EEG Hyperscan to investigate the Patient-Clinician relationship following Theory of Mind Training

Project Summary/Abstract This R21 project aims to enhance therapeutic outcomes for Fibromyalgia (FM) patients by incorporating Theory of Mind (ToM) training into clinical practice. This training is designed to improve patients' ability to understand and empathize with others, particularly in the therapeutic context of patient-clinician interactions. The study will utilize EEG hyperscanning technology to assess real-time brain-to-brain connectivity in FM patients and their clinicians during clinical interactions and pain treatments. Prior studies have demonstrated the importance of the patient-clinician relationship in integrative medicine therapies and the impact that those interactions have on clinical outcomes and the well-being of patients. A recent publication from the Applicant’s team applied a novel approach known as fMRI hyperscanning (i.e. synchronized neuroimaging of two people) to demonstrate that brain concordance in the temporoparietal junction (TPJ) was up-regulated following a clinical interaction and this up-regulation was associated with acupuncture analgesia in fibromyalgia. Moreover, brain concordance in the anterior insula was linked with patients' ratings of therapeutic alliance. The possibility of a behavioral intervention, such as ToM training, as a means for enhancing TPJ/insula brain-to-brain connectivity, interoception and metalizing skills, quality of patient-clinician interaction, and acupuncture treatment effectiveness, has not been investigated yet. Patients will undergo ToM training or a control education condition, followed by a series of acupuncture treatments. Primary and secondary outcomes will be evaluated using validated neuropsychological tasks, EEG hyperscanning during real-time interactions, and clinical measures of pain and well-being. By directly linking cognitive training with clinical interactions, this study seeks to establish a novel approach for improving clinical outcomes in FM, leveraging the neurophysiological mechanisms that underpin effective communication and empathy in therapeutic settings. Testing these novel hypotheses and methodologies has the potential to create new opportunities for integrative medicine therapies to influence healthcare practice and to improve social functioning and quality of life for chronic pain patients. The proposed data collection will leverage the infrastructure of a larger NIH-funded study (R01-AT012144) assessing fMRI brain concordance following ToM training and acupuncture, thereby enabling us to create a uniquely comprehensive dataset that examines brain concordance using both fMRI- and EEG-hyperscan imaging techniques. This integrative approach will allow for an unprecedented exploration of brain dynamics, providing critical insights into the mechanisms that underlie effective patient-clinician interactions and therapeutic outcomes.