PONE-D-21-13357

Questionnaires of interoception do not assess the same construct

PLOS ONE

Dear Dr. Vig,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Yes

Reviewer #3: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: No

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: I would like to commend the authors on a well-written manuscript. The introduction sets up contrasts between these questionnaires well. The widespread use of interoceptive sensibility as a research construct makes the understanding of convergence between measures important.

However, I have some concerns about the analysis that was conducted in this study.

1. Information on distributions of the subscale scores are not reported. From the scatterplots it appears that there may be some skew in the measures, which is particularly apparent in the MAIA Noticing subscale. Non-normality can create artifacts in the parametric statistics that are used in this analysis. I would recommend assessing normality and using linear transformation if needed to ensure alignment between distributions and model assumptions

2. The sample here is relatively small for exploratory factor analysis. I would recommend that the authors consider the role of sample size and its implications for the success of uncovering the underlying factor structure. These articles may provide useful background in this area:

Floyd, F. J. & Widaman, K. F. (1995). Factor analysis in the development and refinement of clinical assessment instruments. Psychological Assessment, 7(3), 286-299.

MacCallum, R. C., Widaman, K. F., Zhang, S., & Hong, S. (1999). Sample size in factor analysis. Psychological Methods, 4(1), 84-99.

3. The decision of how many factors to retain is crucial for this study. In the manuscript, factor retention was solely guided by the eigenvalue > 1 rule, which is known to have limitations. Typical factor analysis recommendations now include comparing fit indices of each solution, the scree test, and/or parallel analysis. Since the key outcome of this study rests on retaining the correct amount of factors, it is important that multiple metrics are used to guide factor retention. The following article provides an overview on this topic:

Fabrigar, L. R., Wegener, D. T., MacCallum, R. C., & Strahan, E. J. (1999). Evaluating the use of exploratory factor analysis in psychological research. Psychological Methods, 4, 272-299.

4. There is no mention of whether oblique or orthogonal rotation was used (based on results, I assume oblique)

5. I could not find supporting data in the supplemental file

6. Data collection and participant features are only briefly described. Several clarifications would be needed: Is country of residence data on participants available? Were there any cleaning procedures to screen out potentially poor quality or incomplete responses? Also, based on the questionnaire descriptions it is assumed that the survey was in Hungarian but this could also be useful in the participant description.

Reviewer #2: The current study examines associations between three interoceptive sensibility measures, and positive and negative affect by means of correlations and exploratory factor analysis in a cross-sectional community sample of 265 adults. I would like to present the following questions and suggestions to the authors.

Abstract

• In the abstract, the SSAS abbreviation is used without introduction.

Introduction

• L.44: To my opinion, the statement that interoceptive accuracy and sensibility are usually independent needs to be formulated a bit more cautiously. As it is formulated now, the statement would imply that interoceptive awareness is usually nonexistent, which is not the case. It is not because generally low correlations are found between interoceptive accuracy and sensibility (for existing measures across participants), that both can be considered independent.

• L.58: I am a bit confused by the use of the term “pure perception”. Perception, and interoception specifically, involves the sensing, identification, differentiation and interpretation of internal sensations, and implies by definition potential bias by associated emotions, cognitions and beliefs, for example deriving from personality factors including self-esteem and affect, as suggested by the authors.

• L.63: It is not completely clear what the “total score” of questionnaires refers to precisely. I assume that the authors refer to the overall underlying construct assessed by questionnaires?

• L.136 and later (continuing in the discussion): If I understand correctly, the authors argue that moderate to high correlations (e.g. between specific interoception questionnaires and positive and negative affect) imply a conceptual overlap between both. Although a correlation represents statistical overlap in terms of variance explained, it does not necessarily imply a conceptual overlap, however. At most, it may suggest a conceptual overlap.

• L.146-151: To me, it is not clear what the precise goal is of this paragraph. Two domains are mentioned in which the BAQ is commonly used. However, the BAQ is used in much more research domains. Therefore it is not clear what the precise message here is. If the two research domains mentioned are examples, this could be made more explicit.

