Timing and self distortions in psychosis: Is it an insula matter?

The concept of timing is an interesting way to understand how the body and brain construct the concept of self, but also how self-distortions arise in the case of psychosis. Analysis of temporal representations in psychosis highlights a deficit that includes both the subjective experience of the flow of time, i.e., time perception, and the ability to process temporal information inherent to any perceptual event, i.e., perceptual timing. The representation of the self is stabilized within temporal windows, and thus the self is experienced as continuous in time. Disturbance in the sense of time, in the form of a loss of temporal continuity, has been described by phenomenologists as a central subjective experience of schizophrenia. The positive symptoms of schizophrenia are associated with overestimation of interval timing, i.e., an acceleration of the 'internal clock', while dopamine neurotransmission is likely to regulate the speed of the internal clock. Moreover, findings highlight the importance of interoceptive precision as an aspect of time perception, since accuracy in time perception is related to interoceptive accuracy and vagal activity. Insula contributes significantly to the total awareness of reality. Global emotional moments and meta-representations of the conscious self are created in the anterior insula. In psychosis, the interaction between the default-mode network and the frontoparietal executive network is disrupted by aberrant salience signals from the right anterior insula. Here, we describe the role of the insula as a key hub for the recognition of major aspects of the self, in parallel with the role of interoceptive predictive coding, which reflects the contribution of the insula to the temporality of the self. Based on the above, new insights focus on the development and implementation of rehabilitation strategies that specifically target the temporal deficits observed in psychosis. New therapeutic interventions are based on sensory education and enhancing the multisensory integration of these patients.