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

摘要 患者与临床医生的互动是包括针灸在内的心身疗法的核心，其中心理社会因素，如临床医生的同理心和治疗联盟，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反映这些心理-社会相互作用背后的客观动态。 重要的是，大脑有一个镜像神经元电路，它支持在另一个人中观察到的经验被体验的能力，就好像它在自我中一样，这是一种对社会交流至关重要的功能。镜像神经元网络最早被报道为在观察到的和产生的运动中重叠，现在被描述为躯体感觉(例如，观察、想象或替代触摸)和社会(例如，移情)镜像。 此外，社交镜像网络的激活在社交互动时会在个体之间同步，更强的耦合可能反映出更成功的沟通。我们认为，治疗过程中社会镜像网络中的医患和谐是针灸的一个重要机制，并与治疗联盟密切相关。一旦协调性被确立为针刺止痛的重要机制(R61)，我们将致力于通过训练的、有针对性的增强相互作用的上下文(R33)来加强协调性和临床结果。测量镜像神经元网络在生态有效的临床医生/患者互动中的影响，需要同时监测两个人的大脑活动的能力(即，超扫描)。我们将注册并同时扫描两种不同的MRI扫描仪，针灸医生和纤维肌痛患者。在R61阶段，将使用“自然主义”的心理社会背景(没有明确的指导)，大脑的协调性将与疼痛结果相关。我们的目的将是确定患者/临床医生的脑协调在电针镇痛和治疗联盟中的作用，并评估脑活动协调是否预测针刺止痛。在R33阶段，我们将施加(1)旨在增强大脑一致性的“增强”交互作用，或(2)“有限的”商业类情境，以及一致性中介情境与止痛之间的关联的假设。我们的目标将是优化临床背景，然后调查这种“以和谐为目标的增强的”与“有限的”交互环境对治疗联盟和针灸医生/患者大脑和谐结果的影响。我们还将评估“以和谐为目标的增强的”与“有限的”交互环境对疼痛结果的影响。强调这些行为将使我们能够优化针灸和其他医疗疗法的医疗结果。

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.