[The DoC-feeling scale, a paramedical assessment tool improving the diagnostic accuracy of the state of consciousness of non-communicative patients]

The Neurological Intensive Care Unit (ICU) at Pitié-Salpêtrière Hospital cares for patients with severe brain injuries, which can lead to acute or chronic disorders of consciousness. To assess the patient's state of consciousness, the team relies on precise clinical examination. This article presents the assessment tools used to establish the patient's prognosis.

What distinguishes emotion-label words from emotion-laden words? The characterization of affective meaning from a multi-componential conception of emotions

Past research that distinguishes between affective and neutral words has predominantly relied on two-dimensional models of emotion focused on valence and arousal. However, these two dimensions cannot differentiate between emotion-label words (e.g., fear) and emotion-laden words (e.g., death). In the current study, we aimed to determine the unique affective characteristics that differentiate emotion-label, emotion-laden, and neutral words. Therefore, apart from valence and arousal, we considered different affective features of multi-componential models of emotion: action, assessment, expression, feeling, and interoception. The study materials included 800 Spanish words (104 emotion-label words, 340 emotion-laden words, and 356 neutral words). To examine the differences between each word type, we carried out a Principal Component Analysis and a Random Forest Classifier technique. Our results indicate that these words are characterized more precisely when the two-dimensional approach is combined with multi-componential models. Specifically, our analyses revealed that feeling, interoception and valence are key features in accurately differentiating between emotion-label, emotion-laden, and neutral words.

Finding Words for Feeling Bodies: Exploring Drawing Techniques in Dutch Care Practices

Feeling is difficult to put into words. Anthropologists have been seeking ways to articulate feeling or other bodily experiences, looking beyond words and borrowing from artistic methods. Drawings, for instance, have been used to make visible what words cannot describe and attributed with qualities associated with feeling or the body. Instead of placing drawing in opposition to words, and words in opposition to bodies, this article presents different ways of using drawing as an ethnographic technique to tentatively find practice-specific words to articulate practices of feeling the body. Rather than evaluating drawings based on their ability to capture feeling bodies, the author reflects on the drawing process as a way to learn about her research subjects in unexpected ways. Thereby, the author learns from artistic practices, not about making drawings, but about making methods. Acknowledging that methodologies are always generative, the author dives into the making of her methodologies to learn about her research subjects. .

Basic Emotions or Constructed Emotions: Insights From Taking an Evolutionary Perspective

The ongoing debate between basic emotion theories (BETs) and the theory of constructed emotion (TCE) hampers progress in the field of emotion research. Providing a new perspective, here we aim to bring the theories closer together by dissecting them according to Tinbergen's four questions to clarify a focus on their evolutionary basis. On the basis of our review of the literature, we conclude that whereas BETs focus on the evolution question of Tinbergen, the TCE is more concerned with the causation of emotion. On the survival value of emotions both theories largely agree: to provide the best reaction in specific situations. Evidence is converging on the evolutionary history of emotions but is still limited for both theories-research within both frameworks focuses heavily on the causation. We conclude that BETs and the TCE explain two different phenomena: emotion and feeling. Therefore, they seem irreconcilable but possibly supplementary for explaining and investigating the evolution of emotion-especially considering their similar answer to the question of survival value. Last, this article further highlights the importance of carefully describing what aspect of emotion is being discussed or studied. Only then can evidence be interpreted to converge toward explaining emotion.

'Development and psychometric evaluation of the safety feeling scale in adult patients at hospital: Exploratory sequential mixed method'

AIM AND OBJECTIVES

This study aimed to develop and examine psychometric properties of the safety feeling scale (SFS) in adult patients to assess their sense of safety during a hospital stay.

DESIGN

Mixed methods design. A SQUIRE checklist was used.

METHODS

This is a study with two phases of scale development and evaluation of the psychometric properties of the scale. In the first phase, the concept of 'safety feeling' was analysed using a hybrid model. Thus, a systematic review and then a qualitative study with hospitalized patients (n = 31) were conducted by conventional content analysis. In the psychometric phase, factorial validity, reliability, feasibility, and responsiveness of the scale were evaluated by different tests in various samples.

