Dynamic brain-to-brain concordance and behavioral mirroring as a mechanism of the patient-clinician interaction

Abstract

The patient-clinician interaction can powerfully shape treatment outcomes such as pain but is often considered an intangible “art of medicine” and has largely eluded scientific inquiry. Although brain correlates of social processes such as empathy and theory of mind have been studied using single-subject designs, specific behavioral and neural mechanisms underpinning the patient-clinician interaction are unknown. Using a two-person interactive design, we simultaneously recorded functional magnetic resonance imaging (hyperscanning) in patient-clinician dyads, who interacted via live video, while clinicians treated evoked pain in patients with chronic pain. Our results show that patient analgesia is mediated by patient-clinician nonverbal behavioral mirroring and brain-to-brain concordance in circuitry implicated in theory of mind and social mirroring. Dyad-based analyses showed extensive dynamic coupling of these brain nodes with the partners’ brain activity, yet only in dyads with pre-established clinical rapport. These findings introduce a putatively key brain-behavioral mechanism for therapeutic alliance and psychosocial analgesia.

Cerebral coherence in task-based fMRI hyperscanning: A new trick to an old dog

“…With EEG-hyperscanning, Jahng et al [21] provided evidence in neural dynamics between dyads when nonverbal cues involving the rTPJ were adopted to predict opponents' intentions to cooperate or defect during the face-to-face prisoner's dilemma game. All the above-mentioned studies adopted either specialized analysis methods or additional cues, such as eye contacts [15] and facial co-analysis between patients and clinicians [26] in their analyses of the information flow. The common mechanism of interpersonal rapport triggering similar brain activities should be a common theme [27][28][29].…”

The Embodied-Enactive-Interactive Brain: Bridging Neuroscience and Creative Arts Therapies

“…Notably, the coordinated or synchronized brain activation across people, i.e., intersubject correlation, was suggested as a mechanism of transmission of shared meaning and common interpretation that goes beyond cultural and linguistic boundaries (Honey et al, 2012): Moments of neural synchrony may be driven by shared attention to external stimuli in the environment or directly mediated by person-to-person communicative signals, through which interaction is conveyed (e.g., eye contact, facial expression, bodily gestures, vocal prosody). Correspondingly, the intersubjective oscillatory brain response has been related to empathic relationships and bonding (Wheatley et al, 2012;Hu et al, 2017), shown to be indicative of rapport (Ellingsen et al, 2020), emotion co-regulation and social learning, through mutual attention, and communication (Leong et al, 2017;Levy et al, 2017;Pratt et al, 2018;Reindl et al, 2018;Piazza et al, 2020). Recently, this implicit interpersonal neural resonance was suggested as the basis of attachment (Schore and Schore, 2008;Siegel, 2015;Long et al, 2020) and also affiliated with the development of resilience (Feldman, 2020).…”

Sykepleiere bør lære å utnytte placeboeffekten

“…Studien fant at smertelindringen ble formidlet gjennom pasient-terapeut-forholdet, nonverbal atferd og sosial speiling, som handler om å gi pasienten full oppmerksomhet gjennom for eksempel øyekontakt, stemmebruk og kroppsspråk (5). Funnene underbygger at sykepleiere kan fremme e ekten av medisinsk behandling gjennom et godt pasientforhold.…”