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The Neurobiology of the Patient-Clinician Interaction, and its Impact on Treatment Outcome (completed)

When meeting a clinician, we are often nervous, uneasy, and distressed about the situation. Many of us are anxious about what the doctor is about to tell us, and hope she/he will be reassuring and show genuine engagement in attempting to treat the illness or discomfort.

About the project

Multiple studies have documented a substantial effect of the quality of the patient-clinician relationship on treatment outcome. A widespread understanding in the field is that a good patient-clinician relationship, characterized by trust, safety, and where the patient feels genuinely cared for, account for a large part of the unspecific effects, or placebo effects, that are prominent in the medical treatment of various conditions, and in particular pain, anxiety and depression. However, we know very little about how a good patient-provider relationship can lead to clinical improvement for the patient.

Objectives

This project aims to elucidate the neurobiological mechanisms, in the patient and the clinician, whereby a good relationship can improve the outcome of pain treatment. To investigate this, we will perform an experiment where clinicians will perform pain treatment on patients suffering from chronic pain, during 2 different contexts. In half of the sessions, the clinician will do a clinical intake of the patient prior to treatment thereby establishing a clinical relationship. In the other half, they will not do an intake and consequently not establish a clinical relationship prior to treatment.

During treatment, we record the clinicians' and patients' brain activity using dual functional magnetic resonance imaging (fMRI), stress responses and (patients) pain relief. Live audio-video transmission during fMRI scanning allows clinicians and patients to communicate as if face-to-face. This setup enables us to assess the impact of the clinical relationship on autonomic responses, brain-to-brain communication, and exchange of facial expression between clinicians and patients and in turn, pain outcomes, during live pain treatment.

In a secondary experiment, we will assess a potential role of the hormone oxytocin, which is important for social bonding, in these relationship effects on pain. To investigate this, participants will self-administer a nasal spray containing either oxytocin or saline prior to the Experiment.

Financing

The Research Council of Norway (FRIMEDBIO - mobility grant ) 2015 - 2019.

Cooperation

The project will be performed partly at Martinos Center for Biomedical Imaging, Massachusetts General Hospital/Harvard Medical School, and partly at the Department of Psychology, University of Oslo.

Publications

  • Dan Mikael Ellingsen; RG Garcia; J Lee; RL Lin; J Kim; AH Thurler; S Castel; L Dimisko; BR Rosen; N Hadjikhani; B Kuo & V Napadow (2017). Cyclic Vomiting Syndrome is characterized by altered functional brain connectivity of the insular cortex: A cross-comparison with migraine and healthy adults. Neurogastroenterology and Motility.  ISSN 1350-1925.  29
  • Dan Mikael Ellingsen; Siri Leknes; Guro Engvig Løseth; Johan Wessberg & Håkan Olausson (2016). The neurobiology shaping affective touch: Expectation, motivation, and meaning in the multisensory context. Frontiers in Psychology.  ISSN 1664-1078.  6

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Published Oct. 21, 2016 1:24 PM - Last modified Dec. 20, 2019 1:00 PM