Exposure shapes the perception of affective touch

Development and validation of the Social Touch Experiences and Attitudes Questionnaire-Chinese version (STEAQ-C): How interpersonal touch relates to subclinical traits and symptoms

Social touch has a vital role in human development and psychological well-being. However, there is a lack of measures assessing individual differences in social touch experiences and attitudes, especially under Eastern cultures. This study developed the Social Touch Experiences and Attitudes Questionnaire - Chinese version (STEAQ-C) and examined its psychometric properties with healthy young Chinese adults. In Study 1, an item pool was generated and principal component analysis (PCA) was used to identify the factor structure of the STEAQ. Study 2 recruited an independent sample and examined its reliability and validity. Network analysis further explored the interrelations between social touch and a variety of subclinical traits and symptoms. PCA identified four factors of the STEAQ-C, relating to childhood touch experiences, current touch with intimate partners, with family and friends, and with unfamiliar people. Study 2 confirmed the four-factor structure and upheld its internal consistency and stability. Positive attitudes towards and greater experiences of social touch were negatively correlated with sensory over-responsiveness and sensory hyposensitivity, as well as childhood trauma particularly emotional neglect, supporting the convergent validity. Evidence of criterion-related validity was accrued via its concurrent and predictive associations with secure attachment style, higher levels of social competence, and lower levels of social anxiety. Network analysis highlighted altered perception of social touch may be a shared feature for psychiatric conditions with social dysfunctions (e.g., autism, social anxiety and negative schizotypy). The newly-developed STEAQ-C may be a timely tool in assessing social touch experiences and attitudes under Eastern cultures.

High frequency heart rate variability is associated with sensitivity to affective touch

C-tactile afferents (CTs) are a class of unmyelinated, mechanosensitive nerve fibre that respond optimally to skin temperature, slow moving touch typical of a caress. They are hypothesised to signal the rewarding value of affiliative tactile interactions. While CT firing frequency is positively correlated with subjective ratings of touch pleasantness, trait differences in sensitivity to the specific hedonic value of CT targeted touch have been reported. Inter-individual differences in vagally mediated, high frequency heart rate variability (HF-HRV) have been linked to variation in visual social cognition. Thus, the aim of the present study was to examine the relationship between resting state HF-HRV and sensitivity to socially relevant CT targeted touch. 58 healthy participants first had a 5-minute electrocardiogram. They then rated the pleasantness of 5 randomly presented velocities of robotically delivered touch. Three velocities fell within (1, 3, 10 cm/s) and two outside (0.3, 30 cm/s) the CT optimal range. Each velocity was delivered twice. On a group level, affective touch ratings were described by a negative quadratic function, with CT optimal velocities rated as more pleasant than slower and faster speeds. Simple regression analysis confirmed participants' HF-HRV was significantly predicted by the quadratic curve fit of their touch ratings, with higher HF-HRV associated with a better quadratic fit. These findings indicate that, in line with previous observations that higher HF-HRV is associated with enhanced sensitivity to visual social cues, trait differences in autonomic control could account for previously reported individual differences in CT sensitivity.

Sleep, Mental Health, and the Need for Physical and Real-Life Social Contact with (Non-)Family Members during the COVID-19 Pandemic: A Bayesian Network Analysis

Background/Objectives: The forced social isolation implemented to prevent the spread of the COVID-19 virus was accompanied by a worsening of mental health, an increase in insomnia symptoms, and the emergence of 'skin hunger'-an increased longing for personal touch. This study aimed to enhance our understanding of the interconnection between sleep, mental health, and the need for physical (NPC) and real-life social contact (NRL-SC). Methods: A total of 2827 adults participated in an online survey during the second COVID-19 lockdown. A Bayesian Gaussian copula graphical model (BGCGM) and a Bayesian-directed acyclic graph (DAG) were estimated, and mixed ANOVAs were carried out. Results: NPC with non-family members (t(2091) = 12.55, p < 0.001, d = 0.27) and relational lifestyle satisfaction (t(2089) = 13.62, p < 0.001, d = 0.30) were lower during the second lockdown than before the pandemic. In our BGCGM, there were weak positive edges between the need for PC and RL-SC on one hand and sleep and mental health on the other. Conclusions: During the second lockdown, people craved less physical contact with non-family members and were less satisfied with their relational lifestyle than before the pandemic. Individuals with a greater need for PC and RL-SC reported poorer mental health (i.e., worry, depression, and mental fatigue).

Tactile discrimination as a diagnostic indicator of cognitive decline in patients with mild cognitive impairment: A narrative review

Background

Tactile discrimination, a cognitive task reliant on fingertip touch for stimulus discrimination, encompasses the somatosensory system and working memory, with its acuity diminishing with advancing age. Presently, the evaluation of cognitive capacity to differentiate between individuals with early Alzheimer's disease (AD) and typical older adults predominantly relies on visual or auditory tasks, yet the efficacy of discrimination remains constrained.

