Interoceptive awareness moderates neural activity during decision-making

•We tested the relationship between cardiac interoceptive awareness and neural responses preceding decision-making.•Cardiac interoceptive awareness was associated with activity in the right anterior insula and the left postcentral gyrus.•Right anterior insula activity was related to decision-making performance in accurate cardiac interoceptive awareness.•These findings support a relationship between body feedback and decision-making. The current study examined the relationship between conscious perception of somatic feedback (interoceptive awareness) and neural responses preceding decision-making. Previous research has suggested that decision-making is influenced by body signals from the periphery or the central representation of the periphery. Using event-related fMRI, participants whose interoceptive awareness was assessed using a heartbeat perception paradigm performed the Iowa Gambling Task. The results show a positive relationship between the degree of interoceptive awareness and selection related activity in the right anterior insula and the left postcentral gyrus. Neural activity within the right anterior insula was associated with decision-making performance only in individuals with accurate but not in those with non-accurate interoceptive awareness. These findings support the role of somatic feedback in decision-making processes. They indicate that the right anterior insula holds a representation of somatic markers and that these are more strongly processed with increased interoceptive awareness.