RESULTS

After integrating the results of the systematic review and qualitative study, a scale item pool with 84 items was developed. In the psychometric phase, 12 items with four factors were specified; 'effective care,' 'confidence in the healthcare team,' 'emotional enrichment' and 'hygienic facilities,' explaining 51% of the total variance of the scale. They were confirmed by confirmatory factor analysis. Internal consistency and stability of the scale were satisfactory. Feasibility and responsiveness were also acceptable.

Emotional state as a modulator of autonomic and somatic nervous system activity in postural control: a review

Advances in our understanding of postural control have highlighted the need to examine the influence of higher brain centers in the modulation of this complex function. There is strong evidence of a link between emotional state, autonomic nervous system (ANS) activity and somatic nervous system (somatic NS) activity in postural control. For example, relationships have been demonstrated between postural threat, anxiety, fear of falling, balance confidence, and physiological arousal. Behaviorally, increased arousal has been associated with changes in velocity and amplitude of postural sway during quiet standing. The potential links between ANS and somatic NS, observed in control of posture, are associated with shared neuroanatomical connections within the central nervous system (CNS). The influence of emotional state on postural control likely reflects the important influence the limbic system has on these ANS/somatic NS control networks. This narrative review will highlight several examples of behaviors which routinely require coordination between the ANS and somatic NS, highlighting the importance of the neurofunctional link between these systems. Furthermore, we will extend beyond the more historical focus on threat models and examine how disordered/altered emotional state and ANS processing may influence postural control and assessment. Finally, this paper will discuss studies that have been important in uncovering the modulatory effect of emotional state on postural control including links that may inform our understanding of disordered control, such as that observed in individuals living with Parkinson's disease and discuss methodological tools that have the potential to advance understanding of this complex relationship.

Assessing Affective Valence and Activation in Stretching Activities with the Feeling Scale and the Felt Arousal Scale: A Systematic Review

Affective responses have been considered key determinants for exercise adherence, but research on affective responses to stretching activities is scarce. Given the role of these responses in exercise adherence, our aim in this review was to explore (a) the utility and feasibility of core affect in stretching-related activities as measured by the Feeling Scale (FS) and/or the Felt Arousal Scale (FAS); (b) the timing of administering these scales; and (c) the scales' applicability and interpretability in this context. Inclusion criteria for studies in this review were experimental and non-experimental studies written in English that based affect assessment on the FS and/or FAS and that applied these scales to participants engaged in physical activity, individually or in groups. We also considered studies that focused on stretching activities that were either isolated or components of a class/activity and studies that used healthy participants of any age. Exclusion criteria were populations with mental health problems, cancer, diabetes, hypertension, cardiovascular disease, or diseases likely to alter pain perception or be associated with chronic pain, instrument validation studies, gray literature, and systematic reviews. We searched PubMed, SPORTDiscus and PsycINFO databases, and we added studies retrieved manually from reference sections while following PRISMA guidelines. We used the Effective Public Health Practice Project tool for judging methodological quality of research articles. Our final analyses were based on 12 empirical studies published between 2003 and 2021with a total of 718 participants. Both scales were found to be useful and feasible in the most usual places for exercise, but core affect results cannot be properly interpreted due to variability of study protocols and the absence of guidelines for adequate baseline assessment. Most studies recorded affect responses pre-session, during session, and post-session. We observed no standardized timing or frequency of assessment, and there was high heterogeneity among stretching protocols. Currently, research in core affect assessment of stretching-related activities lacks sufficient methodological quality to draw generalizable conclusions.