Aims

To review the existing tactile cognitive tasks and explore the interaction between tactile perception and the pathological process of Alzheimer's disease. The tactile discrimination task may be used as a reference index of cognitive decline in patients with mild cognitive impairment and provide a new method for clinical evaluation.

Methods

We searched four databases (Embase, PubMed, Web of Science and Google scholar). The reference coverage was from 1936 to 2023. The search terms included "Alzheimer disease" "mild cognitive impairment" "tactile" "tactile discrimination" "tactile test" and so on. Reviews and experimental reports in the field were examined and the effectiveness of different types of tactile tasks was compared.

Main results

Individuals in the initial phases of Alzheimer's spectrum disease, specifically those in the stage of mild cognitive impairment (MCI), exhibit notable impairments in tasks involving tactile discrimination. These tasks possess certain merits, such as their quick and straightforward comparability, independence from educational background, and ability to circumvent the limitations associated with conventional cognitive assessment scales. Furthermore, tactile discrimination tasks offer enhanced accuracy compared to cognitive tasks that employ visual or auditory stimuli.

Conclusions

Tactile discrimination has the potential to serve as an innovative reference indicator for the swift diagnosis of clinical MCI patients, thereby assisting in the screening process on a clinical scale.

Stroking in early mother-infant exchanges: The role of maternal tactile biography and interoceptive sensibility

Caress-like is a crucial component of caregiving and a key factor in mother-infant interactions. Mother's experience of touch during her own childhood (i.e., tactile biography) has been found to be related to maternal actual use of caress-like touch (i.e., stroking) during mother-infant exchanges. Evidence also suggests that maternal interoceptive sensibility (i.e., self-perceived sensitivity to inner-body sensations) might be related to sensitive caregiving abilities. However, further empirical investigation is needed to understand to what extent tactile biography and interoceptive sensibility have an impact on mothers' stroking when interacting with their infants. Using an online survey, this cross-sectional study explored the potential association between maternal tactile biography, interoceptive sensibility and use of touch for interaction with their own infants in a group of 377 Italian mothers (mean age = 33.29; SD = 4.79). We tested and compared a series of multivariate linear mediation models using maternal tactile biography as predictor, maternal use of affective touch as outcome variable and Multidimensional Assessment of Interoceptive Awareness (MAIA) subscale scores as mediators. We found that, if a mother had positive touch experiences in her own childhood, she may be more likely to use touch in a positive and nurturing way with her own infant (i.e., stroking). Furthermore, mothers' interoceptive sensibility in the form of attention regulation, self-regulation and body listening mediates the association between their past experiences of positive touch and their use of caress-like touch in mother-infant exchanges. This study highlights that maternal tactile biography is directly associated with mothers' use of caress-like touch and indirectly linked to it through the mediating role of interoceptive sensibility.

Perceptuo-affective organization of touched materials in younger and older adults

In everyday interaction we touch different materials, which we experience along a limited number of perceptual and emotional dimensions: For instances, a furry surface feels soft and pleasant, whereas sandpaper feels rough and unpleasant. In a previous study, younger adults manually explored a representative set of solid, fluid and granular materials. Their ratings were made along six perceptual dimensions (roughness, fluidity, granularity, deformability, fibrousness, heaviness) and three emotional ones (valence, arousal, dominance). Perceptual and emotional dimensions were systematically correlated. Here, we wondered how this perceptuo-affective organization of touched materials depends on age, given that older adults show decline in haptic abilities, in particular detail perception. 30 younger participants (~22 years, half females) and 15 older participants (~66 years) explored 25 materials using 18 perceptual and 9 emotional adjectives. We extracted 6 perceptual and 2 emotional dimensions. Older and younger adults showed similar dimensions. However, in younger participants roughness and granularity judgments were done separately, while they were collapsed in a single dimension in older people. Further, age groups differed in the perception of roughness, granularity and valence, and older people did not show a positive correlation between valence and granularity as did younger people. As expected, control analyses between young males and females did not reveal similar gender differences. Overall, the results demonstrate that older people organize and experience materials partly differently from younger people, which we lead back to sensory decline. However, other aspects of perceptual organization that also include fine perception are preserved into older age.

