Getting in touch: A neural model of comforting touch

Could neurofeedback improve therapist-patient communication? Considering the potential for neuroscience informed examinations of the psychotherapeutic relationship

Empathic communication between a patient and therapist is an essential component of psychotherapy. However, finding objective neural markers of the quality of the psychotherapeutic relationship have been elusive. Here we conceptualize how a neuroscience-informed approach involving real-time neurofeedback, facilitated via existing functional magnetic resonance imaging (fMRI) and electroencephalography (EEG) technologies, could provide objective information for facilitating therapeutic rapport. We propose several neurofeedback-assisted psychotherapy (NF-AP) approaches that could be studied as a way to optimize the experience of the individual patient and therapist across the spectrum of psychotherapeutic treatment. Finally, we consider how the possible strengths of these approaches are balanced by their current limitations and discuss the future prospects of NF-AP.

The effects of parental presence on amygdala and mPFC activation during fear conditioning: An exploratory study

Learning safe versus dangerous cues is crucial for survival. During development, parents can influence fear learning by buffering their children's stress response and increasing exploration of potentially aversive stimuli. Rodent findings suggest that these behavioral effects are mediated through parental presence modulation of the amygdala and medial prefrontal cortex (mPFC). Here, we investigated whether similar parental modulation of amygdala and mPFC during fear learning occurs in humans. Using a within-subjects design, behavioral (final N = 48, 6-17 years, mean = 11.61, SD = 2.84, 60% females/40% males) and neuroimaging data (final N = 39, 6-17 years, mean = 12.03, SD = 2.98, 59% females/41% males) were acquired during a classical fear conditioning task, which included a CS+ followed by an aversive noise (US; 75% reinforcement rate) and a CS-. Conditioning occurred once in physical contact with the participant's parent and once alone (order counterbalanced). Region of interest analyses examined the unconditioned stress response by BOLD activation to the US (vs. implicit baseline) and learning by activation to the CS+ (vs. CS-). Results showed that during US presentation, parental presence reduced the centromedial amygdala activity, suggesting buffering of the unconditioned stress response. In response to learned stimuli, parental presence reduced mPFC activity to the CS+ (relative to the CS-), although this result did not survive multiple comparisons' correction. These preliminary findings indicate that parents modulate amygdala and mPFC activity during exposure to unconditioned and conditioned fear stimuli, potentially providing insight into the neural mechanisms by which parents act as a social buffer during fear learning. RESEARCH HIGHLIGHTS: (1)This study used a within-participant experimental design to investigate how parental presence (vs. absence) affects youth's neural responses in a classical fear conditioning task. (2)Parental presence reduced the youth's centromedial amygdala activation to the unconditioned stimulus (US), suggesting parental buffering of the neural unconditioned response (UR). (3)Parental presence reduced the youth's mPFC activation to a conditioned threat cue (CS+) compared to a safety cue (CS-), suggesting possible parental modulation of fear learning.

Propensity to trust shapes perceptions of comforting touch between trustworthy human and robot partners

Touching a friend to comfort or be comforted is a common prosocial behaviour, firmly based in mutual trust. Emphasising the interactive nature of trust and touch, we suggest that vulnerability, reciprocity and individual differences shape trust and perceptions of touch. We further investigate whether these elements also apply to companion robots. Participants (n = 152) were exposed to four comics depicting human-human or human-robot exchanges. Across conditions, one character was sad, the other initiated touch to comfort them, and the touchee reciprocated the touch. Participants first rated trustworthiness of a certain character (human or robot in a vulnerable or comforting role), then evaluated the two touch phases (initiation and reciprocity) in terms of interaction realism, touch appropriateness and pleasantness, affective state (valence and arousal) attributed to the characters. Results support an interactive account of trust and touch, with humans being equally trustworthy when comforting or showing vulnerability, and reciprocity of touch buffering sadness. Although these phenomena seem unique to humans, propensity to trust technology reduces the gap between how humans and robots are perceived. Two distinct trust systems emerge: one for human interactions and another for social technologies, both necessitating trust as a fundamental prerequisite for meaningful physical contact.

