Therapist reactions to patient personality: A pilot study of clinicians’ emotional and neural responses using three clinical vignettes from "In Treatment" series

Introduction: Therapists’ responses to patients play a crucial role in psychotherapy and are considered a key component of the patient–clinician relationship, which promotes successful treatment outcomes. To date, no empirical research has ever investigated therapist response patterns to patients with different personality disorders from a neuroscience perspective. Methods: In the present study, psychodynamic therapists (N = 14) were asked to complete a battery of instruments (including the Therapist Response Questionnaire) after watching three videos showing clinical interactions between a therapist and three patients with narcissistic, histrionic/borderline, and depressive personality disorders, respectively. Subsequently, participants’ high-density electroencephalography (hdEEG) was recorded as they passively viewed pictures of the patients’ faces, which were selected from the still images of the previously shown videos. Supervised machine learning (ML) was used to evaluate whether: (1) therapists’ responses predicted which patient they observed during the EEG task and whether specific clinician reactions were involved in distinguishing between patients with different personality disorders (using pairwise comparisons); and (2) therapists’ event-related potentials (ERPs) predicted which patient they observed during the laboratory experiment and whether distinct ERP components allowed this forecast. Results: The results indicated that therapists showed distinct patterns of criticized/devalued and sexualized reactions to visual depictions of patients with different personality disorders, at statistically systematic and clinically meaningful levels. Moreover, therapists’ late positive potentials (LPPs) in the hippocampus were able to determine which patient they observed during the EEG task, with high accuracy. Discussion: These results, albeit preliminary, shed light on the role played by therapists’ memory processes in psychotherapy. Clinical and neuroscience implications of the empirical investigation of therapist responses are discussed

An fNIRS investigation of perceptual, motor and linguistic representations of complex actions

Objective The present work aimed at exploring potential associations and similarities of perceptual, motor and linguistic representations of complex real-life actions, with a specific interest in potential sensorimotor activation effects induced by the observation of such behaviors or the use of relative action verbs. While it is indeed known that observing simple motor acts (e.g. precision grasping) and listening to the sound of specific actions (e.g. walking) activate sensorimotor structures, less is known when we move to more complex behaviors and more abstract representations (e.g. verbal description, action verbs). We then aimed at investigating hemodynamic activation patterns of the sensorimotor network during different action-related tasks based on complex every-day activities. Participants and methods 20 volunteers were asked to actually execute, observe, or listen to brief verbal descriptions of complex goal-directed real-life actions, or, again, to observe them while listening to their description or to execute them while listening to their description. Cortical functional data have been collected via optical imaging (functional Near-Infrared Spectroscopy - fNIRS). Results The analysis of fNIRS data highlighted that, in the left hemisphere (contralateral to target actions), hemodynamic responses were the lowest during observation of complex actions and observation coupled with listening of consistent simple verbal description of actions, greater during simple listening of verbal description of actions, and maximal when participants actually executed complex actions and when they executed them while listening to consistent simple verbal descriptions. Conclusion Present results suggest that listening to verbal description of actions might keep the sensorimotor network more active than simply observing them, and that coupling execution of complex action with listening of their description similarly recruit sensorimotor regions with respect to simple action execution. Such first evidences hint at potential implication for novel rehabilitation procedures of movement and action deficits

Multiple representations for complex everyday gestures: hemodynamic (fNIRS) correlates of action observation, execution, and listening

Objective: Actions are complex events characterized by multimodal representations. Following the common coding theory, perceptual and motor representations of actions are linked by a common computational code and share common neural substrates. Further, according to the embodied semantics theory, even coding of linguistic material may be fostered by perceptual and motor systems. The present work thus aimed at exploring potential associations of perceptual, motor and linguistic representations of complex real-life actions. In particular, we were interested in hemodynamic activation patterns within sensorimotor areas induced by the observation of such motor acts or the listening to their verbal description. Participants and Methods: Twenty volunteers took part in the study. The experimental design included five blocked conditions: action execution; action observation; listening to brief verbal descriptions of actions; action observation coupled with listening to their verbal description; and action execution coupled with listening to their verbal description. Hemodynamic activity in premotor and sensorimotor cortical regions was monitored and recorded via optical imaging (functional Near-Infrared Spectroscopy \u2013 fNIRS). Results: Hemodynamic data analysis showed that activation in left cortical regions was the lowest during observation of complex actions and observation coupled with listening of description of actions, greater during simple listening of verbal description of actions, and maximal when participants actually executed complex actions and when execution was coupled with listening to consistent verbal descriptions. Conclusions: Findings began hinting at potential practical implications of using verbal description of actions to modulate the activation of specific structures constituting the sensorimotor network and at their potential for prompting the access to stored action representations via alternative neural pathways