Reliability and validity of a simplified touch experiences and attitudes questionnaire for Chinese college students

Touch cultures have both differences and commonalities in different regions. The Touch Experiences and Attitudes Questionnaire (TEAQ) is a widely applicable self-report tool. The purpose of our research was to examine the validity and reliability of the Chinese version of TEAQ for Chinese college students. We translated the 57 items of the original TEAQ into Chinese and assessed its cultural and linguistic adaptation in Chinese context. Two samples were recruited for the assessment of validity and reliability. The Social Support Rating Scale, Index of Well-being Scale and Security Questionnaire were chosen as criterion-related validity indicators. Item analysis, principal component analysis and confirmatory factor analysis indicated that the simplified Chinese version of TEAQ contained 18 items in three factors: Attitude to Intimate Touch, Childhood Touch and Current Positive Touch, with a cumulative variance contribution rate of 57.12%. The 3-factor model had good validity and reliability. The TEAQ was positively correlated with social support, sense of security and well-being. There were demographic differences in sex and left-behind experience. We anticipate the simplified TEAQ will be a valuable tool for the research of touch among Chinese college students.

Longing for touch post-COVID-19: current observations and future directions

Previous studies have reported an association between the COVID-19 pandemic, social distancing regulations and longing for touch (LFT; i.e., a discrepancy between actual touch frequency and one's desire to be touched). However, less is known about the prevalence and severity of LFT in the general population in the absence of social distancing regulations. The aim of this study was therefore to exploratively compare data collected during and after the pandemic. Pandemic data was collected online in an international sample (n = 1982), of which a matched subsample (n = 115) was used in the reported analyses. Post-pandemic data was collected one week after social distancing regulations restrictions were lifted in the Netherlands (n = 60) and when virtually no restrictions were in place (n = 55). The severity of LFT was significantly higher during the pandemic than afterwards. Although there were no significant differences in the general prevalence of LFT, significantly more participants reported high levels of LFT (score of 75-100) during the pandemic. We cautiously conclude that, although LFT may have peaked during the pandemic, a large portion of the general population desires to experience more interpersonal touch, even in the absence of social distancing regulations.

The perception of pain, discriminative touch and affective touch in patients suffering from Borderline Personality Disorder

Borderline Personality Disorder (BPD) is often characterized by self-injurious behaviors, with one-half to two-third of these patients reporting hypalgesic or analgesic phenomena during self-harming. Research on pain perception in BPD suggested abnormal processing of nociception either within the sensory-discriminative and/or motivational-affective systems of pain. Nevertheless, it is still unclear whether pain insensitivity could be generalized to other somatosensory submodalities. To investigate this question, 30 BPD patients and 30 matched healthy controls were enrolled in the current study and underwent a somatosensory battery composed of well-established psychophysical test assessing all the principal submodalities of somatosensation, namely pain perception (i.e., warm, cold and mechanical), discriminative touch (i.e., tactile acuity and tactile sensitivity) as well as affective touch. Results showed abnormal warm detection threshold, warm pain threshold, mechanical pain perception, and tactile sensitivity in BPD patients, but no differences emerged neither for tactile acuity nor for cold pain thresholds, cold tolerance, or for affective touch perception. Findings point to a deficit in nociception, as well as in tactile sensitivity in BPD individuals, and were discussed in relation to BPD clinical features including self-injurious behaviors.

The perception of affective touch in women affected by obesity

Introduction

Pleasant and comforting bodily contacts characterized intimate and affective interactions. Affective touch informs us about others' emotions and intentions, sustains intimacy and closeness, protecting from loneliness and psychological distress. Previous evidence points to an altered experience of affective touch in clinical populations reporting interpersonal difficulties. However, there is no investigation of affective touch in obesity, which is often associated with negative affective-relational experiences since childhood.

Methods

This study aimed to provide the first evidence about the experience of affective touch in obesity by comparing 14 women with obesity with 14 women with healthy weight. Participants rated the pleasantness of both imagined and actual tactile stimuli, which consisted of (i) soft-brush strokes, (ii) touches of the experimenter's hand, and (iii) of a plastic stick (as control, non-affective, stimulation). Participants should report the pleasantness of each kind of touch. Moreover, we explored lifespan experiences of affective touch and interpersonal pleasure in social contexts through self-report questionnaires.

Results

No differences emerged for the pleasantness of affective touch (in both the real and imagery task) between the two groups. However, participants with obesity reported less frequent and less satisfying early experiences of affective touch when compared with the controls.

Discussion

Our results spoke in favor of a preserved experience of affective touch when experimentally probed in obesity, despite a limited early exposure to bodily affective contacts. We interpreted our results in the light of the social reconnection hypothesis. Nevertheless, we provided crucial methodological considerations for future research, considering that both the experimenter's and the brush touch may not resemble adequately real-life experiences, in which affective touch involves intimate people.

