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Optimization of brain-based mechanisms supporting psychosocial aspects of acupuncture therapy - a hyperscanning fMRI study

支持针灸治疗心理社会方面的基于大脑的机制的优化——一项超扫描功能磁共振成像研究

基本信息

批准号：
9999445
负责人：
Ted Kaptchuk
金额：
$ 76万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-09-15 至 2024-05-31
项目状态：
已结题

项目摘要

ABSTRACT The patient-clinician interaction is central to mind-body therapies, including acupuncture, where psychosocial factors, such as clinician empathy and therapeutic alliance, are the source of key mechanisms of action. While self-report assessments of therapeutic alliance correlate with clinical outcomes, such subjective measures do not reflect objective moment-to-moment dynamics underlying these psychosocial interactions. Importantly, the brain has a mirror neuron circuitry, which supports the ability of an observed experience in another to be experienced as if it were in the self, a function critical for social communication. Mirror neuron networks were first reported for overlap in observed and produced movements, and have now been described for both somatosensory (e.g. observed, imagined, or vicarious touch), and social (e.g. empathy) mirroring. Moreover, activation of social mirroring networks synchronizes between individuals when socially interacting, and stronger coupling may reflect more successful communication. We propose that patient-clinician concordance in social mirror networks during therapy represents an important mechanism of acupuncture and is strongly correlated with therapeutic alliance. Once concordance is established as an important mechanism of acupuncture analgesia (R61), we will aim to strengthen concordance and clinical outcomes by trained, targeted augmentation of the interaction context (R33). Measuring the influence of mirror neuron networks in an ecologically valid clinician / patient interaction necessitates the ability to monitor brain activity in two individuals simultaneously (i.e. hyperscanning). We will enroll and simultaneously scan in 2 different MRI scanners, acupuncturists and patients with fibromyalgia. In the R61 Phase, a “naturalistic” psychosocial context (without explicit instructions) will be used, and brain concordance will be correlated with pain outcomes. Our Aims will be to determine the role of patient/clinician brain concordance in EA analgesia and therapeutic alliance, and evaluate whether brain activity concordance predicts acupuncture analgesia. In the R33 stage, we will impose either (1) an “augmented” interaction, aimed at enhancing brain concordance, or (2) a “limited” business-like context, and hypothesize that concordance mediates the association between context and analgesia. Our Aims will be to optimize clinical context and then investigate influence of this “concordance-targeted augmented” vs. “limited” interaction context for therapeutic alliance and acupuncturist/patient brain concordance outcomes. We will also evaluate the influence of “concordance-targeted augmented” vs. “limited” interaction context on pain outcomes. Highlighting these behaviors will allow us to optimize healthcare outcomes for acupuncture and other medical therapies.

摘要患者与临床医生的互动是身心疗法的核心，包括针灸，其中心理社会因素，如临床医生的同情和治疗联盟，是关键作用机制的来源。虽然治疗联盟的自我报告评估与临床结果相关，但这种主观测量并不能反映这些心理社会相互作用背后的客观即时动态。重要的是，大脑有一个镜像神经元回路，它支持在另一个人身上观察到的经验能够像在自己身上一样被体验，这是一个对社会沟通至关重要的功能。镜像神经元网络首先被报道为观察到的和产生的运动的重叠，现在已经被描述为躯体感觉（例如观察，想象或替代触摸）和社会（例如移情）镜像。此外，社会镜像网络的激活在社会互动时会影响个体之间的互动，更强的耦合可能反映出更成功的沟通。我们提出，在治疗过程中社会镜像网络的患者-临床医生的一致性是针灸的一个重要机制，并与治疗联盟密切相关。一旦一致性被确立为针刺镇痛的重要机制（R61），我们的目标是通过训练，有针对性地增强互动环境（R33）来加强一致性和临床结果。测量镜像神经元网络在生态有效的临床医生/患者交互中的影响需要同时监测两个个体的大脑活动的能力（即超扫描）。我们将入组并同时在2台不同的MRI扫描仪上进行扫描，包括针灸师和纤维肌痛患者。在R61阶段，将使用“自然主义”心理社会背景（无明确说明），并且大脑一致性将与疼痛结局相关。我们的目的将是确定患者/临床医生的大脑一致性在EA镇痛和治疗联盟中的作用，并评估大脑活动一致性是否预测针刺镇痛。在R33阶段，我们将施加（1）一个“增强”的互动，旨在提高大脑的一致性，或（2）一个“有限的”类似商业的背景下，并假设一致性介导的上下文和镇痛之间的关联。我们的目标是优化临床环境，然后研究这种“一致性靶向增强”与“有限”相互作用环境对治疗联盟和穿刺医师/患者大脑一致性结局的影响。我们还将评估“一致性目标增强”与“有限”的互动背景对疼痛结局的影响。突出这些行为将使我们能够优化针灸和其他医学疗法的医疗保健结果。