Methods used by Canadian dairy farmers for on-farm euthanasia and the emotions associated with the decision and the practice of euthanasia

On-farm euthanasia is complicated in that farmers have to make the decision to end the life of an animal they are caring for. Studies have shown that some culling decisions are made too late, which results in animal welfare issues. However, information about on-farm euthanasia methods and the decision process leading to the euthanasia of an animal is limited. Additionally, emotions and feelings are involved in the decision and the act of euthanasia. The objectives of this study were to describe current practices related to on-farm euthanasia performed by Canadian dairy farmers and to assess the emotions and complex feelings surrounding the act. A cross-sectional study design was used to gather this information through an online questionnaire completed exclusively by Canadian dairy farmers. Data were analyzed descriptively using frequencies, and associations between the participants' characteristics and their practices and emotions regarding on-farm euthanasia were assessed using logistic regression models. A total of 479 dairy farmers from 5 provinces answered the survey. The most commonly used primary method of on-farm euthanasia was a firearm (>70%). Unacceptable euthanasia methods, such as standard 0.22-caliber long rifle for adult cows or no adjunct method following the use of captive bolt, were used by 25%, 18%, and 58% of the participants for calves, replacement animals, and dairy cows, respectively. Ninety-four percent of the participants reported that the farm owner was the person who always or often made the euthanasia decisions. In addition, 32% of the participants reported that the veterinarian always examined the animal before performing euthanasia, 51% reported at least one person received training to perform euthanasia, and 16% reported having a decision tree for euthanasia. Some participants (17%) were troubled with the responsibility for ending the life of their animals, and 19% perceived other people on the farm to be uncomfortable with performing euthanasia. Half of the participants reported that people performing euthanasia on the farm felt at least one related painful emotion or complex feeling, and half reported they had at least one reason to feel anxiety or unease concerning euthanasia. The results of this study showed gaps such as the limited use of acceptable euthanasia methods and decision trees by Canadian dairy farmers, low availability of on-farm training for euthanasia, and variable involvement of veterinarians.

[Learning about the caregiving relationship in the internship]

Nursing students are confronted with the mysteries of the patient encounter during their internship in psychiatry. From this discovery, questions and enigmas remain to be solved. This ephemeral primary relationship, in a time span of a few weeks, is a source of frustration for them. In this context, the presence and professionalism of the team are precious assets that the student must seize. Discovery of the profession of psychiatric nurse illustrated by the testimonies of two students.

The importance of developing care-worker-centered robotic aides in long-term care

Recent research points to the fact that new medical technological innovations are just as relevant in the context of long-term care or chronic care as they are in the context of acute care. In the spirit of the Nuffield Foundation recommendations, this paper explores the possibilities of using robotic aides in long-term care and identifies the tensions that must be considered and addressed if robotics is to be introduced successfully in nursing homes. Our examination is two-pronged. First, we delve into a fundamental issue surrounding AI, namely that of consciousness. We argue that automation will always have only a limited use in caregiving since caregiving as an activity requires the use of human-type, that is, organic, consciousness. We support the thesis that the emergence and formation of human-type consciousness require feelings such as empathy and the sense of touch, which, in turn, create the sense of kinship with fellow human beings. And second, we examine the benefits as well as risks of using robotic aides such as ZORA and PARO in long-term care facilities. More specifically, we look at ZORA's use in a group setting, and PARO's use in an individual setting. We emphasize that long-term care is one-on-one care, including but not limited to intimate care. Crucially, we argue that touch is at the heart of this type of care. We argue that some of the tensions with the use of robotic aides are generated precisely because of the lack of human touch.

[Socio-cognitive correlates of life satisfaction of students of the National University aged 55-80 years.]

Achieving life satisfaction in a complex epidemiological situation that determines chronic stress, a prolonged regime of socio-economic restrictions and self-isolation, increased mortality, seems to be an urgent and at the same time difficult to solve task. Therefore, understanding the socio-cognitive correlates of life satisfaction after 55 years allows us to model its mental constructions that have a stress-protective property, with the subsequent possibility of their psychological correction. The purpose of the study is to theoretically substantiate, identify and discuss the results of the correlation analysis of the relationship between socio-cognitive characteristics and life satisfaction after 55 years. The hypothesis of the study is based on the assumption of the relationship between the studied indicators. Theoretical analysis of the phenomenology of life satisfaction (life satisfaction) revealed the socio-cognitive nature and emotional, reflective and evaluative indication of its occurrence, functioning and dynamics. Psychodiagnostic methods were used: the questionnaire «Your well-being» (O.S.Kopina, E.A.Suslov, E.V.Zaikin), methods for diagnosing the presence and severity of irrational attitudes (A.Ellis), methods for diagnosing socio-psychological characteristics (T.Leary). The sample consisted of people aged 56-80 years in the number of 80 people. Correlation analysis revealed the conditionality of indicators of life satisfaction and socio-cognitive characteristics of a person in old age.