• Throughout the introduction, the authors repeatedly use the term “susceptibility”. This is not a term commonly used in the interoception literature, and to me it is not clear how it is defined by the authors. Based on what the authors write, but I may misunderstand, it seems they mean mostly “sensitivity” in this regard? Given that “susceptibility” means often more than “sensitivity” and may also imply vulnerability, the term may not be the best choice. In any case, a clear definition is required, especially in the interoception literature in which constructs are generally poorly delineated, or at least have a history of that.

• I would slightly disagree with the authors that the BPQ, BAQ and MAIA are currently used interchangeably by researchers. All three questionnaires are developed with their own purpose and outline the concept they are measuring in different ways. Often this concept is specified by the researchers choosing a specific questionnaire, and the choice is accounted for. However, I do agree with the statement that often all these different questionnaires are considered measuring interoception, which is fundamentally different than them being considered and used interchangeable. Researchers who aim to measure interoceptive sensibility often choose a questionnaire of the three questionnaires used here, but that does not mean they consider them being exchangeable. I do want to add that this does not take away that the message that they should not be used interchangeable (as suggested in the conclusion), is an important message.

Methods

• L.225: It is not clear to me what is meant with “feedback upon request”.

• L.2226: Maybe the editor could address this, but I am not sure whether the information provided on ethics approval is sufficient for PLOS ONE.

• L.232: Since the Hungarian translation of the BAQ seems to differ from the original BAQ in number of items, it may be good to add a reference (I assume Köteles, 2014) directly to this sentence to show a validated version was used.

• L. 254: I wonder what the rationale is to average scores of the MAIA g-factor scales? The average (vs. the sum) limits the range a lot.

• Table 1: The minimum score for the SSAS is probably a type error?

• Is any more information available to better describe the community sample which was investigated? Also, more information on the recruitment process (e.g. how/for which purpose was the study advertised) may be helpful to better understand the studied sample.

Results:

• It would be helpful to add the correlations in the text as well, so it becomes more clear how the strength of the correlations is interpreted. In this regard, it would also be helpful if the authors could indicate which norms or boundaries they used to assess the strength of correlations.

o For example, a correlation of 0.251 (BPQ-BA-26 and MAIA noticing) is considered weak, whereas a correlation of 0.269 (BPQ-BA-26 and SSAS) is considered weak to moderate. Or a correlation of -0.168 (BAQ – NA) is considered weak whereas a correlation of 0.154 (BPQ-BA-26 – NA) is interpreted as very weak.

o In addition, the SSAS is mentioned to only correlate with NA and BPQ-BA-26 in the results, however also shows a correlation of 0.143 with the BAQ (which is higher than the correlation between PA and BPQ-BA-26, which is interpreted as very weak); this correlation is not discussed in the results, yet elaborated upon in the discussion.

o Also, it seems that the associations between BAQ and MAIA noticing/-g are not discussed in the results, as is the association between MAIA noticing and PA, yet both relationships are elaborated upon in the discussion.

o In the results, the associations between BPQ-BA-26 and BAQ are described as weak to moderate, while in the discussion the relationship is described as particularly weak.

• Same goes for the interpretations of the factor loadings. Which cutoff scores were used here? For example a factor loading of 0.3 was interpreted as the BPQ-BA-26 not being part of factor 1, whereas a factor loading of 0.337 was considered indicative of the SSAS belonging to factor 2.

Discussion:

• It is not clear to me, based on the predictions made in the introduction, why the authors describe the moderate to strong relationship between MAIA-g and BAQ (in the results described as moderate) to be remarkable.

• The discussion of NA and its role in interoception is particularly long (l.376-412), and the link with the current findings only comes after. As a reader I felt a bit lost in this part as I did not know where the story was going.

• In this discussion, also the formulation of a questionnaire being “positively or negatively biased”, is unclear to me. To my opinion, based on the current research design and findings, the most accurate conclusion would be in terms of associations.

Minor suggestions:

l.223, l. 272: data were

l.229: The Body Awareness Questionnaire

l.249: The MAIA does not consist of 32 items of 8 scales. It consists of 32 items across 8 scales.

Reviewer #3: This manuscript addresses an important question. However, I have a few concerns that need to be addressed.

ABSTRACT

Typo? On should in In

Final sentence is not clear – is the conclusion that we need a new questionnaire?

INTRODUCTION

Both the question and the concepts are clearly and accurately defined in this section. My main concern is the length – it is over seven pages long. I would recommend shortening this section.

