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.

Grant Number: 1R21AT013513-01
NIH Institute/Center: NIH
Principal Investigator: Alessandra Anzolin