HeartMath Coherence Model Throws New Light on Arka Dhyana Intuitive Meditation

In an experimental evaluation of an introductory Arka Dhyana (Intuitive Meditation) course, HeartMath (HM) Inner Balance or emWave2 electronic technology showed highly significant increases in both coherence and achievement in six participants who learned how to change their level of consciousness as proposed by the Theory of the Six Main Levels of Consciousness. During the course, which was offered to an international audience via Zoom technology, participants intended to connect with their deeper self, being, or essence, by bringing their I-ego-awareness from the thinking mind, often associated with the frontal part of the brain, to 19 energetic stations in the body including the heart centre. Considering the results from the HeartMath Coherence Model viewpoint, it seems this intended shift leads to cardiovascular phase synchronicity and interconnection of various bodily subsystems, which is also comprehensible based on our bodily development during embryogenesis. Qualitative statements involving feeling also point to increases in well-being, indicating changes in levels and individual transformative experiences as predicted by the Theory of the Six Main Levels of Consciousness. Increased focus, stilling of the mind, and calming of emotions also seem to be health benefit by-products of Intuitive Meditation (IM), but further research on more advanced practitioners is needed. This preliminary study needs to be repeated using a bigger sample size and further research on more advanced IM practitioners is required.

Neural Design Principles for Subjective Experience: Implications for Insects

How subjective experience is realized in nervous systems remains one of the great challenges in the natural sciences. An answer to this question should resolve debate about which animals are capable of subjective experience. We contend that subjective experience of sensory stimuli is dependent on the brain's awareness of its internal neural processing of these stimuli. This premise is supported by empirical evidence demonstrating that disruption to either processing streams or awareness states perturb subjective experience. Given that the brain must predict the nature of sensory stimuli, we reason that conscious awareness is itself dependent on predictions generated by hierarchically organized forward models of the organism's internal sensory processing. The operation of these forward models requires a specialized neural architecture and hence any nervous system lacking this architecture is unable to subjectively experience sensory stimuli. This approach removes difficulties associated with extrapolations from behavioral and brain homologies typically employed in addressing whether an animal can feel. Using nociception as a model sensation, we show here that the Drosophila brain lacks the required internal neural connectivity to implement the computations required of hierarchical forward models. Consequently, we conclude that Drosophila, and those insects with similar neuroanatomy, do not subjectively experience noxious stimuli and therefore cannot feel pain.

[Observation: a tool, a technique, a different way of working]

In nurseries, observation is not only a tool for understanding a child's clinical condition. It gives the professional the possibility to adopt a different position, free from bookish knowledge and focused totally on what the child shows. However, it requires learning and time for team reflection so that it is not limited to one interpretation. Testimony.

Feeling Positive About Reopening? New Normal Scenarios From COVID-19 US Reopen Sentiment Analytics

The Coronavirus pandemic has created complex challenges and adverse circumstances. This research identifies public sentiment amidst problematic socioeconomic consequences of the lockdown, and explores ensuing four potential public sentiment associated scenarios. The severity and brutality of COVID-19 have led to the development of extreme feelings, and emotional and mental healthcare challenges. This research focuses on emotional consequences - the presence of extreme fear, confusion and volatile sentiments, mixed along with trust and anticipation. It is necessary to gauge dominant public sentiment trends for effective decisions and policies. This study analyzes public sentiment using Twitter Data, time-aligned to the COVID-19 reopening debate, to identify dominant sentiment trends associated with the push to reopen the economy. Present research uses textual analytics methodologies to analyze public sentiment support for two potential divergent scenarios - an early opening and a delayed opening, and consequences of each. Present research concludes on the basis of textual data analytics, including textual data visualization and statistical validation, that tweets data from American Twitter users shows more positive sentiment support, than negative, for reopening the US economy. This research develops a novel sentiment polarity based public sentiment scenarios (PSS) framework, which will remain useful for future crises analysis, well beyond COVID-19. With additional validation, this research stream could present valuable time sensitive opportunities for state governments, the federal government, corporations and societal leaders to guide local and regional communities, and the nation into a successful new normal future.

