Osteopathy and Mental Health: An Embodied, Predictive, and Interoceptive Framework.

Globally, mental and musculoskeletal disorders present with high prevalence, disease burden, and comorbidity. In order to improve the quality of care for patients with persistent physical and comorbid mental health conditions, person-centered care approaches addressing psychosocial factors are currently advocated. Central to successful person-centered care is a multidisciplinary collaboration between mental health and musculoskeletal specialists underpinned by a robust therapeutic alliance. Such a collaborative approach might be found in osteopathy, which is typically utilized to treat patients with musculoskeletal disorders but may arguably also benefit mental health outcomes. However, research and practice exploring the reputed effect of osteopathy on patients with mental health problems lack a robust framework. In this hypothesis and theory article, we build upon research from embodied cognition, predictive coding, interoception, and osteopathy to propose an embodied, predictive and interoceptive framework that underpins osteopathic person-centered care for individuals with persistent physical and comorbid mental health problems. Based on the premise that, for example, chronic pain and comorbid depression are underlined by overly precise predictions or imprecise sensory information, we hypothesize that osteopathic treatment may generate strong interoceptive prediction errors that update the generative model underpinning the experience of pain and depression. Thus, physical and mental symptoms may be reduced through active and perceptual inference. We discuss how these theoretical perspectives can inform future research into osteopathy and mental health to reduce the burden of comorbid psychological factors in patients with persistent physical symptoms and support person-centered multidisciplinary care in mental health

Osteopathic Care as (En)active Inference: A Theoretical Framework for Developing an Integrative Hypothesis in Osteopathy

Osteopathy is a person-centred healthcare discipline that emphasizes the body’s structure-function interrelationship—and its self-regulatory mechanisms—to inform a whole-person approach to health and wellbeing. This paper aims to provide a theoretical framework for developing an integrative hypothesis in osteopathy, which is based on the enactivist and active inference accounts. We propose that osteopathic care can be reconceptualised under (En)active inference as a unifying framework. Active inference suggests that action-perception cycles operate to minimize uncertainty and optimize an individual’s internal model of the lived world and, crucially, the consequences of their behaviour. We argue that (En)active inference offers an integrative framework for osteopathy, which can evince the mechanisms underlying dyadic and triadic (e.g., in paediatric care) exchanges and osteopathic care outcomes. We propose that this theoretical framework can underpin osteopathic care across the lifespan, from preterm infants to the elderly and those with persistent pain and other physical symptoms. In situations of chronicity, as an ecological niche, the patient-practitioner dyad provides the osteopath and the patient with a set of affordances, i.e., possibilities for action provided by the environment, that through shared intentionally, can promote adaptations and restoration of productive agency. Through a dyadic therapeutic relationship, as they engage with their ecological niche’s affordances—a structured set of affordances shared by agents—osteopath and patient actively construct a shared sense-making narrative and realise a shared generative model of their relation to the niche. In general, touch plays a critical role in developing a robust therapeutic alliance, mental state alignment, and biobehavioural synchrony between patient and practitioner. However, its role is particularly crucial in the fields of neonatology and paediatrics, where it becomes central in regulating allostasis and restoring homeostasis. We argue that from an active inference standpoint, the dyadic shared ecological niche underwrites a robust therapeutic alliance, which is crucial to the effectiveness of osteopathic care. Considerations and implications of this model—to clinical practice and research, both within- and outside osteopathy—are critically discussed

Therapeutic Alliance as Active Inference: The Role of Therapeutic Touch and Synchrony

Recognizing and aligning individuals’ unique adaptive beliefs or “priors” through cooperative communication is critical to establishing a therapeutic relationship and alliance. Using active inference, we present an empirical integrative account of the biobehavioral mechanisms that underwrite therapeutic relationships. A significant mode of establishing cooperative alliances—and potential synchrony relationships—is through ostensive cues generated by repetitive coupling during dynamic touch. Established models speak to the unique role of affectionate touch in developing communication, interpersonal interactions, and a wide variety of therapeutic benefits for patients of all ages; both neurophysiologically and behaviorally. The purpose of this article is to argue for the importance of therapeutic touch in establishing a therapeutic alliance and, ultimately, synchrony between practitioner and patient. We briefly overview the importance and role of therapeutic alliance in prosocial and clinical interactions. We then discuss how cooperative communication and mental state alignment—in intentional communication—are accomplished using active inference. We argue that alignment through active inference facilitates synchrony and communication. The ensuing account is extended to include the role of (C-) tactile afferents in realizing the beneficial effect of therapeutic synchrony. We conclude by proposing a method for synchronizing the effects of touch using the concept of active inference