Rational – some decisions seem arbitrary

(1) the choice of questionnaires needs justification. Why were these three questionnaires chosen over others? E.g., the IAS Murphy, J., Brewer, R., Plans, D., Khalsa, S. S., Catmur, C., & Bird, G. (2020). Testing the independence of self-reported interoceptive accuracy and attention. Quarterly Journal of Experimental Psychology, 73(1), 115-133, or the SCS Fenigstein A, Scheier MF, Buss AH (1975) Public and private self-consciousness: Assessment and theory. J Consult Clin Psychol 43 (4) 522–527 , or the BMQ Burg, J. M., Probst, T., Heidenreich, T., & Michalak, J. (2017). Development and psychometric evaluation of the body mindfulness questionnaire. Mindfulness, 8(3), 807-818. I’m sure there are others……………..

(2) Additionally, what was the reason for focusing on the noticing and ‘g’ scales of the MAIA? You mention in the introduction that the emotional awareness scale had previously been associated with the other questionnaire ……… yet you chose not to focus on the individual scales? This needs more justification. The ‘g’ scale seems to confound a range of different interoceptive constructs. I would recommend considering the scale separately – afterall, the aim of the present paper is to highlight to researchers that such differences need to be considered?

(3) My understanding of The Somatosensory Amplification Scale is that previous research has found it lacks internal reliability. One potential reason is that it may measure more than one construct. As teasing apart body related constructs was the aim of the present paper why use this scale to compare the others against?

ANALYSIS

It might be problematic to add the noticing scale of the MAIA and ‘g’ together into the factor analysis when ‘g’ already contains the noticing scale………again this might be a reason to include each of the MAIA scales separately. Additionally, should the individual items, rather than the scales, go into the factor analysis?

DISCUSSION

The discussion is again very long and reads like a review of questionnaire measures rather than a discussion of the findings. While it raises a number of interesting points the focus should be on the present results.

I am not sure I agree with the statements about an ideal interoception questionnaire L 459-464. Surely there is no such thing as an ‘ideal’ questionnaire, rather researchers should carefully select their questionnaire based on their research question and the underlying interoceptive construct they want to measure. I am not sure it makes conceptual sense to entirely separate interoception and affect as suggested in point 2 in this section. I am also not sure that an ‘ideal’ questionnaire would exclude the evaluative component – surely this is an important component, and again, whether it is assessed will depend on the research question.

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

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PONE-D-21-13357R1Questionnaires of interoception do not assess the same constructPLOS ONE

Dear Dr. Vig,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

 I apologize for the delay. You will find below the comments of R3. I globally agree with these and thus kindly invite you to address them in your revised version. In addition to these comments, here are my comments that I also kindly invite you to address. 1. In the introduction and the method sections, could you provide more information/illustrations about the BAQ (i.e., items) 2. Please discuss the low internal reliability of the SSAS3. I agree with R3 about making your main objective clearer: evaluating the associations between the 3 questionnaires to examine their particularities (rather than proposing guidelines to develop a new questionnaire). 4. I agree with R3 about the different factors the MAIA because you clearly mentioned in the introduction its multi-dimensionality. Removing the two more “maladaptive scales” is a bit surprising and considering each subscale may provide relevant information. I would conduct correlations with all MAIA subscales5. I would suggest to remove the exploratory analysis if the sample size is too small to make appropriate analyses or to increase the sample size. 6. The discussion could indeed more specifically focus on the latent constructs of ISb questionnaires/dimensions based on the correlations (the phrasing issues could be addressed in the limit section). You could also for instance add recommendations about which questionnaires/subscales should be considered in future studies depending on the research objective7. I understand the relevance to include negative affect but please better justify/discuss the implications of the associations between the ISb questionnaires and PA. 8. Conclusion: a word is missing ‘cannot be..to ISb’

Please submit your revised manuscript by Dec 16 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Delphine Grynberg, PhD

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #3: (No Response)

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #3: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #3: No

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #3: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #3: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors have addressed all of my comments regarding the manuscript. I recommend the paper for publication; however, I strongly suggest that the authors closely check the writing for grammar before going to press. There is also formatting inconsistency in use of decimal points or commas to separate the integer and fractional part of numbers.

