Toward an Embodied, Embedded Predictive Processing Account

Osteopathy is a person-centred healthcare discipline that emphasizes the body’s structure-function interrelationship—and its self-regulatory mechanisms—to inform a whole-person approach to health and wellbeing. This paper aims to provide a theoretical framework for developing an integrative hypothesis in osteopathy, which is based on the enactivist and active inference accounts. We propose that osteopathic care can be reconceptualised under (En)active inference as a unifying framework. Active inference suggests that action-perception cycles operate to minimize uncertainty and optimize an individual’s internal model of the lived world and, crucially, the consequences of their behaviour. We argue that (En)active inference offers an integrative framework for osteopathy, which can evince the mechanisms underlying dyadic and triadic (e.g., in paediatric care) exchanges and osteopathic care outcomes. We propose that this theoretical framework can underpin osteopathic care across the lifespan, from preterm infants to the elderly and those with persistent pain and other physical symptoms. In situations of chronicity, as an ecological niche, the patient-practitioner dyad provides the osteopath and the patient with a set of affordances, i.e., possibilities for action provided by the environment, that through shared intentionally, can promote adaptations and restoration of productive agency. Through a dyadic therapeutic relationship, as they engage with their ecological niche’s affordances—a structured set of affordances shared by agents—osteopath and patient actively construct a shared sense-making narrative and realise a shared generative model of their relation to the niche. In general, touch plays a critical role in developing a robust therapeutic alliance, mental state alignment, and biobehavioural synchrony between patient and practitioner. However, its role is particularly crucial in the fields of neonatology and paediatrics, where it becomes central in regulating allostasis and restoring homeostasis. We argue that from an active inference standpoint, the dyadic shared ecological niche underwrites a robust therapeutic alliance, which is crucial to the effectiveness of osteopathic care. Considerations and implications of this model—to clinical practice and research, both within- and outside osteopathy—are critically discussed.

Section: Bayesian Brain Persistent Physical Symptoms and The Sense Of...mentioning

confidence: 99%

Osteopathic Care as (En)active Inference: A Theoretical Framework for Developing an Integrative Hypothesis in Osteopathy

Esteves

Cerritelli²,

Kim

et al. 2022

“…The dependence on embodied priors occurs implicitly, without the requirement to explicitly remember past events (Hutchinson and Barrett, 2019). The comparison of predictions with incoming sensory information forms prediction errors, which serve as corrective feedback and can be minimized using two strategies: (1) changing sensory input through action or (2) changing the internal models of the world (prediction signals) (Venter, 2021).…”

Section: The Predictive Brain and Experience-based Generative Representationsmentioning

confidence: 99%

“…Moments of creative not-knowing may emerge and hence the need for active exploration, innovation and generative possibilities. In that sense, CATs may encompass both strategies to engage predictive processing neurodynamics -sampling new sensory input through action (active inference) and shaping the internal models of the world (prediction signals) through meaning-making (Venter, 2021).…”

Section: The Development and Use Of A Predictive Brain In The Therapeutic Realmmentioning

confidence: 99%

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

Vaisvaser

2021

The recognition and incorporation of evidence-based neuroscientific concepts into creative arts therapeutic knowledge and practice seem valuable and advantageous for the purpose of integration and professional development. Moreover, exhilarating insights from the field of neuroscience coincide with the nature, conceptualization, goals, and methods of Creative Arts Therapies (CATs), enabling comprehensive understandings of the clinical landscape, from a translational perspective. This paper contextualizes and discusses dynamic brain functions that have been suggested to lie at the heart of intra- and inter-personal processes. Touching upon fundamental aspects of the self and self-other interaction, the state-of-the-art neuroscientific-informed views will shed light on mechanisms of the embodied, predictive and relational brain. The conceptual analysis introduces and interweaves the following contemporary perspectives of brain function: firstly, the grounding of mental activity in the lived, bodily experience will be delineated; secondly, the enactive account of internal models, or generative predictive representations, shaped by experience, will be defined and extensively deliberated; and thirdly, the interpersonal simulation and synchronization mechanisms that support empathy and mentalization will be thoroughly considered. Throughout the paper, the cross-talks between the brain and the body, within the brain through functionally connected neural networks and in the context of agent-environment dynamics, will be addressed. These communicative patterns will be elaborated on to unfold psychophysiological linkage, as well as psychopathological shifts, concluding with the neuroplastic change associated with the formulation of CATs. The manuscript suggests an integrative view of the brain-body-mind in contexts relevant to the therapeutic potential of the expressive creative arts and the main avenues by which neuroscience may ground, enlighten and enrich the clinical psychotherapeutic practice.

“…In applying the concepts of embodied cognition to our putative osteopathic framework, it is essential to critically appraisal its theoretical foundations. Crucially, we should differentiate between weaker and more robust versions of embodied cognition, where the non-neural body either contributes to or constitutes cognitive processes, respectively ( Venter, 2021 ). Thus, embodied cognition cannot be regarded as a single viewpoint.…”

Section: Embodied Cognitionmentioning

confidence: 99%

“…The brain can minimize prediction errors in two ways: perceptual inference and active inference. Whereas perceptual inference involves revising the generative model based on prediction errors transmitted up the hierarchy, in active inference , the agent actively acts upon the world to create the state of the world predicted by the current best generative model ( Venter, 2021 ). Active inference is based on the assumption that the brain modifies its afferent sensory input according to prior expectations ( Paulus et al, 2019 ).…”

Section: Predictive Codingmentioning

confidence: 99%

Osteopathy and Mental Health: An Embodied, Predictive, and Interoceptive Framework

Bohlen¹,

Shaw

Cerritelli

et al. 2021

Globally, mental and musculoskeletal disorders present with high prevalence, disease burden, and comorbidity. In order to improve the quality of care for patients with persistent physical and comorbid mental health conditions, person-centered care approaches addressing psychosocial factors are currently advocated. Central to successful person-centered care is a multidisciplinary collaboration between mental health and musculoskeletal specialists underpinned by a robust therapeutic alliance. Such a collaborative approach might be found in osteopathy, which is typically utilized to treat patients with musculoskeletal disorders but may arguably also benefit mental health outcomes. However, research and practice exploring the reputed effect of osteopathy on patients with mental health problems lack a robust framework. In this hypothesis and theory article, we build upon research from embodied cognition, predictive coding, interoception, and osteopathy to propose an embodied, predictive and interoceptive framework that underpins osteopathic person-centered care for individuals with persistent physical and comorbid mental health problems. Based on the premise that, for example, chronic pain and comorbid depression are underlined by overly precise predictions or imprecise sensory information, we hypothesize that osteopathic treatment may generate strong interoceptive prediction errors that update the generative model underpinning the experience of pain and depression. Thus, physical and mental symptoms may be reduced through active and perceptual inference. We discuss how these theoretical perspectives can inform future research into osteopathy and mental health to reduce the burden of comorbid psychological factors in patients with persistent physical symptoms and support person-centered multidisciplinary care in mental health.