Effects of Depressive Symptoms, Feelings, and Interoception on Reward-Based Decision-Making: Investigation Using Reinforcement Learning Model

Background: In this study, we examined the relationships between reward-based decision-making in terms of learning rate, memory rate, exploration rate, and depression-related subjective emotional experience, in terms of interoception and feelings, to understand how reward-based decision-making is impaired in depression. Methods: In all, 52 university students were randomly assigned to an experimental group and a control group. To manipulate interoception, the participants in the experimental group were instructed to tune their internal somatic sense to the skin-conductance-response waveform presented on a display. The participants in the control group were only instructed to stay relaxed. Before and after the manipulation, the participants completed a probabilistic reversal-learning task to assess reward-based decision-making using reinforcement learning modeling. Similarly, participants completed a probe-detection task, a heartbeat-detection task, and self-rated scales. Results: The experimental manipulation of interoception was not successful. In the baseline testing, reinforcement learning modeling indicated a marginally-significant correlation between the exploration rate and depressive symptoms. However, the exploration rate was significantly associated with lower interoceptive attention and higher depressive feeling. Conclusions: The findings suggest that situational characteristics may be closely involved in reward exploration and highlight the clinically-meaningful possibility that intervention for affective processes may impact reward-based decision-making in those with depression.

[Caregivers' perceptions and coping strategies in Ehpad]

The increasing number of residents suffering from neurocognitive diseases, in nursing homes, makes care complex. Behavioral disorders, associated with these pathologies, generate many feelings among professional caregivers which can influence care practices.

How Funerals Accomplish Family: Findings From a Mass-Observation Study

The article analyses how potentially conflicting frames of grief and family operate in a number of English funerals. The data come from the 2010 Mass-Observation directive “Going to Funerals” which asked its panel of correspondents to write about the most recent funeral they had attended. In their writings, grief is displayed through conventional understandings of family. Drawing on Randall Collins, we show how the funeral stratifies mourners into family or nonfamily, a stratification accomplished—by family and nonfamily—through both outward display and inner feeling. The funerals described were more about a very traditional notion of family than about grief; family trumped grief, or at least provided the frame through which grief could be written about; and perceptions of “family” prompted emotions which in turn defined family. The funerals were portrayed as a distinct arena privileging family over the fluid and varied personal attachments highlighted in both the new sociology of personal life and in the concept of disenfranchised grief.

Emotion recognition depends on subjective emotional experience and not on facial expressivity: evidence from traumatic brain injury

BACKGROUND

Recognizing how others feel is paramount to social situations and commonly disrupted following traumatic brain injury (TBI). This study tested whether problems identifying emotion in others following TBI is related to problems expressing or feeling emotion in oneself, as theoretical models place emotion perception in the context of accurate encoding and/or shared emotional experiences.

METHODS

Individuals with TBI (n = 27; 20 males) and controls (n = 28; 16 males) were tested on an emotion recognition task, and asked to adopt facial expressions and relay emotional memories according to the presentation of stimuli (word and photos). After each trial, participants were asked to self-report their feelings of happiness, anger and sadness. Judges that were blind to the presentation of stimuli assessed emotional facial expressivity.

RESULTS

Emotional experience was a unique predictor of affect recognition across all emotions while facial expressivity did not contribute to any of the regression models. Furthermore, difficulties in recognizing emotion for individuals with TBI were no longer evident after cognitive ability and experience of emotion were entered into the analyses.

CONCLUSIONS

Emotion perceptual difficulties following TBI may stem from an inability to experience affective states and may tie in with alexythymia in clinical conditions.