Reviewer #3: Thank you for considering my comments. I still have a few remaining concerns

Reviewer #3:

Final sentence is not clear – is the conclusion that we need a new questionnaire?

Reply 32: This is the second (more distal) part of the conclusion, which is preceded by a more direct conclusion (“These findings suggest that the investigated questionnaires cannot be used interchangeably to assess interoceptive sensibility.”). At the end of the discussion of the manuscript, we conclude that the existing questionnaires do have their weaknesses, thus there is room for another, theoretically well-founded questionnaire. ____

I didn’t have any concerns about the conclusion that the questionnaires should not be used interchangeably. You have provided data that support that conclusion. What is not clear is why you review the limitations of each questionnaire and conclude that a new questionnaire is needed. This is going beyond the aim of your study which was to see if the questionnaire measures the same underlying latent construct. If you want to critically review the interoception questionnaires, then this is a different aim and should be a different paper. I maintain that the final sentence of the abstract does not tally up to the aim of the study.

Additionally, what was the reason for focusing on the noticing and ‘g’ scales of the MAIA? You mention in the introduction that the emotional awareness scale had previously been associated with the other questionnaire ……… yet you chose not to focus on the individual scales? This needs more justification. The ‘g’ scale seems to confound a range of different interoceptive constructs. I would recommend considering the scale separately – afterall, the aim of the present paper is to highlight to researchers that such differences need to be considered?

Reply 34: We think that the g-scale does not confound a range of different constructs but represents an overarching factor behind those constructs. In other words, the differentiation of the six subscales is not really justified, as shown by Ferentzi et al., 2020 (“However, a recent paper showed that the most prominent component of the construct can be well grasped with an overreaching factor (called MAIA-g in this paper) that includes six out of eight factors, while the remaining two (Not-Worrying and NotDistracting) are independent (Ferentzi et al., 2020).”). Thus, the use of the g-scale appears more appropriate than the inclusion of the separate scales. The only exception is the Noticing scale, because it measures primary experience (“Concerning the level of cognitive processing, only the Noticing subscale refers to the direct body experience, and, according to Mehling (2016), it is the most similar to the earlier questionnaires (and concepts) of bodily awareness.”). ____

I still disagree with this. There are now plenty of studies that find some sub-scales of the MAIA relate to particular disorders, while others don’t. This implies they are not measuring the same thing. I would like to see a factor analysis in supplementary information using the individual scales.

(3) My understanding of The Somatosensory Amplification Scale is that previous research has found it lacks internal reliability. One potential reason is that it may measure more than one construct. As teasing apart body related constructs was the aim of the present paper why use this scale to compare the others against?

Reply 35: We had two reasons. First, the SSAS was used in the validation process of the BPQ-BA and their positive association was interpreted as indicator of convergent validity. Second, somatosensory amplification is a construct that is very close to ISb (actually, it fits the definition of Garfinkel et al (2015, p.67): “the self-perceived dispositional tendency to be internally self-focused and interoceptively cognisant”; this is explicitly stated in the revised version), but usually does not considered an aspect of it, mainly because of its association with NA. This makes it an excellent anchor point for our study, which attempts to explore the associations between indicators of ISb and PA/NA. ____

This response doesn’t really address my question about reliability?

ANALYSIS It might be problematic to add the noticing scale of the MAIA and ‘g’ together into the factor analysis when ‘g’ already contains the noticing scale………again this might be a reason to include each of the MAIA scales separately. Additionally, should the individual items, rather than the scales, go into the factor analysis?

Reply 36: The size of the sample does not allow the inclusion of individual items into the FA. To address the issue with the noticing subscale and the g-scale, we rerun the factor-analysis with a g-scale that does not contain the four items of the Noticing subscale (the correlation between the full and this shortened g-scale is .99). ____

Irrespective of the correlation it is still inappropriate to the noticing scale and the g scale (including noticing) into the same factor analysis as this would inflate the chances of the two loading onto the same factor. If removing noticing from the g scale does not influence the results then why not report that analysis? It would be more appropriate?