Depression severity is associated with reduced pleasantness of observed social touch and fewer current intimate touch experiences

Depression is associated with loss of pleasure in previously enjoyed activities and withdrawal from social interactions. Depression alters the perception of social cues, but it is currently unclear whether this extends to social touch. In the current cross-sectional study, we explored the association between depression severity, perceived pleasantness of observed social touch, and general longing for touch. For observed touch, we contrasted videos of slow touch (1-10cm/s), which optimally activates C tactile afferent nerve fibres and generally feels pleasant, with 'non-CT-optimal' touch (i.e., outside the 1-10cm/s range, commonly rated more neutral). We predicted that greater depression severity would be related to lower pleasantness ratings specifically for CT-optimal touch, and less longing for touch. N = 226 adults completed self-report measures of depression severity and longing for touch, and rated touch pleasantness for six videos depicting social touch at three velocities (3cm/s in the CT-optimal range, 0.5 and 30cm/s outside this range) and at two locations varying in CT innervation (palm vs. arm). We controlled for general anhedonia and individual differences in touch experiences and attitudes. Across touch locations, greater depression severity was associated with lower perceived pleasantness of touch, especially for the fastest non-CT-optimal (rather than the CT-optimal) velocity, contrary to our prediction. However, when grouping participants into probable vs. no/minimal depression, the probable depression group rated both the fastest non-CT-optimal and the CT-optimal velocity as less pleasant than did the no/minimal depression group. Overall, while depression was associated with perceived pleasantness of observed touch, this was not specific to CT-optimal touch. Furthermore, touch longing was not associated with depression severity. Instead, variance in depression symptoms was better explained by reduced levels of current intimate touch. Though the direction of causality is unclear, greater depression severity is related to lower pleasantness of observed social touch, and lower levels of current intimate touch.

Love and affectionate touch toward romantic partners all over the world

Touch is the primary way people communicate intimacy in romantic relationships, and affectionate touch behaviors such as stroking, hugging and kissing are universally observed in partnerships all over the world. Here, we explored the association of love and affectionate touch behaviors in romantic partnerships in two studies comprising 7880 participants. In the first study, we used a cross-cultural survey conducted in 37 countries to test whether love was universally associated with affectionate touch behaviors. In the second study, using a more fine-tuned touch behavior scale, we tested whether the frequency of affectionate touch behaviors was related to love in romantic partnerships. As hypothesized, love was significantly and positively associated with affectionate touch behaviors in both studies and this result was replicated regardless of the inclusion of potentially relevant factors as controls. Altogether, our data strongly suggest that affectionate touch is a relatively stable characteristic of human romantic relationships that is robustly and reliably related to the degree of reported love between partners.

Somatovisceral influences on emotional development

Frameworks of emotional development have tended to focus on how environmental factors shape children's emotion understanding. However, individual experiences of emotion represent a complex interplay between both external environmental inputs and internal somatovisceral signaling. Here, we discuss the importance of afferent signals and coordination between central and peripheral mechanisms in affective response processing. We propose that incorporating somatovisceral theories of emotions into frameworks of emotional development can inform how children understand emotions in themselves and others. We highlight promising directions for future research on emotional development incorporating this perspective, namely afferent cardiac processing and interoception, immune activation, physiological synchrony, and social touch.

Affective touch in anorexia nervosa: Exploring the role of social anhedonia and lifespan experiences

BACKGROUND

The pleasantness of a gentle and slow, namely affective, touch experienced in interpersonal interactions motivates social closeness. In anorexia nervosa (AN), independent evidence suggests lower pleasantness of affective touch, as well as social withdrawal. We aim to probe both the experience of affective touch and its possible association with social anhedonia and lifespan experiences of affective bodily contacts in AN.

METHODS

The pleasantness of affective and non-affective touch was compared between fourteen women with AN and fourteen healthy women. Stimuli were traditionally delivered with a brush, with the experimenter's hand, as novelty, and with a stick, as control. The pleasantness of imagined and real touch was probed. Self-report questionnaires assessed social anhedonia and lifespan experiences of affective touch.

RESULTS

A preserved pleasantness of affective touch emerged in AN in both the imagery and real task, despite higher social anhedonia and less lifespan experience of affective touch than healthy women.

LIMITATIONS

Affective touch involves loved ones; thus, the experimenter's touch may not resemble real-life interactions. Future research may take advantage of imagery procedures to solve this issue.

CONCLUSIONS

Body-oriented therapy for AN recognizes touch as a therapeutic tool: ascertaining how touch is experienced is crucial to maximize rehabilitative outcomes. Furthermore, clarifying the possible interplay between interpersonal difficulties in AN and affective touch is especially relevant considering the possible role of the attachment style, which is intensively debated in AN, on affective touch.

