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

支持针灸治疗心理社会方面的基于大脑的机制的优化——一项超扫描功能磁共振成像研究

基本信息

批准号：
9999445
负责人：
Ted Kaptchuk
金额：
$ 76万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-09-15 至 2024-05-31
项目状态：
已结题

项目摘要

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.

抽象的患者临床医生是思维疗法的核心，是关键作用机理的来源，这种主观措施并不能反映这些心理社会相互作用的客观力矩到时刻的动态。重要的是，大脑具有一个镜子电路，该电路支持经验丰富的经验，例如在In。LF中，这是社交通信至关重要的功能。动作，现在已经描述了体感（例如观察到，想象中的或替代的触摸）和社交（例如同理心）的镜像。此外，网络在个人之间同步，更强的耦合可能会反映出更努力的沟通。针灸镇痛（R61）下雨了，靶向相互作用的靶向增强（R33）在生态有效的临床医生 /患者相互作用中测量了镜像神经元网络的影响在R61阶段的2个不同的MRIST和疼痛结果中，在R61阶段的肌痛中，疼痛是一致的。（1）旨在增强大脑一致性的“增强”，（2）“有限的”类似商业的上下文ze，一致性介导了我们的目标和镇痛之间的关联。以一致性为目标的增强“ vs.”有限的“ UTIC联盟和针灸师/患者脑的一致性结果”。我们还将评估“与一致性靶向的增强”。“有限的”相互作用背景。