DISCUSSION The discussion is again very long and reads like a review of questionnaire measures rather than a discussion of the findings. While it raises a number of interesting points the focus should be on the present results. Reply 37: Similarly to the introduction, the discussion was substantially shortened in the revised version (see also Reply 28). ____ I am not sure I agree with the statements about an ideal interoception questionnaire L 459-464. Surely there is no such thing as an ‘ideal’ questionnaire, rather researchers should carefully select their questionnaire based on their research question and the underlying interoceptive construct they want to measure. I am not sure it makes conceptual sense to entirely separate interoception and affect as suggested in point 2 in this section. I am also not sure that an ‘ideal’ questionnaire would exclude the evaluative component – surely this is an important component, and again, whether it is assessed will depend on the research question. Reply 38: We think that the entire framework of Garfinkel and colleagues (2015) relies on the sensory aspect of interoception. We formulated our recommendations with keeping this approach in mind. This does not mean that the evaluative aspect is not important or can be completely separated from the sensory. This is elaborated in the discussion of the revised version.

The discussion still seems to go well beyond a discussion of the present results and the aim. Indeed, there are sections where your results are not referred to. In terms of Garfinkels definition, two scales recently developed by Murphy et al. seem to have taken care of that question. The Interoceptive Accuracy Scale and the Interoceptive Attention Scale. Please comment on what you think is needed beyond these two well validated and conceptualised scales.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #3: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

PONE-D-21-13357R2Questionnaires of interoception do not assess the same construct

PLOS ONE

Dear Dr. Vig,

Thank you for submitting your revised manuscript to PLOS ONE. Although one reviewer recommends acceptance at this stage, the other reviewer (reviewer 4) raises very important and valid concerns which I agree will need to be addressed before this paper could potentially be accepted. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised.

Please submit your revised manuscript by Jun 24 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

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Reviewers' comments:

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Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #4: (No Response)

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #4: Partly

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #4: No

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #4: Yes

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PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #4: No

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: I have no new comments. All of my requests from the previous round of revisions were addressed by the authors.

Reviewer #4: Thank you for the opportunity to review this research, particularly at this late stage in the peer-review process. Having read through the paper, and the dialogue between the authors and the other reviewers, I have some suggestions to add which may assist the authors in publishing the work, and making a useful contribution to the literature.

It is unfortunate timing perhaps, but I found the statement in the Introduction (and the premise of the paper) “Although the implicit assumption is that these questionnaires assess basically the same (or at least highly similar aspects of the same) phenomenon, this has not been systematically investigated to date” – to be incorrect. In fact, Desmedt, Heeren, and colleagues (2022) recently considered the associations between five self-report measures, including the three measures focused on in the present work (the BAQ, the BPQ and the MAIA). Given that Desmedt, Heeren, and colleagues (2022) used a much larger sample (n = 1003), a wider pool of measures, and more sophisticated set of analyses, I am not sure what the present work adds with regards to the associations between measures of interoception (particularly as the paper used a novel Hungarian translation of the BPQ, which has not been fully validated). The correlational analyses alone are not a strong assessment of the underlying associations between the measures.

To that end, my suggestion is that the authors refocus the paper in one of two ways:

• Focus on the reporting the validation of the Hungarian translation of the BPQ (see Swami & Barron, 2019 for reporting and analytic guidelines). I recommend that the authors collect more data if they pursue this option.

• Focus on the relationships between the interoception measures and the indices of positive and negative affect. For example, it would be interesting to see hierarchical regression analyses that identify the variance in positive/negative affect that is uniquely accounted for by each questionnaire measure. This could support the authors’ assertion that the questionnaire measures are incrementally distinct.

General

I suggest that the authors have the manuscript proofread for grammatical issues, which will enhance the clarity of the work.

Abstract

Line 1 – the phrasing of this sentence is not clear. I know you mean that questionnaire measures are sometimes referred to as interoceptive sensibility, but it looks as though you are saying that interoception itself is sometimes called interoceptive sensibility.

Introduction

The authors focus heavily on Garfinkel and colleagues’ (2015) tripartite model of interoception. However, more recent models (e.g., Desmedt, Luminet et al., 2022; Khalsa et al., 2018) might be a more appropriate and useful theoretical underpinning for distinguishing between the different components of interoception the authors purport to be measured by the BAQ, BPQ and MAIA.

Methods

Briefly comment on the I-PANAS-SF Hungarian valiation. i.e., did it support the original factor structure?

I recommend computing McDonald’s omega instead of Cronbach’s alpha for these questionnaire measures, as it performs more reliably.

