title: Enhanced cardiac perception predicts impaired performance in the Iowa Gambling Task in patients with panic disorder.
abstract: OBJECTIVE
  Somatic marker theory predicts that somatic cues serve intuitive decision making; however, cardiovascular symptoms are threat cues for patients with panic disorder (PD). Therefore, enhanced cardiac perception may aid intuitive decision making only in healthy individuals, but impair intuitive decision making in PD patients.
  
  
  METHODS
  PD patients and age-and sex-matched volunteers without a psychiatric diagnosis (n = 17, respectively) completed the Iowa Gambling Task (IGT) as a measure of intuitive decision making. Interindividual differences in cardiac perception were assessed with a common mental-tracking task.
  
  
  RESULTS
  In line with our hypothesis, we found a pattern of opposing associations (Fisher's Z = 1.78, P = 0.04) of high cardiac perception with improved IGT-performance in matched control-participants (r = 0.36, n = 14) but impaired IGT-performance in PD patients (r = -0.38, n = 13).
  
  
  CONCLUSIONS
  Interoceptive skills, typically assumed to aid intuitive decision making, can have the opposite effect in PD patients who experience interoceptive cues as threatening, and tend to avoid them. This may explain why PD patients frequently have problems with decision making in everyday life. Screening of cardiac perception may help identifying patients who benefit from specifically tailored interventions.
authors.affiliation: Department of Psychology I, University of Würzburg Würzburg, Germany ; Schön Klinik Roseneck, Hospital of Behavioral Medicine Prien am Chiemsee, Germany.
authors.forename: Julian
authors.initials: J
authors.lastname: Wölk
authors.affiliation: Lillehammer University College, Department of Psychology Lillehammer, Norway ; Research Group on Health Psychology, University of Leuven Leuven, Belgium.
authors.forename: Stefan
authors.initials: S
authors.lastname: Sütterlin
authors.affiliation: Schön Klinik Roseneck, Hospital of Behavioral Medicine Prien am Chiemsee, Germany ; Paracelsus Medical University Salzburg Austria.
authors.forename: Stefan
authors.initials: S
authors.lastname: Koch
authors.affiliation: Research Group on Health Psychology, University of Leuven Leuven, Belgium ; Research Group Self-Regulation and Health, Research Unit INSIDE, University of Luxembourg Luxembourg, Luxembourg.
authors.forename: Claus
authors.initials: C
authors.lastname: Vögele
authors.affiliation: Department of Psychology I, University of Würzburg Würzburg, Germany ; Comprehensive Heart Failure Center, University of Würzburg Würzburg, Germany.
authors.forename: Stefan M
authors.initials: SM
authors.lastname: Schulz
mesh_terms: D000328:Adult; D003657:Decision Making / Q000502:physiology*; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D065812:Interoception / Q000502:physiology*; D019545:Intuition / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D016584:Panic Disorder / Q000503:physiopathology*; D011597:Psychomotor Performance / Q000502:physiology*
keywords: Cardiac perception; Iowa Gambling Task; decision making; interoception; panic disorder; somatic marker hypothesis