Therapeutic touch and therapeutic alliance in pediatric care and neonatology: An active inference framework

Therapeutic affective touch has been recognized as essential for survival, nurturing supportive interpersonal interactions, accelerating recovery-including reducing hospitalisations, and promoting overall health and building robust therapeutic alliances. Through the lens of active inference, we present an integrative model, combining therapeutic touch and communication, to achieve biobehavioural synchrony. This model speaks to how the brain develops a generative model required for recovery, developing successful therapeutic alliances, and regulating allostasis within paediatric manual therapy. We apply active inference to explain the neurophysiological and behavioural mechanisms that underwrite the development and maintenance of synchronous relationships through touch. This paper foregrounds the crucial role of therapeutic touch in developing a solid therapeutic alliance, the clinical effectiveness of paediatric care, and triadic synchrony between health care practitioner, caregiver, and infant in a variety of clinical situations. We start by providing a brief overview of the significance and clinical role of touch in the development of social interactions in infants; facilitating a positive therapeutic alliance and restoring homeostasis through touch to allow a more efficient process of allostatic regulation. Moreover, we explain the role of CT tactile afferents in achieving positive clinical outcomes and updating prior beliefs. We then discuss how touch is implemented in treatment sessions to promote cooperative interactions in the clinic and facilitate theory of mind. This underwrites biobehavioural synchrony, epistemic trust, empathy, and the resolution of uncertainty. The ensuing framework is underpinned by a critical application of the active inference framework to the fields of pediatrics and neonatology.

Horses' Tactile Reactivity Differs According to the Type of Work: The Example of Equine-Assisted Intervention

Tactile perception in humans varies between individuals and could depend on extrinsic factors such as working activity. In animals, there is no study relating the influence of animals' work and their tactile reactivity per se. We investigated horses' tactile reactivity using von Frey filament in different body areas and compared horses working only in equine-assisted interventions (EAI), in riding school (RS) lessons, and in both activities (EAI-RS). We further compared tactile actions by people with or without mental and/or developmental disorders during brushing sessions. The results indicated that EAI horses showed higher tactile reactivity compared to EAI-RS and RS horses, both in terms of number of reactions overall, and especially when the test involved thin filaments. All horses showed high tactile reactivity when tested on the stifle, and this was particularly true for EAI horses. These differences could be related to humans' actions, as participants diagnosed with disorders brushed more the hindquarters and showed more fragmented actions. This study opens new lines of thought on the influence of EAI working activity on horses' tactile reactivity, and hence, on horses' sensory perception. Tactile reactivity outside work, may be directly (via tactile stimulations) or indirectly (via the welfare state), influenced by working conditions.

Velocity-tuning of somatosensory EEG predicts the pleasantness of gentle caress

Numerous studies have established an inverted u-shaped effect between the velocity of a caress and its pleasantness and linked this effect to the C-tactile (CT) system considered central for physical and mental health. This study probed whether cortical somatosensory representations predict and explain the inverted u-shaped effect and addressed associated individual differences. Study participants (N = 90) rated the pleasantness of stroking at varying velocities while their electroencephalogram was being recorded. An analysis across all participants replicated a preference for intermediate velocities, while a cluster analysis discriminated individuals who preferred slow (N = 43) from those who preferred fast stroking (N = 47). In both groups, intermediate velocities maximized amplitudes of a somatosensory event-related potential referred to as sN400, in line with the average rating effect. By contrast, group differences emerged in how velocity modulated a late positive potential (LPP) and Rolandic power. Notably, both the sN400 and the velocity-tuning of LPP and Rolandic power predicted the participants' pleasantness ratings. Participants were more likely to prefer slow over fast stroking the better their LPP and Rolandic power differentiated between different velocities. Together, these results shed light on the complexity of tactile affect. They corroborate an average preference for intermediate velocities that relates to largely shared effects of CT-targeted touch on the activity of somatosensory cortex. Additionally, they identify individual differences as a function of how accurately somatosensory cortex represents the velocity of peripheral input and suggest these differences are relevant for the extent to which individuals pursue beneficial, CT-targeted touch.

Caressed by music: Related preferences for velocity of touch and tempo of music?

Given that both hearing and touch are 'mechanical senses' that respond to physical pressure or mechanical energy and that individuals appear to have a characteristic internal or spontaneous tempo, individual preferences in musical and touch rhythms might be related. We explored this in two experiments probing individual preferences for tempo in the tactile and auditory modalities. Study 1 collected ratings of received stroking on the forearm and measured the velocity the participants used for stroking a fur. Music tempo preferences were assessed as mean beats per minute of individually selected music pieces and via the adjustment of experimenter-selected music to a preferred tempo. Heart rate was recorded to measure levels of physiological arousal. We found that the preferred tempo of favorite (self-selected) music correlated positively with the velocity with which each individual liked to be touched. In Study 2, participants rated videos of repeated touch on someone else's arm and videos of a drummer playing with brushes on a snare drum, both at a variety of tempos. We found that participants with similar rating patterns for the different stroking speeds did not show similar rating patterns for the different music beats. The results suggest that there may be a correspondence between preferences for favorite music and felt touch, but this is either weak or it cannot be evoked effectively with vicarious touch and/or mere drum beats. Thus, if preferences for touch and music are related, this is likely to be dependent on the specific type of stimulation.