Maps of subjective feelings

Subjective feelings are a central feature of human life. We defined the organization and determinants of a feeling space involving 100 core feelings that ranged from cognitive and affective processes to somatic sensations and common illnesses. The feeling space was determined by a combination of basic dimension rating, similarity mapping, bodily sensation mapping, and neuroimaging meta-analysis. A total of 1,026 participants took part in online surveys where we assessed (i) for each feeling, the intensity of four hypothesized basic dimensions (mental experience, bodily sensation, emotion, and controllability), (ii) subjectively experienced similarity of the 100 feelings, and (iii) topography of bodily sensations associated with each feeling. Neural similarity between a subset of the feeling states was derived from the NeuroSynth meta-analysis database based on the data from 9,821 brain-imaging studies. All feelings were emotionally valenced and the saliency of bodily sensations correlated with the saliency of mental experiences associated with each feeling. Nonlinear dimensionality reduction revealed five feeling clusters: positive emotions, negative emotions, cognitive processes, somatic states and illnesses, and homeostatic states. Organization of the feeling space was best explained by basic dimensions of emotional valence, mental experiences, and bodily sensations. Subjectively felt similarity of feelings was associated with basic feeling dimensions and the topography of the corresponding bodily sensations. These findings reveal a map of subjective feelings that are categorical, emotional, and embodied.

Designing Brains for Pain: Human to Mollusc

There is compelling evidence that the "what it feels like" subjective experience of sensory stimuli arises in the cerebral cortex in both humans as well as mammalian experimental animal models. Humans are alone in their ability to verbally communicate their experience of the external environment. In other species, sensory awareness is extrapolated on the basis of behavioral indicators. For instance, cephalopods have been claimed to be sentient on the basis of their complex behavior and anecdotal reports of human-like intelligence. We have interrogated the findings of avoidance learning behavioral paradigms and classical brain lesion studies and conclude that there is no evidence for cephalopods feeling pain. This analysis highlighted the questionable nature of anthropometric assumptions about sensory experience with increased phylogenetic distance from humans. We contend that understanding whether invertebrates such as molluscs are sentient should first begin with defining the computational processes and neural circuitries underpinning subjective awareness. Using fundamental design principles, we advance the notion that subjective awareness is dependent on observer neural networks (networks that in some sense introspect the neural processing generating neural representations of sensory stimuli). This introspective process allows the observer network to create an internal model that predicts the neural processing taking place in the network being surveyed. Predictions arising from the internal model form the basis of a rudimentary form of awareness. We develop an algorithm built on parallel observer networks that generates multiple levels of sensory awareness. A network of cortical regions in the human brain has the appropriate functional properties and neural interconnectivity that is consistent with the predicted circuitry of the algorithm generating pain awareness. By contrast, the cephalopod brain lacks the necessary neural circuitry to implement such an algorithm. In conclusion, we find no compelling behavioral, functional, or neuroanatomical evidence to indicate that cephalopods feel pain.

Balancing bioethics by sensing the aesthetic

This article is critical of "bioethics" as it is widely understood and taught, noting in particular an emphasis given to philosophical justification, reason and rationality. It is proposed that "balancing" bioethics be achieved by giving greater weight to practice and the aesthetic: Defined in terms of sensory perception, emotion and feeling. Each of those three elements is elaborated as a non-cognitive capacity and, when taken together, comprise aesthetic sensitivity and responsiveness. This is to recognise the aesthetic as a productive element in bioethics as practice. Contributions from the philosophy of art and aesthetics are drawn into the discussion to bring depth to an understanding of "the aesthetic". This approach is buttressed by philosophers - including Foucault and 18th century German philosophers (in particular Kant) - who recognized a link between ethics and aesthetics. The article aims to give substance to a claim that bioethics necessarily comprises a cognitive component, relating to reason, and a non-cognitive component that draws on aesthetic sensibility and relates to practice. A number of advantages of bioethics, understood to explicitly acknowledge the aesthetic, are proffered. Having defined bioethics in conventional terms, there is discussion of the extent to which other approaches to bioethics (including casuistry, virtue ethics, and narrative ethics) recognize aesthetic sensitivity in their practice. It is apparent that they do so to varying extents although not always explicitly. By examining this aspect of applied ethics, the paper aims to draw attention to aesthetic sensitivity and responsiveness as integral to ethical and effective health care.

