ArticleFrontiers in human neuroscience2016
Allostatic Self-efficacy: A Metacognitive Theory of Dyshomeostasis-Induced Fatigue and Depression.
Article in Frontiers in human neuroscience, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 189 papers, 3 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
189 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Pathophysiological mechanisms of post-exertional malaise: an integrative analysis based on the metabolism-immune-neuro interaction model.Frontiers in immunology · 2026Pooled it
- The prevalence of obstructive sleep apnea-hypopnea syndrome in patients with multiple sclerosis: a systematic review and meta-analysis.Frontiers in neurology · 2024Pooled it
- Disrupted Dorsal Mid-Insula Activation During Interoception Across Psychiatric Disorders.The American journal of psychiatry · 2021Pooled it
- A semi-randomised control trial assessing psychophysiological effects of breathwork and cold immersion.Scientific reports · 2025Trial
- Using functional connectivity changes associated with cognitive fatigue to delineate a fatigue network.Scientific reports · 2020Trial
- The effects of intravenous iron supplementation on fatigue and general health in non-anemic blood donors with iron deficiency: a randomized placebo-controlled superiority trial.Scientific reports · 2020Trial
- Neural correlates of perceived physical and mental fatigability in older adults: A pilot study.Experimental gerontology · 2019Trial
- Toward an Embodied Medicine: A Portable Device with Programmable Interoceptive Stimulation for Heart Rate Variability Enhancement.Sensors (Basel, Switzerland) · 2018Trial
- Trial
- Towards an integrative neuroscience of metacognition.Nature reviews. Neuroscience · 2026Review
- If Not All Paths Lead to Mental Fatigue, Perhaps Mental Fatigue Is Not the Destination.Sports medicine (Auckland, N.Z.) · 2026Article
- Closed-Loop Neuromodulation for Brain Fatigue: From Real-Time Biomarkers to Adaptive Intervention.International journal of molecular sciences · 2026Review
- A Dual Prediction Error Populations Model of Schizophrenia Spectrum Disorders: Bridging NMDA Hypofunction and Gain Hyperfunction.Schizophrenia bulletin · 2026Article
- Increased exertion variability is linked to disruptions in effort assessment in multiple sclerosis.Multiple sclerosis (Houndmills, Basingstoke, England) · 2026Article
- Brain rhythms of depression: A predictive processing perspective.Trends in neurosciences · 2026Review
- Functional Connectivity Alterations of the Central Autonomic Network in Multiple Sclerosis: Links to Fatigue and Aerobic Training Effects.Neurology(R) neuroimmunology & neuroinflammation · 2026Article
- Exposure to false cardiac feedback alters pain perception and anticipatory cardiac frequency.eLife · 2026Article
- Reduced sensitivity to tactile stimuli associated with physical and mental disorders: A monozygotic twin study.Scientific reports · 2026Article
- Interoceptive and metacognitive contributors to fatigue in multiple sclerosis: network and mediation analyses.Acta neurologica Belgica · 2026Article
- Digital Approaches for Managing Brain Fog in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): Interventions, Monitoring, and Future Directions.Life (Basel, Switzerland) · 2026Review
129 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
11 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
This paper outlines a hierarchical Bayesian framework for interoception, homeostatic/allostatic control, and meta-cognition that connects fatigue and depression to the experience of chronic dyshomeostasis. Specifically, viewing interoception as the inversion of a generative model of viscerosensory inputs allows for a formal definition of dyshomeostasis (as chronically enhanced surprise about bodily signals, or, equivalently, low evidence for the brain's model of bodily states) and allostasis (as a change in prior beliefs or predictions which define setpoints for homeostatic reflex arcs). Critically, we propose that the performance of interoceptive-allostatic circuitry is monitored by a metacognitive layer that updates beliefs about the brain's capacity to successfully regulate bodily states (allostatic self-efficacy). In this framework, fatigue and depression can be understood as sequential responses to the interoceptive experience of dyshomeostasis and the ensuing metacognitive diagnosis of low allostatic self-efficacy. While fatigue might represent an early response with adaptive value (cf. sickness behavior), the experience of chronic dyshomeostasis may trigger a generalized belief of low self-efficacy and lack of control (cf. learned helplessness), resulting in depression. This perspective implies alternative pathophysiological mechanisms that are reflected by differential abnormalities in the effective connectivity of circuits for interoception and allostasis. We discuss suitably extended models of effective connectivity that could distinguish these connectivity patterns in individual patients and may help inform differential diagnosis of fatigue and depression in the future.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.