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

• 批准号: 9348587
• 负责人: Ted Kaptchuk
• 金额: $ 47.04万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-15 至 2018-09-14
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9348587
• 关键词: Absence of pain sensation; Acupuncture Analgesia; Acupuncture Therapy; Anterior; Base of the Brain; Behavior; Brain; Businesses; Clinical; Communication; Coupling; Data; Electroacupuncture; Empathy; Enrollment; Eye; Face; Fibromyalgia; Functional Magnetic Resonance Imaging; Healthcare; Individual; Instruction; Insula of Reil; Intake; Intervention; Interview; Joints; Link; Magnetic Resonance Imaging; Measures; Mediating; Medical; Mind-Body Intervention; Monitor; Motor; Movement; Needles; Outcome; Pain; Pain Disorder; Patient Self-Report; Patients; Phase; Prefrontal Cortex; Psyche structure; Psychosocial Assessment and Care; Psychosocial Factor; Reporting; Role; Scanning; Social Behavior; Social support; Source; Therapeutic; Tissues; Touch sensation; Training; base; body-mind; brain circuitry; chronic widespread pain; experience; mirror neuron; psychosocial; relating to nervous system; response; social; social communication; somatosensory; spatiotemporal

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 - 临床医生的互动是思维体疗法的核心，包括针灸，在这种情况下，社会心理因素（例如临床同理心和治疗联盟）是关键作用机理的来源。尽管对治疗联盟的自我报告评估与临床结果相关，但这种主题措施并不能反映这些社会心理相互作用的基于的客观时刻动力学。 重要的是，大脑具有一个镜像神经元电路，该电路支持观察到的经历的能力，就像它在自我中一样，这对于社交交流至关重要。首先报道了镜像神经元网络在观察和产生的运动中重叠，现在已经描述了体感（例如观察，想象或替代触摸）和社交（例如移情）镜像。 此外，社交镜像网络的激活在社交互动时在个人之间同步，并且更强的耦合可能反映出更成功的沟通。我们建议在治疗期间，社交镜网络中的患者 - 阵容一致性代表着针灸的重要机制，并且与治疗联盟密切相关。一旦建立了一致性作为针灸镇痛的重要机制（R61），我们将通过受过训练的，有针对性的相互作用环境（R33）来增强一致性和临床结果（R33）。在生态有效的临床 /患者相互作用中测量镜像神经元网络的影响必要的能力，可以简单地监测两个个体的大脑活动（即高扫描）。我们将在2种不同的MRI扫描仪，Accuspuncturists和纤维肌痛患者中轻松扫描并轻松扫描。在R61阶段，将使用“自然主义”的社会心理环境（无明确的说明），并且大脑一致性将与疼痛结果相关。我们的目标是确定患者/临床医生大脑一致性在EA镇痛和治疗联盟中的作用，并评估大脑活动一致性是否预测针灸镇痛。在R33阶段，我们将（1）旨在增强大脑一致性的“增强”相互作用，或者（2）类似“有限”的业务状态，并假设一致性介导了环境与镇痛之间的关联。我们的目的是优化临床环境，然后研究这种“以一致性的增强”的影响，与治疗联盟和针灸师/患者大脑一致性结果的“有限”相互作用背景。我们还将评估“以一致性的增强”与“有限”的相互作用背景对疼痛结果的影响。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保健结果。