Teaching Behavioral Pain Management to Healthcare Professionals: A Systematic Review of Research in Training Programs

Pain is a common and potentially debilitating condition. Whereas there is vast literature on developmentally appropriate behavioral techniques for pain management, results of curriculum evaluations and knowledge surveys reveal a dearth of awareness of these strategies in healthcare professionals. As a result, the development and evaluation of pain management training programs is an important endeavor. Results of studies evaluating such programs are promising and suggest that training may be an effective means of impacting healthcare professionals’ knowledge, attitudes, and even patient care. These results must be interpreted with caution however, as the literature contains several conceptual and methodological limitations. These limitations, in combination with the wide diversity in program components, format of delivery, and research methods preclude definitive conclusions on the most practical and effective means to provide training. To address this question, further systematic work on the development and evaluation of pain management training programs is warranted

Heartfelt embodiment: Changes in body-ownership and self-identification produce distinct changes in interoceptive accuracy

Interoceptive and exteroceptive information are both essential for the construction and update of self-awareness. Whereas several studies have shown how interoceptive accuracy or cardiac feedback influences body-awareness, no studies have looked at the reverse effect, namely how exteroceptively-driven changes in body-ownership and self-identification can influence individuals’ ability to detect internal bodily signals. We exposed participants to the Rubber Hand Illusion (Experiment 1) and to the Enfacement Illusion (Experiment 2), and tested how this change in the sense of body-ownership and self-identification affected their interoceptive accuracy (IAcc). The heartbeat-counting task was used to measure IAcc before the bodily illusions, and then the same task was interleaved with periods of visuo-tactile stimulation, during which synchronous and asynchronous multisensory stimulation was applied. We found that a change in body-ownership significantly improved performance of participants with lower interoceptive accuracy. In contrast, a change in self-identification significantly decreased performance of participants with higher interoceptive accuracy. These results suggest that changes in different domains of self-awareness can differentially impact individuals’ ability to accurately detect signals arising from within the body, highlighting the distinct role that interoceptive signals play for different facets of bodily self-consciousness

