisceral feedback in participants high in cardiac

perception. This is in line with previous studies showing no

differences in heart rate or skin conductance between

participants high and low in cardiac perception (Eichler &

Katkin, 1994; Hantas et al., 1982; Werner et al., 2009a, b;

Wiens et al., 2000). As we however did not assess car-

diodynamic measures we cannot rule out the possibility

that differences in cardiodynamic mechanisms could

account for the differences in cognitive performance under

stress with regard to cardiac perception. Previous studies

have shown that high cardiac perception is related to

increased contractility of the heart (Herbert et al., 2010;

Schandry et al., 1993). Thus increases in cardiac contrac-

tility under stress may be perceived by individuals high in

cardiac perception and impair cognitive processes.

Our study suggests that individuals high in cardiac

perception may be especially at risk of developing stress-

related diseases as they show a more pronounced emotional

vulnerability to stress and their cognitive performance is

more impaired under stress. This matches well with early

studies on cardiac perception and anxiety where cardiac

perception has been assumed to be of particular importance

for the etiology and the maintenance of anxiety and anxiety

disorders (cf. Domschke et al., 2010; Ehlers & Breuer,

1996). For instance, research has shown that patients with

panic disorder display a more accurate cardiac perception

than do healthy controls (Ehlers & Breuer, 1992; Eley

et al., 2004; Van der Does et al., 2010). However, there are

also studies suggesting a positive effect of cardiac per-

ception on emotion regulation (e.g. Werner et al., 2013)

and cognitive performance (Matthias et al., 2009; Werner

et al., 2009a, b, c, 2010). Therefore it seems that a tripartite

model of cardiac perception may explain the relation

between cardiac perception and emotional responses best.

Accordingly, low levels of cardiac perception are accom-

panied by less emotional stress responses, high cardiac

perception by dysfunctional emotional stress responses and

middle cardiac perception by average emotional stress

responses. Dunn et al. (2010) already distinguished three

groups of cardiac perception (average, better and worse)

and showed that bodily signals affected decision-making

more in high cardiac perception than in low cardiac per-

ception.

Finally, some limitations of the study have to be con-

sidered. The stress induced in the study was quite moder-

ate, as ratings of the emotional experience indicate.

Nevertheless, there were significant increases in heart rate

and skin conductance level from the rest period to the stress

period. However, it is necessary to analyze the relationship

between cardiac perception, performance and emotional

experience in more distressing situations in order to gen-

eralize the present findings. In this context, it would be

interesting to investigate whether cardiac perception

moderates emotional experience and performance in a

sample of participants having been exposed to severe

stressful events, like patients with burnout or posttraumatic

stress disorder. Furthermore, it would be interesting to

investigate the relationship between cardiac perception and

cardiovascular diseases, as these diseases are strongly

J Behav Med

123

related to chronic stress experiences. This could provide

new insights into the etiology and therapy of this disorder.

Another limitation concerns the artificial stressor that we

used in our study. To determine the relevance of our results

for daily life, it is necessary to analyze the impact on

cardiac perception on cognitive performance and emotions

under a natural stressor, such as examination stress.

In summary, our study showed a moderating effect of

cardiac perception on emotional experience and cognitive

performance in response to a stressor. Our results indicate

that cardiac perception processes affect stress processes.

Therefore, cardiac perception should be taken into con-

sideration as a further factor explaining variance in the

individual stress response.

Conflict of interest Authors Nicole K. Kindermann and Natalie S.

Werner declare that they have no conflict of interest.

Animal and Human Rights and Informed Consent All proce-

dures followed were in accordance with ethical standards of the

responsible committee on human experimentation (institutional and

national) and with the Helsinki Declaration of 1975, as revised in

2000. Informed consent was obtained from all patients for being

included in the study.

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