From interoception to anxiety and social cognition: the mediating roles of intolerance of uncertainty and alexithymia

Daily life requires navigating uncertainty arising from external events and internal bodily sensations. Although uncertainty often elicits anxiety, individuals differ markedly in their sensitivity to it, a trait termed Intolerance of Uncertainty (IU). Across two studies, we examined how IU and alexithymia (difficulties identifying and describing emotions) mediate the links between interoceptive sensibility (self-reported awareness, attention, and appraisal concerning bodily sensations) and both anxiety and social cognition. In Study 1 (N = 190), participants completed questionnaires assessing interoceptive sensibility, alexithymia, IU, and anxiety. Study 2 (N = 154) included additional measures of empathic tendencies and performance on an emotion recognition task analysed using Drift Diffusion Modelling (DDM). Maladaptive interoceptive attention styles were associated with elevated anxiety and greater empathic distress. Both IU and alexithymia significantly mediated the relationships between interoceptive sensibility, anxiety, and personal distress. Exploratory DDM analyses unexpectedly suggested more efficient perceptual processing in individuals with higher IU, reflected in enhanced recognition of positive emotional expressions. These findings highlight the complex interplay among interoceptive sensibility, IU, alexithymia, anxiety, and social cognition, and suggest that interventions targeting uncertainty sensitivity and emotional awareness may improve emotional well-being and social functioning.