Impact of Theory of Mind Training on Brain-to-Brain Patient-Clinician Concordance

摘要 病人与临床医生的互动是大多数治疗的核心，并得到关键人际关系的支持。 行动机制，如临床医生的同情，治疗联盟和信任。然而，神经 这种影响的基础大多是未知的。我们最近发表的研究应用功能性磁共振成像（fMRI） 超扫描（即，在同步MRI中同时对慢性疼痛患者和临床医生进行神经成像 扫描仪）表明，在颞顶交界处（TPJ）的脑-脑一致性上调 在临床相互作用后，与患者镇痛相关。我们的研究还发现， 表达镜像与更高的治疗联合和更大的诱发疼痛镇痛相关。 有趣的是，TPJ被认为是心理理论处理（ToM，即心理化， 观点采择），定义为推断和理解他人心理状态的能力--一种认知功能 对社交沟通、同理心和社交镜像至关重要。此外，ToM培训方案具有 被发现可以提高心智能力，这可以推广到其他认知/生活质量功能。我们 提出患者/临床医生TPJ一致性，与ToM处理相关，是治疗的一个关键方面， 联盟，因此对纤维肌痛患者进行ToM训练将增加联盟，面部表情镜像， TPJ一致性，后者介导针灸治疗后疼痛结局的改善， 已确立的慢性疼痛非药物疗法。纤维肌痛是一种伤害性慢性疼痛障碍 在心理理论处理中表现出缺陷，可能导致社会功能的困难 这种疾病的特征，并且非常需要新的治疗方法。我们的研究将评估一部小说的影响 多模式治疗，一种已知可改善疼痛结局的方法，由美国医学研究所推荐。 慢性疼痛管理的医学报告。我们的研究设计也将允许我们评估一个神经模型， 支持纤维肌痛疼痛结局的治疗联盟，其中组合的ToM训练和 针灸将协同地靶向关键的治疗途径-即，患者-提供者联盟，实例化 TPJ concordance。我们的目的是：（1）确定心理理论训练的行为和神经生理效应， (2)通过功能磁共振成像超扫描评估心理理论训练对脑-脑一致性的影响，以及（3） 评估大脑/行为标记物是否介导心理理论训练对纵向针灸结果的影响。

Abstract The patient-clinician interaction is central to most therapies and is supported by key interpersonal mechanisms of action such as clinician empathy, therapeutic alliance, and trust. However, the neural underpinnings of this effect are mostly unknown. Our recently published study applied functional MRI (fMRI) hyperscanning (i.e. simultaneously neuroimaging chronic pain patients and clinicians in synchronized MRI scanners) demonstrated that brain-to-brain concordance in the temporoparietal junction (TPJ) is up-regulated following a clinical interaction and associated with patient analgesia. Our study also found that greater facial expression mirroring is associated with higher therapeutic alliance and greater evoked pain analgesia. Interestingly, the TPJ is known to be a key region for theory-of-mind processing (ToM, i.e. mentalizing, perspective-taking), defined as the ability to infer and understand others’ mental states - a cognitive function critical for social communication, empathy, and social mirroring. Furthermore, ToM training protocols have been found to improve mentalizing ability, which can generalize to other cognitive / quality of life functions. We propose that patient/clinician TPJ concordance, linked with ToM processing, is a key aspect of therapeutic alliance, and thus ToM training for fibromyalgia patients will increase alliance, facial expression mirroring, and TPJ concordance, with the latter mediating improvements in pain outcomes following acupuncture therapy, an established non-pharmacological therapy for chronic pain. Fibromyalgia is a nociplastic chronic pain disorder showing a deficit in ToM processing, potentially contributing to the difficulties in social functioning characterizing this condition, and in great need of novel therapies. Our study will evaluate the impact of a novel multimodal therapy, a type of approach known to improve pain outcomes and recommended by the Institute of Medicine report for chronic pain management. Our study design will also allow us to evaluate a neural model supporting therapeutic alliance for pain outcomes for fibromyalgia wherein combined ToM training and acupuncture will synergistically target a critical therapeutic pathway - i.e., patient-provider alliance, instantiated by TPJ concordance. Our Aims will: (1) Determine behavioral and neurophysiological effects of ToM training, (2) Evaluate the impact of ToM training on brain-to-brain concordance with fMRI hyperscanning, and (3) Assess if brain/behavioral markers mediate the effect of ToM training on longitudinal acupuncture outcomes.