Rapid Processing of Observed Touch through Social Perceptual Brain Regions: An EEG-fMRI Fusion Study

Seeing social touch triggers a strong social-affective response that involves multiple brain networks, including visual, social perceptual, and somatosensory systems. Previous studies have identified the specific functional role of each system, but little is known about the speed and directionality of the information flow. Is this information extracted via the social perceptual system or from simulation from somatosensory cortex? To address this, we examined the spatiotemporal neural processing of observed touch. Twenty-one human participants (seven males) watched 500-ms video clips showing social and nonsocial touch during electroencephalogram (EEG) recording. Visual and social-affective features were rapidly extracted in the brain, beginning at 90 and 150 ms after video onset, respectively. Combining the EEG data with functional magnetic resonance imaging (fMRI) data from our prior study with the same stimuli reveals that neural information first arises in early visual cortex (EVC), then in the temporoparietal junction and posterior superior temporal sulcus (TPJ/pSTS), and finally in the somatosensory cortex. EVC and TPJ/pSTS uniquely explain EEG neural patterns, while somatosensory cortex does not contribute to EEG patterns alone, suggesting that social-affective information may flow from TPJ/pSTS to somatosensory cortex. Together, these findings show that social touch is processed quickly, within the timeframe of feedforward visual processes, and that the social-affective meaning of touch is first extracted by a social perceptual pathway. Such rapid processing of social touch may be vital to its effective use during social interaction.SIGNIFICANCE STATEMENT Seeing physical contact between people evokes a strong social-emotional response. Previous research has identified the brain systems responsible for this response, but little is known about how quickly and in what direction the information flows. We demonstrated that the brain processes the social-emotional meaning of observed touch quickly, starting as early as 150 ms after the stimulus onset. By combining electroencephalogram (EEG) data with functional magnetic resonance imaging (fMRI) data, we show for the first time that the social-affective meaning of touch is first extracted by a social perceptual pathway and followed by the later involvement of somatosensory simulation. This rapid processing of touch through the social perceptual route may play a pivotal role in effective usage of touch in social communication and interaction.

Words hurt: common and distinct neural substrates underlying nociceptive and semantic pain

Introduction

Recent studies have shown that processing semantic pain, such as words associated with physical pain, modulates pain perception and enhances activity in regions of the pain matrix. A direct comparison between activations due to noxious stimulation and processing of words conveying physical pain may clarify whether and to what extent the neural substrates of nociceptive pain are shared by semantic pain. Pain is triggered also by experiences of social exclusion, rejection or loss of significant others (the so-called social pain), therefore words expressing social pain may modulate pain perception similarly to what happens with words associated with physical pain. This event-related fMRI study aims to compare the brain activity related to perceiving nociceptive pain and that emerging from processing semantic pain, i.e., words related to either physical or social pain, in order to identify common and distinct neural substrates.

Methods

Thirty-four healthy women underwent two fMRI sessions each. In the Semantic session, participants were presented with positive words, negative pain-unrelated words, physical pain-related words, and social pain-related words. In the Nociceptive session, participants received cutaneous mechanical stimulations that could be either painful or not. During both sessions, participants were asked to rate the unpleasantness of each stimulus. Linguistic stimuli were also rated in terms of valence, arousal, pain relatedness, and pain intensity, immediately after the Semantic session.

Results

In the Nociceptive session, the 'nociceptive stimuli' vs. 'non-nociceptive stimuli' contrast revealed extensive activations in SI, SII, insula, cingulate cortex, thalamus, and dorsolateral prefrontal cortex. In the Semantic session, words associated with social pain, compared to negative pain-unrelated words, showed increased activity in most of the same areas, whereas words associated with physical pain, compared to negative pain-unrelated words, only activated the left supramarginal gyrus and partly the postcentral gyrus.

Discussion

Our results confirm that semantic pain partly shares the neural substrates of nociceptive pain. Specifically, social pain-related words activate a wide network of regions, mostly overlapping with those pertaining to the affective-motivational aspects of nociception, whereas physical pain-related words overlap with a small cluster including regions related to the sensory-discriminative aspects of nociception. However, most regions of overlap are differentially activated in different conditions.

