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, the specific behavioral and neural mechanisms underpinning the patient-clinician interaction are unknown. Using a two-person interactive design, we simultaneously recorded functional MRI (i.e. hyperscanning) in patient-clinician dyads, who interacted via live video while clinicians treated evoked pain in chronic pain patients. 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 where clinical rapport had been established prior to the interaction. These findings point to a putatively key brain-behavioral mechanism for therapeutic alliance and psychosocial analgesia.

A social affective neuroscience lens on placebo analgesia

“…A recent study of acupuncture analgesia makes an important first step toward illuminating behavioral and neurobiological processes that underlie patient-provider interactions [62]. Researchers used fMRI hyper-scanning to simultaneously measure neural responses in fibromyalgia patients undergoing experimental acute pain and clinicians.…”

On symptom perception, placebo effects, and the Bayesian brain

“…Without denying that PP models can be useful, one of their problems is that they invite internalist, individualist explanations, and downplay the embodied, social, and environmental factors that the authors themselves show to be important. 5,6,10,15,16 The formalism underlying predictive models has difficulty capturing relational properties, for example, affordances, 17 and the effects of affect on attention. 18 Concrete applications require fitting these complex relational or affective factors as input signals to a PP model.…”

“…The plurality we call for invites a broadening of experimental resources. Combinations of the latest technological advances (eg, hyperscanning 5 ), experimental paradigms such as OLP, and methods from anthropology and phenomenology 20 can shed new light on embodied and interactive processes and experiences. These underexplored possibilities are likely to play key roles in pain and placebo research.…”

Association between personality traits and placebo effects: a preregistered systematic review and meta-analysis

“…Finally, since placebo-related improvement is influenced by the social context, such as qualities of a patient-clinician interaction (Ellingsen et al, 2020;Kelley et al, 2009) or by observing what happens to others who receive the same treatment (Colloca & Benedetti, 2009;Schenk & Colloca, 2020), traits related to dispositional empathy have been hypothesized to promote placebo effects (Davis, 1983). A general hypothesis is that an individual who scores high on empathy, and thus better internalizes others' experience, may be more likely to form a positive expectation after observing other participants' symptom improvement (Colloca & Benedetti, 2009;Hunter et al, 2014;Valentini et al, 2014).…”