Functional correlates of perceptual, motor and linguistic representations of complex actions: electrophysiological and optical imaging data

Similarities between action observation and action execution processes \u2013 as well as action imagination and simulation ones \u2013 have been consistently reported to date by electrophysiological, neuroimaging and brain stimulation studies. According to the common coding hypothesis, perceptual and motor representations are associated and ground on a common computational code. Observing an action, then, would prime the relative action representation, and executing an action would facilitate relative representations of its perceivable effects. Furthermore, a link has been suggested between motor and conceptual-linguistic representations of actions and supported, for example, by behavioural evidences on the action-sentence compatibility effect. The present study aims at extending existing observations on simple actions and at investigating electrophysiological (EEG) and hemodynamic (functional Near-Infrared Spectroscopy, fNIRS) correlates of the execution and observation of complex common actions. So to explore potentially shared encoding processes with respect to conceptual-linguistic representations of those actions, we also looked at cortical correlates of listening to their relative verbal descriptions. Twenty healthy young adults took part in the study and were asked to: observe realistic complex actions (e.g. to pour some wine), actually execute them, or listen to their verbal description (brief verb and object phrases, e.g. \u201cpour some wine\u201d). We also included two combined tasks (observation and listening; execution and listening) so to investigate potential cross-facilitation effects. The integrated recording setup included 15 evenly distributed EEG electrodes and 16 fNIRS channels (over bilateral prefrontal and pre-motor regions). The analysis of EEG data highlighted the role of contralateral sensorimotor areas in all experimental tasks, as marked by a modulation of the upper-alpha band, and task-specific modulations of oscillatory activity over midline electrodes. Conversely, fNIRS prefrontal and pre-motor hemodynamic responses mainly highlighted task-specific peculiarities, with greater contralateral activity during action execution, lower activation during action observation, and no relevant hemispheric asymmetries during the listening conditions. To sum up, electrophysiological findings pointed out interesting similarities in motor and somatosensory cortical activity during observation, execution and listening conditions even when focusing on realistic actions, in line with common coding theories. Task specificities revealed by fNIRS measures might instead mirror the differential role of anterior cortical structures

Therapist reactions to patient personality: A pilot study of clinicians’ emotional and neural responses using three clinical vignettes from In Treatment series

Introduction: Therapists’ responses to patients play a crucial role in psychotherapy and are considered a key component of the patient–clinician relationship, which promotes successful treatment outcomes. To date, no empirical research has ever investigated therapist response patterns to patients with different personality disorders from a neuroscience perspective. Methods: In the present study, psychodynamic therapists (N = 14) were asked to complete a battery of instruments (including the Therapist Response Questionnaire) after watching three videos showing clinical interactions between a therapist and three patients with narcissistic, histrionic/borderline, and depressive personality disorders, respectively. Subsequently, participants’ high-density electroencephalography (hdEEG) was recorded as they passively viewed pictures of the patients’ faces, which were selected from the still images of the previously shown videos. Supervised machine learning (ML) was used to evaluate whether: (1) therapists’ responses predicted which patient they observed during the EEG task and whether specific clinician reactions were involved in distinguishing between patients with different personality disorders (using pairwise comparisons); and (2) therapists’ event-related potentials (ERPs) predicted which patient they observed during the laboratory experiment and whether distinct ERP components allowed this forecast. Results: The results indicated that therapists showed distinct patterns of criticized/devalued and sexualized reactions to visual depictions of patients with different personality disorders, at statistically systematic and clinically meaningful levels. Moreover, therapists’ late positive potentials (LPPs) in the hippocampus were able to determine which patient they observed during the EEG task, with high accuracy. Discussion: These results, albeit preliminary, shed light on the role played by therapists’ memory processes in psychotherapy. Clinical and neuroscience implications of the empirical investigation of therapist responses are discussed

Haemodialysis treatment in uremic patients: investigation of the correlation between depression, reward system and chronic fatigue