How does health feel? Towards research on the affective atmospheres of digital health

The concept of affective atmospheres has recently emerged in cultural geography to refer to the feelings that are generated by the interactions and movements of human and nonhuman actors in specific spaces and places. Affective atmospheres can have profound effects on the ways in which people think and feel about and sense the spaces they inhabit and through which they move and the other actors in those spaces. Thus far, very little research has adopted this concept to explore the ways in which digital health technologies are used. As part of seeking to redress this lacuna, in this essay I draw on previously published literature on affective atmospheres to demonstrate and explain the implications of this scholarship for future theoretical and empirical scholarship about digital health practices that pays attention to their affective and sensory elements. The article is structured into six parts. The first part outlines the concepts and research practices underpinning affective atmospheres scholarship. In the second part, I review some of the research that looks at place, space and mobilities in relation to affective atmospheres. In the third part I focus more specifically on the affective atmospheres of medical encounters, and then move on to digital technology use in the fourth part. I then address in the fifth part, some relevant scholarship on digital health technologies. I end the essay with some reflections of directions in which future research taking up the concept of affective atmospheres in the context of digital health technologies can go. The key research question that these topics all work towards is that asking ‘How does digital health feel?’

The Insula: An Underestimated Brain Area in Clinical Neuroscience, Psychiatry, and Neurology

Supported by recent human neuroimaging studies, the insula is re-emerging as an important brain area not only in the physiological understanding of the brain, but also in pathological contexts in clinical research. In this opinion article, we briefly introduce the anatomical and histological features of the human insula. We then summarize the physiological functions of the insula and underscore its pathological roles in psychiatric and neurological disorders that have long been underestimated. We finally propose possible strategies through which the role of the insula may be further understood for both basic and clinical neuroscience.

The Brainstem in Emotion: A Review

Emotions depend upon the integrated activity of neural networks that modulate arousal, autonomic function, motor control, and somatosensation. Brainstem nodes play critical roles in each of these networks, but prior studies of the neuroanatomic basis of emotion, particularly in the human neuropsychological literature, have mostly focused on the contributions of cortical rather than subcortical structures. Given the size and complexity of brainstem circuits, elucidating their structural and functional properties involves technical challenges. However, recent advances in neuroimaging have begun to accelerate research into the brainstem’s role in emotion. In this review, we provide a conceptual framework for neuroscience, psychology and behavioral science researchers to study brainstem involvement in human emotions. The “emotional brainstem” is comprised of three major networks – Ascending, Descending and Modulatory. The Ascending network is composed chiefly of the spinothalamic tracts and their projections to brainstem nuclei, which transmit sensory information from the body to rostral structures. The Descending motor network is subdivided into medial projections from the reticular formation that modulate the gain of inputs impacting emotional salience, and lateral projections from the periaqueductal gray, hypothalamus and amygdala that activate characteristic emotional behaviors. Finally, the brainstem is home to a group of modulatory neurotransmitter pathways, such as those arising from the raphe nuclei (serotonergic), ventral tegmental area (dopaminergic) and locus coeruleus (noradrenergic), which form a Modulatory network that coordinates interactions between the Ascending and Descending networks. Integration of signaling within these three networks occurs at all levels of the brainstem, with progressively more complex forms of integration occurring in the hypothalamus and thalamus. These intermediary structures, in turn, provide input for the most complex integrations, which occur in the frontal, insular, cingulate and other regions of the cerebral cortex. Phylogenetically older brainstem networks inform the functioning of evolutionarily newer rostral regions, which in turn regulate and modulate the older structures. Via these bidirectional interactions, the human brainstem contributes to the evaluation of sensory information and triggers fixed-action pattern responses that together constitute the finely differentiated spectrum of possible emotions.