An Active Inference Account of Touch and Verbal Communication in Therapy

This paper offers theoretical explanations for why “guided touch” or manual touch with verbal communication can be an effective way of treating the body (e.g., chronic pain) and the mind (e.g., emotional disorders). The active inference theory suggests that chronic pain and emotional disorders can be attributed to distorted and exaggerated patterns of interoceptive and proprioceptive inference. We propose that the nature of active inference is abductive. As such, to rectify aberrant active inference processes, we should change the “Rule” of abduction, or the “prior beliefs” entailed by a patient’s generative model. This means pre-existing generative models should be replaced with new models. To facilitate such replacement—or updating—the present treatment proposes that we should weaken prior beliefs, especially the one at the top level of hierarchical generative models, thereby altering the sense of agency, and redeploying attention. Then, a new prior belief can be installed through inner communication along with manual touch. The present paper proposes several hypotheses for possible experimental studies. If touch with verbal guidance is proven to be effective, this would demonstrate the relevance of active inference and the implicit prediction model at a behavioral level. Furthermore, it would open new possibilities of employing inner communication interventions, including self-talk training, for a wide range of psychological and physical therapies

Osteopathic Manipulative Treatment and Cardiovascular Autonomic Parameters in Rugby Players: A Randomized, Sham-Controlled Trial

Objective: The purpose of this study was to investigate the effects of osteopathic manipulative treatment (OMT) on cardiovascular autonomic parameters after a rugby match. Methods: Resting and reactivity (ie, response to orthostasis) measures of mean arterial pressure, heart rate, and heart rate variability were assessed in 23 male players after a single session of OMT, both 18 to 20 hours after a rugby match and in a corresponding no-match condition, in a randomized, sham-controlled, crossover design. Results: Signs of reduced heart rate variability and elevated mean arterial pressure and heart rate were found 18 to 20 hours after a rugby match compared with the no-match condition. A significant increase in heart rate variability and a significant reduction in mean arterial pressure were observed after OMT in both the after-match and no-match conditions. Heart rate and heart rate variability responses to orthostasis were not affected by previous match competition, but were significantly larger after OMT compared with sham treatment. Conclusion: This study suggests the presence of cardiovascular autonomic alterations in rugby players after a competitive match, which may be indicative of prolonged fatigue and incomplete recovery. In these players, favorable changes in cardiovascular autonomic parameters were observed following a single session of OMT

The role of gentle touch in perinatal osteopathic manual therapy.

Osteopathic medicine is a system of manual diagnosis and treatment. While there is growing evidence that osteopathy is effective in a range of clinical conditions, the underlying biological basis of its therapeutic effects remain largely unknown. Given that the sense of touch plays a critical role in osteopathy, in this perspective article, with a particular focus on perinatal care, we explore the potential mechanisms by which stimulation of the skin senses can exert beneficial physiological and psychological effects, aiding growth and development. We propose that a class of low threshold mechanosensitive c-fibre, named c-tactile afferents, which respond optimally to gentle, slow moving touch are likely to play a direct and significant role in the efficacy of manual therapies. A greater understanding of the impact the type and quality of touch plays in therapeutic tactile interventions and in particular the neuroscience underpinning these effects will aid the development of more targeted, population specific interventions

Large-scale movements in the oceanic environment identify important foraging areas for loggerheads in central Mediterranean Sea