Therapeutic touch and therapeutic alliance in pediatric care and neonatology: An active inference framework

Therapeutic affective touch has been recognized as essential for survival, nurturing supportive interpersonal interactions, accelerating recovery-including reducing hospitalisations, and promoting overall health and building robust therapeutic alliances. Through the lens of active inference, we present an integrative model, combining therapeutic touch and communication, to achieve biobehavioural synchrony. This model speaks to how the brain develops a generative model required for recovery, developing successful therapeutic alliances, and regulating allostasis within paediatric manual therapy. We apply active inference to explain the neurophysiological and behavioural mechanisms that underwrite the development and maintenance of synchronous relationships through touch. This paper foregrounds the crucial role of therapeutic touch in developing a solid therapeutic alliance, the clinical effectiveness of paediatric care, and triadic synchrony between health care practitioner, caregiver, and infant in a variety of clinical situations. We start by providing a brief overview of the significance and clinical role of touch in the development of social interactions in infants; facilitating a positive therapeutic alliance and restoring homeostasis through touch to allow a more efficient process of allostatic regulation. Moreover, we explain the role of CT tactile afferents in achieving positive clinical outcomes and updating prior beliefs. We then discuss how touch is implemented in treatment sessions to promote cooperative interactions in the clinic and facilitate theory of mind. This underwrites biobehavioural synchrony, epistemic trust, empathy, and the resolution of uncertainty. The ensuing framework is underpinned by a critical application of the active inference framework to the fields of pediatrics and neonatology.

Pain control based on oscillatory brain activity using transcranial alternating current stimulation: An integrative review

Developing effective tools and strategies to relieve chronic pain is a high-priority scientific and clinical goal. In particular, the brain regions related to pain processing have been investigated as potential targets to relieve pain by non-invasive brain stimulation (NIBS). In addition to elucidating the relationship between pain and oscillatory brain activity, transcranial alternating current stimulation (tACS), which can non-invasively entrain oscillatory brain activity and modulate oscillatory brain communication, has attracted scientific attention as a possible technique to control pain. This review focuses on the use of tACS to relieve pain through the manipulation of oscillatory brain activity and its potential clinical applications. Several studies have reported that tACS on a single brain reduces pain by normalizing abnormal oscillatory brain activity in patients with chronic pain. Interpersonal tACS approaches based on inter-brain synchrony to manipulate inter-brain communication may result in pain relief via prosocial effects. Pain is encoded by the spatiotemporal neural communication that represents the integration of cognitive, emotional-affective, and sensorimotor aspects of pain. Therefore, future studies should seek to identify the pathological oscillatory brain communication in chronic pain as a therapeutic target for tACS. In conclusion, tACS could be effective for re-establishing oscillatory brain activity and assisting social interaction, and it might help develop novel approaches for pain control.

A thalamo-preoptic pathway promotes social grooming in rodents

Social touch is an essential component of communication. Little is known about the underlying pathways and mechanisms. Here, we discovered a novel neuronal pathway from the posterior intralaminar thalamic nucleus (PIL) to the medial preoptic area (MPOA) involved in the control of social grooming. We found that the neurons in the PIL and MPOA were naturally activated by physical contact between female rats and also by the chemogenetic stimulation of PIL neurons. The activity-dependent tagging of PIL neurons was performed in rats experiencing physical social contact. The chemogenetic activation of these neurons increased social grooming between familiar rats, as did the selective activation of the PIL-MPOA pathway. Neurons projecting from the PIL to the MPOA express the neuropeptide parathyroid hormone 2 (PTH2), and the central infusion of its receptor antagonist diminished social grooming. Finally, we showed a similarity in the anatomical organization of the PIL and the distribution of the PTH2 receptor in the MPOA between the rat and human brain. We propose that the discovered neuronal pathway facilitates physical contact with conspecifics.

An integrative perspective on the role of touch in the development of intersubjectivity

Touch concerns a fundamental component of sociality. In this review, we examine the hypothesis that somatomotor development constitutes a crucial psychophysiological element in the ontogeny of intersubjectivity. An interdisciplinary perspective is provided on how the communication channel of touch contributes to the sense of self and extends to the social self. During gestation, the transformation of random movements into organized sequences of actions with sensory consequences parallels the development of the brain's functional architecture. Brain subsystems shaped by the coordinated activity of somatomotor circuits to support these first body-environment interactions are the first brain functional arrangements to develop. We propose that tactile self-referring behaviour during gestation constitutes a prototypic mode of interpersonal exchange that supports the subsequent development of intersubjective exchange. The reviewed research suggests that touch constitutes a pivotal bodily experience that in early stages builds and later filters self-other interactions. This view is corroborated by the fact that aberrant social-affective touch experiences appear fundamentally associated with attachment anomalies, interpersonal trauma, and personality disorders. Given the centrality of touch for the development of intersubjectivity and for psychopathological conditions in the social domain, dedicated research is urged to elucidate the role of touch in the evolution of subjective self-other coding.