Haemodialysis is considered a life-saving treatment, allowing a good level of survival for uremic patients waiting for organ transplant. Uraemia, if not addressed in an adequate manner, can lead to death. However, treatment greatly influences the patient\u2019s life. Eighty percent of patients has chronic fatigue, affecting the quality of life (QoL). Fatigue is a multidimensional symptom. The \u201cphysical\u201d dimension is linked to obvious bodily limitations, but recovery mechanisms save all of their effectiveness, allowing to get the strength back as a result of an adequate rest period. The \u201cmotivational\u201d dimension, however, is more complex and refers to a central fatigue, often associated with pain, disturbed sleep, affective and cognitive disorders. In spite of studies carried out in groups of patients with chronic disease, suggest that psychological interventions to decrease the fatigue is necessary, these interventions are not available for haemodialysis patients. The aim of this study is to evaluate the level of fatigue, assuming a comorbidity with a past of anxiety and depression, and how the motivation mechanisms are affected with a significant impact on QoL. Evaluative scales have been administered to a sample of haemodialysis patients (N=94) older than 18 years, with no neurocognitive disease. Fatigue Severity Scale (FSS) has been applied to measure the impact of fatigue on motivation and social functionality. BIS/BAS Scale has been administered to investigate the mechanisms of reward: Behavioural Activation System (BAS) and Behavioural Inhibition System (BIS) result in behavioural inhibition/activation to rewards/punishments. Finally, the State-Trait Anxiety Inventory (STAI-Y) and the Back Depression Inventory (BDI-II) have been used to evaluate the potential presence of anxiety and depression disorders. For a qualitative analysis, a semi-structured interview has been performed. The results show a linear correlation between the fatigue and depression level: a. Fatigue is directly proportional to symptoms such as sadness, frustration, irritability, difficulty concentrating and loss of interest. b. The inclination to act, led by the BAS system, is inversely proportional to depression. Therefore, its indirect correlation with chronic fatigue is conceivable. c. The BIS system, on the other hand, is directly related to the sense of fatigue, especially in men. This study shows that the sense of fatigue is not exclusively linked to pathophysiologic factors of uraemia and haemodialysis but to a central fatigue on a psychological level. A psychosocial intervention would be useful to improve the QoL of the haemodialysis patients, lessening the \u201cfatigue\u201d symptom

The effect of centesimal prismatic lenses on attention orienting processes: neuroscientific evidence

Prismatic Adaptation has different clinical applications but, given its association with attention orienting mechanisms, it might hold a potential even for neurocognitive empowerment. The present study aimed at investigating the empowerment effect of a protocol based on centesimal prismatic lenses (SiXDEVICE\u2122) on attention orientation processes and their electrophysiological markers (event-related potentials, ERPs) by using a spatial cueing paradigm. Twenty participants were divided into an experimental group, training with SiXDEVICE\u2122, and an active control group, performing traditional visual training. The comparison of pre/post-training performance measures and ERP markers of attention orienting \u2013 namely, the P300 component \u2013 highlighted qualitatively different patterns of performance modulation between the groups and a significant reduction of P300 amplitude over parietal areas in response to invalid cue trials in experimental participants. Preliminary results hint at the potential of the tested optical device and protocol as supportive tools to foster attention skills even in healthy people

Action perception and suboptimal motor performances: electrophysiological correlates

Objective: The activation of sensorimotor cortical structures can be enhanced by observing actions. Such cross-modal interaction is influenced by expertise, as shown by studies focused on complex expert gestures and on high-level motor proficiency. Conversely, the potential influence of familiarity with suboptimal motor performances on observers’ sensorimotor activation is still poorly explored, notwithstanding potential practical implications in clinical contexts. Following on a preliminary TMS study, we then devised an electrophysiological (EEG) investigation of processes supporting observation of complex actions performed by healthy individuals and patients affected by multiple sclerosis (MS). Participants and Methods: Twenty volunteers were asked to carefully observe videos depicting a healthy confederate, a minimally-impaired MS patient, a mildly-impaired MS patient, or a confederate trying to simulate mild motor difficulties who were performing a task tapping on fine motor abilities. EEG activity was recorded during the observation of videos. EEG frequency components were then extracted to analyse their modulation across conditions and video reiterations. Results: Data analysis highlighted globally lower beta power during the observation of patients’ videos with respect to confederate’s videos, even when he simulated poor motor performances. In addition, EEG activity in the beta range over somatosensory regions proved to gradually increase across videos reiterations, but only while participants observed the minimally-impaired patient’ performance. Conclusions: Findings suggest that even observation of suboptimal motor performances leads to a modulation of the activity of sensorimotor structures and corroborate the hypothesis that familiarity with peculiar kinematic patterns might modulate sensorimotor responses to observed actions, as if such suboptimal motor performances were progressively integrated into the individual repository of motor schemata

Correlati EEG dell\u2019osservazione di azioni. Integrazione visuo-motoria e osservazione di performance motorie sub-ottimali