Embodiment and body awareness in meditators

[EN] Mindfulness practice consists of focusing attention in an intentional way on the experience of the present moment, including bodily sensations, thoughts or feelings, and the environment, with an attitude of acceptance and without judging. The body and, especially, body awareness are key elements in mindfulness. Embodiment or the feeling of being located within one's physical body is a related concept, and it is composed of the sense of ownership, location, and agency of the body. The rubber hand illusion (RHI) is an experimental paradigm that has been used to understand the mechanisms of embodiment, and evidence shows that body awareness modulates this illusion. To our knowledge, no studies have analyzed embodiment processes in meditators. The aim of this study is to use the RHI to analyze the mechanisms of embodiment and its relationship with body awareness and mindfulness in meditators and non-meditators. The sample was composed of long-term meditators (n = 15) and non-meditators (n = 15). Objective and self-report measures for embodiment with the RHI and self-report questionnaires of body awareness and mindfulness were administered. One-way ANOVA revealed significant differences between groups in sense of agency in the rubber hand. Meditators experienced less sense of agency in the rubber hand than non-meditators. Pearson's correlations showed that this lower sense of agency in the rubber hand was associated with higher body awareness and mindfulness. Results highlight the role of body awareness and mindfulness in embodiment mechanisms. This study has clinical implications, especially in psychopathological disorders that can be influenced by disturbances in these processes.The authors would like to acknowledge the "BODYTA" project (Spanish Ministry of Economy and Competitiveness, PSI2014-51928-R), "PROMOSAM" (Spanish Ministry of Economy and Competitiveness, PSI2014-56303-REDT), and "Excellence Research Program PROMETEO II" (Generalitat Valenciana, Conselleria de Educacion, Cultura y Deporte, PROMETEOII/2013/003). CIBERobn is an initiate of the ISCIII. PROMOSAM Excellence in Research Program (PSI2014-56303-REDT), MINECO, Spain.Cebolla, A.; Miragall, M.; Palomo, P.; Llorens Rodríguez, R.; Soler, J.; Demarzo, M.; García Campayo, J.... (2016). Embodiment and body awareness in meditators. Mindfulness. 7(6):1297-1305. https://doi.org/10.1007/s12671-016-0569-xS1297130576Aguado, J., Luciano, J. V., Cebolla, A., Serrano-Blanco, A., Soler, J., & García-Campayo, J. (2015). Bifactor analysis and construct validity of the five facet mindfulness questionnaire (FFMQ) in non-clinical Spanish samples. Frontiers in Psychology, 6, 404.Arzy, S., Thut, G., Mohr, C., Michel, C. M., & Blanke, O. (2006). Neural basis of embodiment: distinct contributions of temporoparietal junction and extrastriate body area. The Journal of Neuroscience, 26(31), 8074–8081.Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13(1), 27–45.Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., et al. (2004). Mindfulness: a proposed operational definition. Clinical Psychology: Science and Practice, 11(3), 230–241.Bornemann, B., Herbert, B. M., Mehling, W. E., & Singer, T. (2015). Differential changes in self-reported aspects of interoceptive awareness through 3 months of contemplative training. Frontiers in Psychology, 5, 1504.Botvinick, M., & Cohen, J. (1998). Rubber hands “feel” touch that eyes see. Nature, 391(6669), 756–756.Calsius, J., Courtois, I., Stiers, J., & De Bie, J. (2015). How do fibromyalgia patients with alexithymia experience their body? A qualitative approach. SAGE Open, 5, 1–10.Cascio, C. J., Foss-Feig, J. H., Burnette, C. P., Heacock, J. L., & Cosby, A. A. (2012). The rubber hand illusion in children with autism spectrum disorders: delayed influence of combined tactile and visual input on proprioception. Autism, 16(4), 406–419.Cebolla, A., Garcia-Palacios, A., Soler, J., Guillen, V., Baños, R., & Botella, C. (2012). Psychometric properties of the Spanish validation of the Five Facets of Mindfulness Questionnaire (FFMQ). The European Journal of Psychiatry, 26(2), 118–126.Cebolla, A., Vara, M. D., Miragall, M., Palomo, P., & Baños, R. M. (2015). Embodied mindfulness: review of the body’s participation in the changes associated with the practice of mindfulness. Actas españolas de Psiquiatría, 43, 36–41.Cioffi, D. (1991). Sensory awareness versus sensory impression: affect and attention interact to produce somatic meaning. Cognition & Emotion, 5(4), 275–294.Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale: Lawrence Erlbaum Associates Inc.Craig, A. D. (2009). How do you feel—now? The anterior insula and human awareness. Nature Reviews Neuroscience, 10(1), 59–70.Dreeben, S. J., Mamberg, M. H., & Salmon, P. (2013). The MBSR body scan in clinical practice. Mindfulness, 4(4), 394–401.Dummer, T., Picot-Annand, A., Neal, T., & Moore, C. (2009). Movement and the rubber hand illusion. Perception, 38(2), 271.Dunn, B. D., Galton, H. C., Morgan, R., Evans, D., Oliver, C., Meyer, M., et al. (2010). Listening to your heart. How interoception shapes emotion experience and intuitive decision making. Psychological Science, 21(12), 1835–1844.Ehrsson, H. H., Spence, C., & Passingham, R. E. (2004). That’s my hand! Activity in premotor cortex reflects feeling of ownership of a limb. Science, 305(5685), 875–877.Eshkevari, E., Rieger, E., Longo, M. R., Haggard, P., & Treasure, J. (2012). Increased plasticity of the bodily self in eating disorders. Psychological Medicine, 42(04), 819–828.Farb, N., Daubenmier, J. J., Price, C. J., Gard, T., Kerr, C., Dunn, B., et al. (2015). Interoception, contemplative practice, and health. Frontiers in Psychology, 6, 763.Fox, K. C., Zakarauskas, P., Dixon, M., Ellamil, M., Thompson, E., Christoff, K., et al. (2012). Meditation experience predicts introspective accuracy. PLoS ONE, 7(9), e45370.Grossman, P., Tiefenthaler-Gilmer, U., Raysz, A., & Kesper, U. (2007). Mindfulness training as an intervention for fibromyalgia: evidence of postintervention and 3-year follow-up benefits