Affective Touch and Regulation of Stress Responses

Much has been documented on the association between stress and health. Both direct and indirect pathways have been identified and explored extensively, helping us understand trajectories from healthy individuals to reductions in well-being, and development of preclinical and disease states. Some of these pathways are well established within the field; physiology, affect regulation, and social relationships. The purpose of this review is to push beyond what is known separately about these pathways and provide a means to integrate them using one common mechanism. We propose that social touch, specifically affective touch, may be the missing active ingredient fundamental to our understanding of how close relationships contribute to stress and health. We provide empirical evidence detailing how affective touch is fundamental to the development of our stress systems, critical to the development of attachment bonds and subsequent social relationships across the life course. We will also explore how we can use this in applied contexts and incorporate it into existing interventions.

Do we enjoy what we sense and perceive? A dissociation between aesthetic appreciation and basic perception of environmental objects or events

This integrative review rearticulates the notion of human aesthetics by critically appraising the conventional definitions, offerring a new, more comprehensive definition, and identifying the fundamental components associated with it. It intends to advance holistic understanding of the notion by differentiating aesthetic perception from basic perceptual recognition, and by characterizing these concepts from the perspective of information processing in both visual and nonvisual modalities. To this end, we analyze the dissociative nature of information processing in the brain, introducing a novel local-global integrative model that differentiates aesthetic processing from basic perceptual processing. This model builds on the current state of the art in visual aesthetics as well as newer propositions about nonvisual aesthetics. This model comprises two analytic channels: aesthetics-only channel and perception-to-aesthetics channel. The aesthetics-only channel primarily involves restricted local processing for quality or richness (e.g., attractiveness, beauty/prettiness, elegance, sublimeness, catchiness, hedonic value) analysis, whereas the perception-to-aesthetics channel involves global/extended local processing for basic feature analysis, followed by restricted local processing for quality or richness analysis. We contend that aesthetic processing operates independently of basic perceptual processing, but not independently of cognitive processing. We further conjecture that there might be a common faculty, labeled as aesthetic cognition faculty, in the human brain for all sensory aesthetics albeit other parts of the brain can also be activated because of basic sensory processing prior to aesthetic processing, particularly during the operation of the second channel. This generalized model can account not only for simple and pure aesthetic experiences but for partial and complex aesthetic experiences as well.

Vicarious ratings of self vs. other-directed social touch in women with and recovered from Anorexia Nervosa

Anorexia Nervosa (AN) is an eating pathology characterized by restricted eating, body image distortions and impaired socio-cognitive abilities. Altered responses to affective touch—a pleasant interoceptive stimulus hypothesised to involve activation of the C-Tactile (CT) system, may contribute to the aetiology and maintenance of this disorder. Here, we investigated whether third-party social touch vicarious ratings of different body sites at CT-optimal vs. non-CT optimal velocities differed in women with and recovered from AN (RAN) and healthy controls (HCs). Thirty-five HCs, 27 AN and 29 RAN provided pleasantness ratings for two different tasks designed to probe expectations of how touch is perceived by self (self-directed touch) vs. others (other-directed touch). Findings revealed that both clinical groups, compared to HCs, did not differ in their pleasantness ratings to touch for another but when evaluating touch for self, both clinical groups rated CT-optimal touch as less pleasant than HCs. These findings suggest that AN and RAN women demonstrate an atypical vicarious pleasantness response to affective touch involving self, but not others. Novel therapeutic approaches that help anorexics to better interpret or improve tolerance of affective tactile experiences involving the self may be an important addition to current standard treatments.

Affective touch perception and longing for touch during the COVID-19 pandemic

Interpersonal touch and affective touch play a crucial role in social interactions and have a positive influence on mental health. The social distancing regulations implemented during the COVID-19 pandemic have reduced the ability to engage in interpersonal touch. This could cause longing for touch, and it might subsequently alter the way in which affective touch is perceived. To investigate this, we conducted an online survey and included 1982 participants, which contained questions regarding the COVID-19 regulations, longing for touch, and the perceived pleasantness of affective and non-affective touch. Results showed that participants reported feelings of longing for touch. This significantly increased with the duration and severity of the COVID-19 regulations. In addition, participants who experienced more longing for touch rated videos of affective and non-affective touch as more pleasant. Current results provide insight in the impact of sudden and prolonged COVID-19 regulations and show that increasing the duration and severity of these regulations is associated with a higher desire for touch, which is associated with increased perceived pleasantness of observing touch.

Acute tryptophan depletion alters affective touch perception

RATIONALE

Affiliative tactile interactions help regulate physiological arousal and confer resilience to acute and chronic stress. C-tactile afferents (CTs) are a population of unmyelinated, low threshold mechanosensitive cutaneous nerve fibres which respond optimally to a low force stimulus, moving at between 1 and 10 cm/s. As CT firing frequencies correlate positively with subjective ratings of touch pleasantness, they are hypothesised to form the first stage of encoding affiliative tactile interactions. Serotonin is a key modulator of social responses with known effects on bonding.