Therapeutic Alliance as Active Inference: The Role of Therapeutic Touch and Biobehavioural Synchrony in Musculoskeletal Care

Touch is recognised as crucial for survival, fostering cooperative communication, accelerating recovery, reducing hospital stays, and promoting overall wellness and the therapeutic alliance. In this hypothesis and theory paper, we present an entwined model that combines touch for alignment and active inference to explain how the brain develops "priors" necessary for the health care provider to engage with the patient effectively. We appeal to active inference to explain the empirically integrative neurophysiological and behavioural mechanisms that underwrite synchronous relationships through touch. Specifically, we offer a formal framework for understanding - and explaining - the role of therapeutic touch and hands-on care in developing a therapeutic alliance and synchrony between health care providers and their patients in musculoskeletal care. We first review the crucial importance of therapeutic touch and its clinical role in facilitating the formation of a solid therapeutic alliance and in regulating allostasis. We then consider how touch is used clinically - to promote cooperative communication, demonstrate empathy, overcome uncertainty, and infer the mental states of others - through the lens of active inference. We conclude that touch plays a crucial role in achieving successful clinical outcomes and adapting previous priors to create intertwined beliefs. The ensuing framework may help healthcare providers in the field of musculoskeletal care to use hands-on care to strengthen the therapeutic alliance, minimise prediction errors (a.k.a., free energy), and thereby promote recovery from physical and psychological impairments.

Of Orchids and Dandelions: Empathy but Not Sensory Processing Sensitivity Is Associated with Tactile Discrimination Abilities

Many concepts of the human personality are based on assumptions about underlying physiological processes. The most prominent example is probably the concept of extraversion introduced by H.J. Eysenck decades ago. However, more recent approaches also propose that personality traits may be reflected by physiological processes. For example, empathic personality dimensions have been linked to tactile perception, suggesting that individuals with higher tactile sensitivity are also more empathetic to the sensations of others. Another recent example is the concept of sensory processing sensitivity, which has been linked to enhanced primary sensory processing. However, the exact relationship between tactile abilities and personality is still unclear, thus the current study aims to test whether different personality dimensions affect the performance in a tactile acuity task. Tactile abilities of healthy participants were tested with tactile 2-point-thresholds on the hands. Personality dimensions were examined with respect to empathy, sensory processing sensitivity, and the Big Five. Results revealed that empathy, but not sensory processing sensitivity, was associated with tactile performance. We conclude that the ability to feel with someone else seems to be linked to the perception of our own body. Thus, the sense of touch may play an important role for empathy. We discuss explanations of these results and highlight possible implications of our findings.

Therapeutic Alliance as Active Inference: The Role of Therapeutic Touch and Synchrony

Recognizing and aligning individuals' unique adaptive beliefs or "priors" through cooperative communication is critical to establishing a therapeutic relationship and alliance. Using active inference, we present an empirical integrative account of the biobehavioral mechanisms that underwrite therapeutic relationships. A significant mode of establishing cooperative alliances-and potential synchrony relationships-is through ostensive cues generated by repetitive coupling during dynamic touch. Established models speak to the unique role of affectionate touch in developing communication, interpersonal interactions, and a wide variety of therapeutic benefits for patients of all ages; both neurophysiologically and behaviorally. The purpose of this article is to argue for the importance of therapeutic touch in establishing a therapeutic alliance and, ultimately, synchrony between practitioner and patient. We briefly overview the importance and role of therapeutic alliance in prosocial and clinical interactions. We then discuss how cooperative communication and mental state alignment-in intentional communication-are accomplished using active inference. We argue that alignment through active inference facilitates synchrony and communication. The ensuing account is extended to include the role of (C-) tactile afferents in realizing the beneficial effect of therapeutic synchrony. We conclude by proposing a method for synchronizing the effects of touch using the concept of active inference.