in well-being. Psychotherapy and Psychosomatics, 76(4), 226–233.Holmes, N. P., Snijders, H. J., & Spence, C. (2006). Reaching with alien limbs: visual exposure to prosthetic hands in a mirror biases proprioception without accompanying illusions of ownership. Perception & Psychophysics, 68(4), 685–701.Hölzel, B. K., Ott, U., Gard, T., Hempel, H., Weygandt, M., Morgen, K., et al. (2008). Investigation of mindfulness meditation practitioners with voxel-based morphometry. Social Cognitive and Affective Neuroscience, 3(1), 55–61.Hölzel, B. K., Lazar, S. W., Gard, T., Schuman-Olivier, Z., Vago, D. R., & Ott, U. (2011). How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspectives on Psychological Science, 6(6), 537–559.Kalckert, A., & Ehrsson, H. H. (2012). Moving a rubber hand that feels like your own: a dissociation of ownership and agency. Frontiers in Human Neuroscience, 6, 40.Karnath, H. O., & Baier, B. (2010). Right insula for our sense of limb ownership and self-awareness of actions. Brain Structure and Function, 214(5-6), 411–417.Keizer, A., Smeets, M. A., Postma, A., van Elburg, A., & Dijkerman, H. C. (2014). Does the experience of ownership over a rubber hand change body size perception in anorexia nervosa patients? Neuropsychologia, 62, 26–37.Kerr, C. E., Sacchet, M. D., Lazar, S. W., Moore, C. I., & Jones, S. R. (2013). Mindfulness starts with the body: somatosensory attention and top-down modulation of cortical alpha rhythms in mindfulness meditation. Frontiers in Human Neuroscience, 7, 12.Lakhan, S. E., & Schofield, K. L. (2013). Mindfulness-based therapies in the treatment of somatization disorders: a systematic review and meta-analysis. PLoS ONE, 8(8), e71834.Lazar, S. W., Kerr, C. E., Wasserman, R. H., Gray, J. R., Greve, D. N., Treadway, M. T., et al. (2005). Meditation experience is associated with increased cortical thickness. Neuroreport, 16(17), 1893–1897.Longo, M. R., Schüür, F., Kammers, M. P., Tsakiris, M., & Haggard, P. (2008). What is embodiment? A psychometric approach. Cognition, 107(3), 978–998.McManus, F., Surawy, C., Muse, K., Vazquez-Montes, M., & Williams, J. M. G. (2012). A randomized clinical trial of mindfulness-based cognitive therapy versus unrestricted services for health anxiety (hypochondriasis). Journal of Consulting and Clinical Psychology, 80(5), 817–828.Mehling, W. E., Gopisetty, V., Daubenmier, J., Price, C. J., Hecht, F. M., & Stewart, A. (2009). Body awareness: construct and self-report measures. PLoS ONE, 4(5), e5614.Mehling, W. E., Price, C., Daubenmier, J. J., Acree, M., Bartmess, E., & Stewart, A. (2012). The multidimensional assessment of interoceptive awareness (MAIA). PLoS ONE, 7(11), e48230.Mirams, L., Poliakoff, E., Brown, R. J., & Lloyd, D. M. (2013). Brief body-scan meditation practice improves somatosensory perceptual decision making. Consciousness and Cognition, 22(1), 348–359.Moseley, G. L., Olthof, N., Venema, A., Don, S., Wijers, M., Gallace, A., et al. (2008). Psychologically induced cooling of a specific body part caused by the illusory ownership of an artificial counterpart. Proceedings of the National Academy of Sciences, 105(35), 13169–13173.Mussap, A. J., & Salton, N. (2006). A ‘rubber-hand’ illusion reveals a relationship between perceptual body image and unhealthy body change. Journal of Health Psychology, 11(4), 627–639.Naranjo, J. R., & Schmidt, S. (2012). Is it me or not me? Modulation of perceptual-motor awareness and visuomotor performance by mindfulness meditation. BMC Neuroscience, 13(1), 88.Parkin, L., Morgan, R., Rosselli, A., Howard, M., Sheppard, A., Evans, D., et al. (2014). Exploring the relationship between mindfulness and cardiac perception. Mindfulness, 5(3), 298–313.Pollatos, O., Kurz, A. L., Albrecht, J., Schreder, T., Kleemann, A. M., Schöpf, V., et al. (2008). Reduced perception of bodily signals in anorexia nervosa. Eating Behaviors, 9(4), 381–388.Quezada-Berumen, L., González-Ramírez, M. T., Cebolla, A., Soler, J., & García-Campayo, J. (2014). Conciencia corporal y mindfulness: Validación de la versión española de la escala de conexión corporal (SBC). Actas Españolas de Psiquiatría, 42(2), 57–67.Rohde, M., Di Luca, M., & Ernst, M. O. (2011). The rubber hand illusion: feeling of ownership and proprioceptive drift do not go hand in hand. PLoS One, 6(6), e21659.Schauder, K. B., Mash, L. E., Bryant, L. K., & Cascio, C. J. (2015). Interoceptive ability and body awareness in autism spectrum disorder. Journal of Experimental Child Psychology, 131, 193–200.Sze, J. A., Gyurak, A., Yuan, J. W., & Levenson, R. W. (2010). Coherence between emotional experience and physiology: does body awareness training have an impact? Emotion, 10(6), 803–814.Teper, R., & Inzlicht, M. (2013). Meditation, mindfulness and executive control: the importance of emotional acceptance and brain-based performance monitoring. Social Cognitive and Affective Neuroscience, 8(1), 85–92.Thakkar, K. N., Nichols, H. S., McIntosh, L. G., & Park, S. (2011). Disturbances in body ownership in schizophrenia: evidence from the rubber hand illusion and case study of a spontaneous out-of-body experience. PLoS One, 6(10), e27089.Tran, U. S., Glück, T. M., & Nader, I. W. (2013). Investigating the Five Facet Mindfulness Questionnaire (FFMQ): construction of a short form and evidence of a two‐factor higher order structure of mindfulness. Journal of Clinical Psychology, 69(9), 951–965.Tsakiris, M., & Haggard, P. (2005). The rubber hand illusion revisited: visuotactile integration and self-attribution. Journal of Experimental Psychology: Human Perception and Performance, 31(1), 80.Tsakiris, M., Tajadura-Jiménez, A., & Costantini, M. (2011). Just a heartbeat away from one’s body: interoceptive sensitivity predicts malleability of body-representations. Proceedings of the Royal Society of London B: Biological Sciences, 278(1717), 2470–2476.Van Ravesteijn, H., Lucassen, P. L. B. J., Bor, H., Van Weel, C., & Speckens, A. (2013). Mindfulness-based cognitive therapy for patients with medically unexplained symptoms: a randomized controlled trial. Psychotherapy and Psychosomatics, 82(5), 299–310

