Modulating the Interplay Between Impulsivity and Interoception Through HD-tDCS to the Right Insula and Anterior Cingulate Cortex

<b>Background:</b> Interoception has been proposed as a key mechanism underlying impulsive behaviours, including maladaptive eating. However, the brain mechanisms supporting the interaction between interoception and impulsivity across different reward types remain unclear. This study investigated whether modulating the right insula and the dorsal anterior cingulate cortex (dACC) using high-definition transcranial direct current stimulation (HD-tDCS) could affect interoceptive accuracy and impulsive decision-making. <b>Methods:</b> Model-based HD-tDCS montages were defined to target the right insula and dACC. Two behavioural paradigms were administered: (i) the heartbeat detection task (HBD) to assess interoceptive accuracy and (ii) two versions of the delay discounting (DD) task with food and monetary rewards to measure impulsivity. Heart rate variability (HRV) was recorded as an index of autonomic activity. HD-tDCS was delivered online during the HBD, while DD tasks were completed offline. Twenty-four participants took part in four sessions in a within-subject design: baseline DD tasks, anodal HD-tDCS targeting the insula, dACC, or sham stimulation. <b>Results:</b> Stimulation of both the insula and dACC reduced participants' ability to detect synchronous heartbeat while improving accuracy in exteroceptive trials. Discounting rates significantly increased following insula stimulation. Moreover, HD-tDCS effects on DD performance varied depending on reward type. <b>Conclusions:</b> These findings suggest differential contributions of the dACC and insula in interoceptive and exteroceptive processing and support the effect of HD-tDCS combined with interoceptive tasks to modulate impulsive decision-making. Reward-specific effects highlight the importance of stimulus type when designing interventions for impulsive eating behaviours.