Feeling one's way in the world: Making a life

This paper argues for the psychoanalytic relevance of the works of James Gibson and Susanne Langer in explicating the early development of the human child and makes use of this combined formulation of development to think about psychoanalytic theory and practice. From the insights of James Gibson's ecological psychology we can appreciate the embodiment and embeddedness of the child's growing mind within both her physical and social environments. Making use of Susanne Langer's concept of feeling to redefine ecological psychology's perceptual counterpart to action allows us to understand the child's seamless transition into active participation in her culture, as she learns to project her animalian capacity to feel into intersubjectively defined forms of behavior and experience with others. The paper presents a lengthy exposition of Gibson's ecological psychology, before explaining Langer's thinking and launching into the combined insights of these scholars to explicate the nature of the child's mind as she feels her way in the world and makes a life for herself within it. This is the life she will be able to remake in the embeddedness of a psychoanalytic therapeutic relationship where she can learn to feel her way in the world in a new light.

Effects of oriental medicine music therapy in an ovarian cancer patient with So-Eum-type constitution: a case report

The cancer incidence in Korea has been increasing, although there is a serious lack of supportive care for the treatment and management of the rapidly increasing number of cancer patients, and there is an immense need for therapeutic interventions to support cancer patients. A 47-year-old So-Eum-type Korean female patient, who was diagnosed with ovarian cancer, had been receiving chemotherapies. She was experiencing pain due to swelling of her hands and feet, and under extreme stress due to hardships of life. During the patient's fourth chemotherapy treatment, she received oriental medicine music therapy twice per week for 2 weeks, for 1 hour each time (4 sessions in total). A self-administered questionnaire and the visual analog scale were used to assess and determine the level of negative and positive feelings. After receiving the oriental medicine music therapy, her negative and positive feelings as well as the visual analog scale score that reflects subjective health conditions have improved and stabilized. This case report suggests the potential of oriental medicine music therapy as a complementary and alternative medical treatment method to promote and enhance quality of life and health conditions of cancer patients in postsurgical care and chemotherapy treatment.

The neural subjective frame: from bodily signals to perceptual consciousness

The report 'I saw the stimulus' operationally defines visual consciousness, but where does the 'I' come from? To account for the subjective dimension of perceptual experience, we introduce the concept of the neural subjective frame. The neural subjective frame would be based on the constantly updated neural maps of the internal state of the body and constitute a neural referential from which first person experience can be created. We propose to root the neural subjective frame in the neural representation of visceral information which is transmitted through multiple anatomical pathways to a number of target sites, including posterior insula, ventral anterior cingulate cortex, amygdala and somatosensory cortex. We review existing experimental evidence showing that the processing of external stimuli can interact with visceral function. The neural subjective frame is a low-level building block of subjective experience which is not explicitly experienced by itself which is necessary but not sufficient for perceptual experience. It could also underlie other types of subjective experiences such as self-consciousness and emotional feelings. Because the neural subjective frame is tightly linked to homeostatic regulations involved in vigilance, it could also make a link between state and content consciousness.

The feeling of action tendencies: on the emotional regulation of goal-directed behavior

In this article, we review the nature of the functional and causal relationship between neurophysiologically/psychologically generated states of emotional feeling and action tendencies and extrapolate a novel perspective. Emotion theory, over the past century and beyond, has tended to regard feeling and action tendency as independent phenomena: attempts to outline the functional and causal relationship that exists between them have been framed therein. Classically, such relationships have been viewed as unidirectional, but an argument for bidirectionality rooted in a dynamic systems perspective has gained strength in recent years whereby the feeling–action tendency relationship is viewed as a composite whole. On the basis of our review of somatic–visceral theories of feelings, we argue that feelings are grounded upon neural-dynamic representations (elevated and stable activation patterns) of action tendency. Such representations amount to predictions updated by cognitive and bodily feedback. Specifically, we view emotional feelings as minimalist predictions of the action tendency (what the agent is physiologically and cognitively primed to do) in a given situation. The essence of this point is captured by our exposition of action tendency prediction–feedback loops which we consider, above all, in the context of emotion regulation, and in particular, of emotional regulation of goal-directed behavior. The perspective outlined may be of use to emotion theorists, computational modelers, and roboticists.