Diverse evidenze in letteratura hanno mostrato come l\u2019osservazione di azioni possa incrementare l\u2019attivazione del sistema sensomotorio. Tale effetto \ue8 stato ricondotto a meccanismi di priming e di facilitazione delle risposte neurali. In aggiunta, si \ue8 osservato come i processi di facilitazione visuo-motoria e di osservazione di azioni possano essere influenzati dall\u2019esperienza. Il ruolo dell\u2019esperienza \ue8 stato, per\uf2, principalmente studiato focalizzando le indagini su atti motori che richiedono elevati livelli di competenza (e.g. danza). Di conseguenza, mentre \ue8 stato dimostrato che l\u2019osservazione di gesti tecnici che sono stati oggetto di allenamento induce maggiore responsivit\ue0 motoria in gruppi di atleti, non sono ancora presenti dati consolidati circa i possibili effetti dell\u2019osservazione di performance motorie deficitarie. Tali effetti sono stati indagati con un primo studio di stimolazione cerebrale non-invasiva (TMS - Transcranial Magnetic Stimulation), che ha mostrato come la responsivit\ue0 della corteccia motoria possa essere modulata anche dalla visione di performance motorie sub-ottimali. Al fine di approfondire tali evidenze, \ue8 stato quindi effettuato un secondo studio grazie al quale indagare i correlati elettrofisiologici (EEG) dell\u2019osservazione di azioni complesse effettuate da individui con e senza difficolt\ue0 motorie. 20 volontari hanno preso parte allo studio EEG e osservato diverse clip video in cui un attore eseguiva il Nine-Hole Peg Test, un compito standardizzato di motricit\ue0. Il compito poteva essere eseguito da un confederato senza difficolt\ue0 di movimento, da un paziente affetto da sclerosi multipla con lievi deficit motori, da un paziente affetto da sclerosi multipla con deficit motori moderati, o da un confederato che tentava di simulare lievi deficit motori. L\u2019analisi dei dati di power per le principali bande di frequenza EEG ha evidenziato una generale diminuzione della prevalenza di attivit\ue0 della banda beta durante l\u2019osservazione di performance motorie deficitarie, ma solo se reali e non simulate. In aggiunta, in corrispondenza delle aree somatosensoriali, il power di beta ha presentato un progressivo incremento associato alla reiterazione degli stimoli, particolarmente evidente per quanto riguarda il video del paziente con lievi difficolt\ue0 motorie. In linea con la lettura funzionale delle oscillazioni beta, tali evidenze suggeriscono la presenza di una progressiva integrazione delle performance motorie sub-ottimali negli schemi motori degli osservatori, fenomeno riconducibile all\u2019intrinseca sensibilit\ue0 e responsivit\ue0 del sistema sensomotorio umano

An electrophysiological investigation of action observation: evidences for integration of suboptimal movement performances

Neural priming and facilitation phenomena have been observed in sensorimotor cortical regions during observation of actions. The effects of such visual-motor facilitation have been shown via non-invasive brain stimulation (NIBS) and imaging techniques. Related mechanisms proved to be modelled by practice and influenced by previous motor expertise. Nonetheless, the role of expertise has been primarily studied by focusing on high-level motor proficiency, while the potential effects of coding suboptimal motor performances is still unclear. A first NIBS study highlighted that the responsivity of the sensorimotor system can be modulated by observing poorly-executed actions. To better understand those evidences, we devised an electrophysiological (EEG) study to explore functional correlates of the observation of optimal vs. suboptimal execution of complex actions. Electroencephalographic data have been recorded from twenty right-handed healthy young adults while they observed four randomly reiterated videos. Videos depicted a healthy confederate, a minimally-impaired MS patient, a mildly-impaired MS patient, or a confederate trying to simulate mild motor difficulties performing the Nine Hole Peg Test (NHPT), a test tapping on fine motor abilities. EEG data have been processed to extract frequency-domain metrics. Frequency-domain data have been analysed taking into account trials and conditions, so to also explore habituation trends. We observed globally lower beta power during the observation of patients\u2019 videos with respect to confederate\u2019s videos, even when he simulated poor motor performances. Again, beta activity over somatosensory areas gradually increased across reiterations of the minimally-impaired patient\u2019 video. Those evidences corroborate the hypothesis that familiarity with peculiar kinematic patterns might modulate sensorimotor responses to observed actions and they might mirror a progressive integration of slightly suboptimal motor performances into participants\u2019 motor schemata. Further, present findings may inform on the innate sensitivity and responsivity of human sensorimotor system