OBJECTIVES

The aim of the present study was to determine the effect of acutely lowering central serotonin levels on perceptions of CT-targeted affective touch.

METHODS

In a double blind, placebo-controlled design, the effect of acute tryptophan depletion (ATD) on 25 female participants' ratings of directly and vicariously experienced touch was investigated. Psychophysical techniques were used to deliver dynamic tactile stimuli; some velocities were targeted to optimally activate CTs (1-10 cm/s), whereas other, faster and slower strokes fell outside the CT optimal range. Discriminative tactile function, cold pain threshold and tolerance were also measured.

RESULTS

ATD significantly increased pleasantness ratings of both directly and vicariously experienced affective touch, increasing discrimination of the specific hedonic value of CT targeted velocities. While ATD had no effect on either tactile or cold pain thresholds, there was a trend for reduced tolerance to cold pain.

CONCLUSIONS

These findings are consistent with previous reports that depletion of central serotonin levels modulates neural and behavioural responsiveness to appetitive sensory signals.

Maternal sensitivity and infant neural response to touch: an fNIRS study

The mother's attunement to her infant's emotional needs influences her use of touching behaviors during mother-infant interactions. Moreover, maternal touch appears to modulate infants' physiological responses to affective touch. However, little is known about the impact of maternal sensitivity on infants' touch processing at a brain level. This study explored the association between maternal sensitivity when infants (N = 24) were 7 months old and their patterns of cortical activation to touch at 12 months. Brain activation was measured using functional near-infrared spectroscopy. Changes in oxy-hemoglobin (HbO2) and deoxy-hemoglobin (HHb) concentrations were measured in the left somatosensory cortex and right temporal cortex while infants received two types of tactile stimulation-affective and discriminative touch. Results showed that a lower maternal sensitivity was associated with a higher HbO2 response for discriminative touch over the temporal region. Additionally, infants of less sensitive mothers tended to present a higher response in HbO2 for affective touch over the somatosensory region. These findings suggest that less sensitive interactions might result in a lower exposure to maternal touch, which can be further related to infants' neural processing of touch.

Why do we hunger for touch? The impact of daily gentle touch stimulation on maternal-infant physiological and behavioral regulation and resilience

We report the impact of a Gentle Touch Stimulation (GTS) program. Forty-three mothers provided daily 10-min GTS with C-tactile (CT) afferent optimal stroking touch, for 4 weeks to their 3-12 weeks old infants. CT-afferents are cutaneous unmyelinated, low-threshold mechanosensitive nerves hypothesized to underly the regulatory impact of affective touch. We compared physiological and behavioral responses during a no-touch-baseline (BL), static-touch-baseline (BL-T), intervention/control (GTS/CTRL), Still Face (SF) and Reunion (RU) condition for GTS-infants versus a control-group (CTRL) at the start (T1) and end of (T2) of the program. We collected mother-infant ECG, respiration, cortisol, video-recordings, and diary-reports. At T1, physiological arousal significantly increased during SF in both groups, that is, decreased respiratory sinus arrhythmia (RSA) and R-R interval (RRI). At T2, GTS-infants showed significantly increased RSA, RRI, decreased respiration during GTS, buffering SF-arousal and allowing complete recovery during RU; CTRL-infants showed higher SF-arousal and small recovery, under initial BL-levels. Maternal cardio-respiratory showed a metabolic investment during RU. Cortisol and behavioral analyses showed higher arousal in CTRL-infants than GTS-infants at T2. We suggest that the combination of phasic short-term and tonic long-term responses to CT-optimal stroking touch, delivered in a structured daily manner, contribute to the building of infant stress regulation and resilience.

Vicarious ratings of social touch the effect of age and autistic traits

Tactile sensitivities are common in Autism Spectrum Conditions (autism). Psychophysically, slow, gentle stroking touch is typically rated as more pleasant than faster or slower touch. Vicarious ratings of social touch results in a similar pattern of velocity dependent hedonic ratings as directly felt touch. Here we investigated whether adults and children’s vicarious ratings vary according to autism diagnosis and self-reported autistic traits. Adults’ scoring high on the AQ rated stroking touch on the palm as less pleasant than a Low AQ group. However, in contrast to our hypothesis, we did not find any effect of autism diagnosis on children’s touch ratings despite parental reports highlighting significant somatosensory sensitivities. These results are discussed in terms of underpinning sensory and cognitive factors.

