Testing the correlation between the heartbeat counting task and anxiety, depression and alexithymia scales: a behavioural study and meta-analysis

Abstract A link between interoceptive accuracy, as measured by the heartbeat counting task (HCT), and psychological phenomena like anxiety, alexithymia and depression has been proposed. Previous research using the HCT alongside popular questionnaires—the State-Trait Anxiety Inventory (STAI-T), Toronto Alexithymia Scale (TAS-20) and Beck Depression Inventory-II (BDI-II)—has shown inconsistent results. This inconsistency may stem from publication bias, methodological variations or underpowered studies. To investigate this inconsistency, we conducted a behavioural study and a meta-analysis. Our findings showed no association between HCT scores and responses on the TAS-20 or BDI-II. The meta-analysis found only a weak correlation between HCT and STAI-T responses (r = 0.06), which was moderated by the specific task instructions given to participants. While no evidence of publication bias was seen, the included studies were consistently low powered. These results challenge the idea of a meaningful relationship between the HCT and these common psychological measures. We highlight key methodological issues that may be contributing to the lack of robust findings in this field and discuss limitations of the HCT itself.