Loggerhead sea turtles (Caretta caretta) are known to display a wide range of movement patterns during the different stages of their life cycle, but empirical information to document this extensive behavioural plasticity is still limited. This is especially true for large, adult-sized individuals, that are thought to mainly forage in neritic areas. In the present paper, eight adult-sized loggerhead turtles were tracked using satellite telemetry to identify the location of their foraging grounds in the seas along the western coast of the Italian peninsula. Tracked turtles mostly stayed in the region between the Italian peninsula and the islands of Sicily and Sardinia, that was reached following quick, directed movements by the turtles from a release site to the north. In this area, two turtles took up residence in spatially limited neritic sites along the coast, while the remaining six alternated circumscribed coastal stays with long-distance, circuitous movements in the oceanic environment. An utilization distribution analysis clearly identified an area, mostly comprising oceanic waters, that was continuously used by turtles in different seasons and years. The present results contribute to the still-limited knowledge of the spatial ecology of loggerheads frequenting the Western Mediterranean Sea and highlight the presence of a potentially important oceanic region in the Southern Tyrrhenian Sea where adult-sized turtles forage for extended periods. These findings increase our knowledge of complex life history traits of loggerhead turtles and provide important information to be considered for evidence-based conservation measures

Therapeutic Alliance as Active Inference: The Role of Therapeutic Touch and Biobehavioural Synchrony in Musculoskeletal Care

Touch is recognised as crucial for survival, fostering cooperative communication, accelerating recovery, reducing hospital stays, and promoting overall wellness and the therapeutic alliance. In this hypothesis and theory paper, we present an entwined model that combines touch for alignment and active inference to explain how the brain develops “priors” necessary for the health care provider to engage with the patient effectively. We appeal to active inference to explain the empirically integrative neurophysiological and behavioural mechanisms that underwrite synchronous relationships through touch. Specifically, we offer a formal framework for understanding – and explaining – the role of therapeutic touch and hands-on care in developing a therapeutic alliance and synchrony between health care providers and their patients in musculoskeletal care. We first review the crucial importance of therapeutic touch and its clinical role in facilitating the formation of a solid therapeutic alliance and in regulating allostasis. We then consider how touch is used clinically – to promote cooperative communication, demonstrate empathy, overcome uncertainty, and infer the mental states of others – through the lens of active inference. We conclude that touch plays a crucial role in achieving successful clinical outcomes and adapting previous priors to create intertwined beliefs. The ensuing framework may help healthcare providers in the field of musculoskeletal care to use hands-on care to strengthen the therapeutic alliance, minimise prediction errors (a.k.a., free energy), and thereby promote recovery from physical and psychological impairments

Effect of Continuous Touch on Brain Functional Connectivity Is Modified by the Operator’s Tactile Attention

Touch has been always regarded as a powerful communication channel playing a key role in governing our emotional wellbeing and possibly perception of self. Several studies demonstrated that the stimulation of C-tactile afferent fibers, essential neuroanatomical elements of affective touch, activates specific brain areas and the activation pattern is influenced by subject’s attention. However, no research has investigated how the cognitive status of who is administering the touch produces changes in brain functional connectivity of touched subjects. In this functional magnetic resonance imaging (fMRI) study, we investigated brain connectivity while subjects were receiving a static touch by an operator engaged in either a tactile attention or auditory attention task. This randomized-controlled single-blinded study enrolled 40 healthy right-handed adults and randomly assigned to either the operator tactile attention (OTA) or the operator auditory attention (OAA) group. During the five fMRI resting-state runs, the touch was delivered while the operator focused his attention either: (i) on the tactile perception from his hands (OTA group); or (ii) on a repeated auditory stimulus (OAA group). Functional connectivity analysis revealed that prolonged sustained static touch applied by an operator engaged with focused tactile attention produced a significant increase of anticorrelation between posterior cingulate cortex (PCC-seed) and right insula (INS) as well as right inferior-frontal gyrus but these functional connectivity changes are markedly different only after 15 min of touching across the OTA and OAA conditions. Interestingly, data also showed anticorrelation between PCC and left INS with a distinct pattern over time. Indeed, the PCC-left INS anticorrelation is showed to start and end earlier compared to that of PCC-right INS. Taken together, the results of this study showed that if a particular cognitive status of the operator is sustained over time, it is able to elicit significant effects on the subjects’ functional connectivity patterns involving cortical areas processing the interoceptive and attentional value of touch