Exploring the role of interoceptive and exteroceptive signals in shaping corporeal awareness in women

The experience of corporeal awareness, namely the individual's consciousness of their own body and its sensations, is influenced by internal and external cues that interplay to create a coherent representation of the self. Specifically, interoceptive signals, which are physiological signals coming from inside our bodies (e.g., heartbeat, breathing, stomach, gut, and bladder stimuli), play a crucial role in shaping our perception of the whole body and the way through which we process specific bodily sensations, such as pain. After a review of the state of the art concerning different facets of bodily awareness, in Part One of this thesis, the role of internal signals in influencing bodily awareness in a sample of healthy females and women affected by a chronic pain disorder (i.e., endometriosis) was explored. In particular, the role of interoception in chronic pain conditions, specifically those affecting women, remains unclear and has been investigated only through self-report questionnaires or cardiac interoceptive accuracy tasks. The first study presented in this thesis (Chapter 2) aims to address this gap by exploring how women suffering from endometriosis, compared to healthy controls, process signals coming from three different body districts: cardiac, gastric, and urinary. Since there is no interoceptive task specifically assessing bladder stimuli in a non-invasive way, a novel urinary interoceptive task is proposed, as we consider it crucial to examine the perception of these signals in conditions characterised by chronic pelvic pain, as these inputs derive from an organ located in the pelvic area, a focal area for these pathologies. Chapter 3 proposes a study investigating the role of breath, another interoceptive signal, in shaping corporeal awareness in healthy women. To achieve this purpose, we take advantage of the ‘Embreathment’ illusion, a virtual reality paradigm previously validated in men. Part Two of this work will focus on how exteroceptive cues, particularly visual cues through virtual reality, can shape women’s corporeal awareness and behaviours. The first study of Chapter 4 describes how embodying a female role model (i.e., Angela Merkel) in virtual reality can alter women’s implicit and explicit attitudes towards themselves. The effects of different kinds of exposure used in the role modelling context are also discussed: priming, which involves the exposure to a role model through an image or, as in our case, a picture presented at the back of the virtual room, and embodiment, which consists of incorporating an avatar by temporarily assuming its physical features and, according to The “Proteus Effect”, also allowing people to act accordingly to the virtual bodily features. The second study of Chapter 4 will also explore whether exposure to a successful female role model can support women’s performance during a stressful virtual reality task, such as giving a talk in front of an audience. We also expect that embodying or being primed with a role model might change not only participants' perceived self-efficacy and performance but also stress-related physiological signals (i.e., heart rate variability) and hormonal levels (i.e., cortisol). Finally, the potential applications of these lines of research in clinical practice and social contexts are discussed.