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

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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.