Limitations

The present findings may be constrained by linguistic or local contextual factors, which might influence the understanding/meaning of the latent constructs, and potentially limit generalisability (for discussions, see Ma-Kellams, 2014; Todd, 2020; see also Swami & Barron, 2019).

Table 1

Why were some scores computed for some measures, and means for others? Consistency in computing means would facilitate comparison for readers across the measures.

References

Desmedt, O., Heeren, A., Corneille, O., & Luminet, O. (2022). What do measures of self-report interoception measure? Insights from a systematic review, latent factor analysis, and network approach. Biological Psychology, 108289. https://doi.org/10.1016/j.biopsycho.2022.108289

Desmedt, O., Luminet, O., Maurage, P., & Corneille, O. (2022). Discrepancies in the definition and measurement of interoception: A comprehensive discussion and suggested ways forward. https://doi.org/10.31234/osf.io/xd3nj

Ma-Kellams, C. (2014). Cross-cultural differences in somatic awareness and interoceptive accuracy: A review of the literature and directions for future research. Frontiers in Psychology, 5, 1379. https://doi.org/10.3389/fpsyg.2014.01379

Swami, V., & Barron, D. (2019). Translation and validation of body image instruments: Challenges, good practice guidelines, and reporting recommendations for test adaptation. Body Image, 31, 204-220. https://doi.org/10.1016/j.bodyim.2018.08.014

Todd, J., Barron, D., Aspell, J. E., Toh, E. K. L., Zahari, H. S., Khatib, N. A. M., & Swami, V. (2020). Translation and validation of a Bahasa Malaysia (Malay) version of the Multidimensional Assessment of Interoceptive Awareness (MAIA). PLoS One, 15(4), e0231048. https://doi.org/10.1371/journal.pone.0231048

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PONE-D-21-13357R3Questionnaires of interoception do not assess the same constructPLOS ONE

Dear Dr. Vig,

Thank you for submitting your manuscript to PLOS ONE. One reviewer has  recommended the paper be accepted but the other reviewer has a few minor remaining issues that need addressing.

Please submit your revised manuscript by Aug 26 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Jane Elizabeth Aspell, PhD

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #4: (No Response)

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #4: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #4: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #4: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #4: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #4: Thank you for the opportunity to review this work again. The authors have addressed most of my comments thoroughly. I have just a few remaining minor suggestions, following which I believe the work will be suitable for publication.

I refer to the editor for guidance on PLos referencing style, which appears incorrect.

Participants:

- Did participants receive any payment?

- What was deemed to be a ‘high proportion of missing items’? e.g., >20%?

- Is data available for additional participant characteristics that would better characterise the representativeness of the sample, E.g., occupation status etc.?

Line 392 tacked changes document, ‘details’ should be changed back to ‘detail’

Supplementary materials

In line with my previous review comments, I have some concerns about the novel psychometric validation of the BPQ (I recommend further data collection for a full validation, if possible).

- The authors do not indicate if or how they divided the sample for the EFA and CFA analyses (it is not appropriate to conduct EFAs and CFAs using the same sample). See Worthington & Whittaker (2006) or Swami and Barron (2019) for sample size recommendations for EFA based on item communalities. Given the small sample, I recommend prioritising EFA over CFA (see Swami et al., 2021), and recommending that CFA is performed in the future in the Discussion.

- Principal axis would be preferable to maximum likelihood (see Watkins, 2018; Statistical simulations have found that PA outperforms ML when the relationships between measured variables and factors are relatively weak (≤.40), sample size is relatively small (≤300), multivariate normality is violated, or when the number of factors underlying the measured variables is misspecified)

- What rotation was used for the EFA? (e.g., Quartimax, given the expectation of a single orthogonal factor?)

- How did you determine the number of factors to extract in the EFA? (e.g., eigenvalues >1, parallel analysis, examination of scree plot, minimum average partials, etc.?) I recommend parallel analysis or MAP

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Questionnaires of interoception do not assess the same construct

PONE-D-21-13357R4

Dear Dr. Vig,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Jane Elizabeth Aspell, PhD

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PLOS ONE

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #4: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #4: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #4: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #4: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #4: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #4: The authors have fully addressed all of my previous comments and I am happy to recommend publication.

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Reviewer #4: No

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