Developmental perspectives on interpersonal affective touch

In the last decade, philosophy, neuroscience and psychology alike have paid increasing attention to the study of interpersonal affective touch, which refers to the emotional and motivational facets of tactile sensation. Some aspects of affective touch have been linked to a neurophysiologically specialised system, namely the C tactile (CT) system. While the role of this sys-tem for affiliation, social bonding and communication of emotions have been widely investigated, only recently researchers have started to focus on the potential role of interpersonal affective touch in acquiring awareness of the body as our own, i.e. as belonging to our psychological ‘self’. We review and discuss recent developmental and adult findings, pointing to the central role of interpersonal affective touch in body awareness and social cognition in health and disorders. We propose that interpersonal affective touch, as an interoceptive modality invested of a social nature, can uniquely contribute to the ongoing debate in philosophy about the primacy of the relational nature of the minimal self

Getting to the heart of the matter: Does aberrant interoceptive processing contribute towards emotional eating?

According to estimates from Public Health England, by 2034 70% of adults are expected to be overweight or obese, therefore understanding the underpinning aetiology is a priority. Eating in response to negative affect contributes towards obesity, however, little is known about the underlying mechanisms. Evidence that visceral afferent signals contribute towards the experience of emotion is accumulating rapidly, with the emergence of new influential models of ‘active inference’. No longer viewed as a ‘bottom up’ process, new interoceptive facets based on ‘top down’ predictions have been proposed, although at present it is unclear which aspects of interoception contribute to aberrant eating behaviour and obesity. Study one examined the link between eating behaviour, body mass index and the novel interoceptive indices; interoceptive metacognitive awareness (IAw) and interoceptive prediction error (IPE), as well as the traditional measures; interoceptive accuracy (IAc) and interoceptive sensibility (IS). The dissociation between these interoceptive indices was confirmed. Emotional eaters were characterised by a heightened interoceptive signal but reduced meta-cognitive awareness of their interoceptive abilities. In addition, emotional eating correlated with IPE; effects that could not be accounted for by differences in anxiety and depression. Study two confirmed the positive association between interoceptive accuracy and emotional eating using a novel unbiased heartbeat discrimination task based on the method of constant stimuli. Results reveal new and important mechanistic insights into the processes that may underlie problematic affect regulation in overweight populations