Patient–clinician brain concordance underlies causal dynamics in nonverbal communication and negative affective expressivity

Abstract

Patient–clinician concordance in behavior and brain activity has been proposed as a potential key mediator of mutual empathy and clinical rapport in the therapeutic encounter. However, the specific elements of patient–clinician communication that may support brain-to-brain concordance and therapeutic alliance are unknown. Here, we investigated how pain-related, directional facial communication between patients and clinicians is associated with brain-to-brain concordance. Patient–clinician dyads interacted in a pain-treatment context, during synchronous assessment of brain activity (fMRI hyperscanning) and online video transfer, enabling face-to-face social interaction. In-scanner videos were used for automated individual facial action unit (AU) time-series extraction. First, an interpretable machine-learning classifier of patients’ facial expressions, from an independent fMRI experiment, significantly distinguished moderately painful leg pressure from innocuous pressure stimuli. Next, we estimated neural-network causality of patient-to-clinician directional information flow of facial expressions during clinician-initiated treatment of patients’ evoked pain. We identified a leader–follower relationship in which patients predominantly led the facial communication while clinicians responded to patients’ expressions. Finally, analyses of dynamic brain-to-brain concordance showed that patients’ mid/posterior insular concordance with the clinicians’ anterior insula cortex, a region identified in previously published data from this study1, was associated with therapeutic alliance, and self-reported and objective (patient-to-clinician-directed causal influence) markers of negative-affect expressivity. These results suggest a role of patient-clinician concordance of the insula, a social-mirroring and salience-processing brain node, in mediating directional dynamics of pain-directed facial communication during therapeutic encounters.

Retracted: Effect of Sham Acupuncture on Chronic Pain: A Bayesian Network Meta-Analysis

“…Psychologists have found that various positive factors (somatosensory stimulation, enhanced doctor–patient relationships, and treatment context) in the healing ritual can contribute to a significant placebo effect [ 8 ]. Recent studies have suggested that this placebo effect for patient analgesia might be associated with dynamic patient-brain to clinician-brain concordance during patient–clinician interaction [ 86 , 87 ]. Furthermore, SA can also induce a physiological response that is similar to, but weaker than, that produced by RA, probably leading to a specific effect [ 8 ].…”

The increased inter‐brain neural synchronization in prefrontal cortex between simulated patient and acupuncturist during acupuncture stimulation: Evidence from functional near‐infrared spectroscopy hyperscanning

“…As a new paradigm, hyperscanning realizes the conversion of traditional “one‐person” approach to “two or more person” approach and the transformation from brain–computer interaction to brain–brain coupling, which greatly enhanced the research on inter‐personal brain mechanism (Gvirts & Perlmutter, 2020 ; Schilbach et al, 2013 ). Recently, using hyperscanning techniques to reveal the influence of patient–doctor interaction on clinical outcomes attracts growing attention (Anzolin et al, 2020 ; Crum et al, 2022 ; Ellingsen et al, 2020 ; Ellingsen et al, 2022 ). For example, an fNIRS hyperscanning study reported that INS in the PFC of patient–doctor pair was significantly greater during clinical interactions compared to everyday‐life communication (Crum et al, 2022 ).…”

“…The blue and red curves represent the HbO time series from the ROI_1 of "patient" and acupuncturist, respectively. HbO, oxyhemoglobin; ROI, region of interest the influence of patient-doctor interaction on clinical outcomes attracts growing attention (Anzolin et al, 2020;Crum et al, 2022;Ellingsen et al, 2020;Ellingsen et al, 2022). For example, an fNIRS hyperscanning study reported that INS in the PFC of patientdoctor pair was significantly greater during clinical interactions compared to everyday-life communication (Crum et al, 2022).…”

“…In order to get desired therapeutic effects, the process of traditional Chinese acupuncture therapy requires a high degree of cooperation and a joint experience of needling sensation between the patient and acupuncturist. Both ancient literature and modern research confirmed that patientacupuncturist interaction was a critical influencing factor for acupuncture effects (Anzolin et al, 2020;Ellingsen et al, 2020;Ellingsen et al, 2022;Fei et al, 2022), and the enhanced interaction between acupuncturist and patient was associated with better therapeutic effect (Suarez-Almazor et al, 2010). The needling sensation is the key to obtaining acupuncture effect and an essential manifestation of patient-acupuncturist interaction.…”

Could neurofeedback improve therapist-patient communication? Considering the potential for neuroscience informed examinations of the psychotherapeutic relationship

“…In a therapeutic setting involving hyperscanning, there are potential opportunities for both the patient and therapist to detect dyadic influences on neural activation (Figure 2). One study found that brain-to-brain concordance between the mid/posterior insular cortex of the patient and the anterior insular cortex of the therapist were positively associated with subjective assessments of therapeutic alliance [Ellingsen et al 2022]. Another study showed that among therapist and chronic pain patient dyads, brain-to-brain concordance in networks involved in mentalizing and social mirroring resulted in increased patient analgesia [Ellingsen et al 2020].…”