Pleasantness ratings in response to affective touch across hairy and glabrous skin: A meta-analysis

The processing of hedonic aspects of touch, namely affective touch, is associated with the activation of C-Tactile (CT) fibers. CTs were thought to be present only in hairy skin, with glabrous skin being often used as control site in affective touch studies. Nevertheless, several articles comparing pleasantness perception across hairy and glabrous skin reported no significant differences. Surprisingly, CT fibers have also been recently detected on the glabrous palm, further questioning whether affective touch perception across both hairy and glabrous skin is comparable. The present meta-analysis thus aimed to quantify pleasantness perception of affective tactile stimulations on both hairy and glabrous sites. Pooled effect sizes (Hedges' g) from 18 studies were analyzed using random effect models. No systematic preference towards affective stimulations on hairy or glabrous skin was observed. Moreover, studies were highly heterogeneous, suggesting high variance in the results of the retrieved articles. Results were not affected by publication bias nor by other moderators. Variables affecting affective touch perception on hairy and glabrous skin and methodological considerations were discussed.

Social touch deprivation during COVID-19: effects on psychological wellbeing and craving interpersonal touch

Social touch has positive effects on social affiliation and stress alleviation. However, its ubiquitous presence in human life does not allow the study of social touch deprivation 'in the wild'. Nevertheless, COVID-19-related restrictions such as social distancing allowed the systematic study of the degree to which social distancing affects tactile experiences and mental health. In this study, 1746 participants completed an online survey to examine intimate, friendly and professional touch experiences during COVID-19-related restrictions, their impact on mental health and the extent to which touch deprivation results in craving touch. We found that intimate touch deprivation during COVID-19-related restrictions is associated with higher anxiety and greater loneliness even though this type of touch is still the most experienced during the pandemic. Moreover, intimate touch is reported as the type of touch most craved during this period, thus being more prominent as the days practising social distancing increase. However, our results also show that the degree to which individuals crave touch during this period depends on individual differences in attachment style: the more anxiously attached, the more touch is craved; with the reverse pattern for avoidantly attached. These findings point to the important role of interpersonal and particularly intimate touch in times of distress and uncertainty.

Strengths and weaknesses of affective touch studies over the lifetime: A systematic review

C-Tactile (CT) fibers are activated by slow, caress-like stimulations, and convey a specific tactile processing of hedonic and interpersonal components, defined as affective touch. Given the beneficial effects deriving from affective tactile experiences in social interactions at all ages, a systematic review of experimental studies on affective touch perception across the lifespan was performed with the aims of 1) examining whether and how affective touch has been studied in a systematic manner throughout the lifespan; 2) verifying whether the pleasantness associated to affective stimulations is found during the entire lifespan. Empirical human studies on affective touch were searched in two databases (PubMed, PsychINFO) and 112 articles were retrieved. Results indicated that most of the studies recruited participants with a mean age ranging from 18 to 40 years, whereas other age ranges came out as under-represented or not represented at all. Despite high heterogeneity across studies, affective touch was considered as a pleasant experience across the lifetime, and it was associated to specific psychophysiological patterns in infants and adults.

Social and affective touch in primates and its role in the evolution of social cohesion

Primates are long-lived, highly social mammals who maintain long-term social bonds and cohesive social groups through many affiliative mechanisms, foremost among them social touch. From birth through adulthood, social touch - primarily mutual grooming - creates and maintains relationships of trust and reliance, which are the basis for individual physical and emotional well-being and reproductive success. Because social touch helps to establish, maintain, and repair social alliances in primates, it contributes to the emotional stability of individuals and the cohesion of social groups. In these fundamental ways, thus, social touch supports the slow life histories of primates. The reinforcing neurochemistry of social touch insures that it is a pleasurable activity and this, in turn, makes it a behavioral commodity that can be traded between primates for desirable rewards such as protection against future aggression or opportunities to handle infants. Social touch is essential to normal primate development, and individuals deprived of social touch exhibit high levels of anxiety and lower fertility compared to those receiving regular social touch. Understanding the centrality of social touch to primate health and well-being throughout the lifespan provides the foundation for appreciating the importance of social touch in human life.

Childhood Adversity and Affective Touch Perception: A Comparison of United Kingdom Care Leavers and Non-care Leavers

In the United Kingdom, the most common reasons for a child to come under the care of social services are neglect and abuse. Such early childhood adversity is a risk factor for social-isolation and poor mental health in adulthood. Touch is a key channel for nurturing interactions, and previous studies have shown links between early somatosensory input, experience dependent neural plasticity, and later life emotional functioning. The aim of the present study was to test the relationship between childhood neglect/abuse and later life experiences, attitudes, and hedonic ratings of affective touch. Here, affective touch is defined as low force, dynamic touch which C-Tactile afferents (CTs) respond optimally to. We hypothesized that a childhood lacking in early nurturing tactile stimulation would be associated with reduced sensitivity to socially relevant affective touch in adulthood. To test this, 19 care leavers (average 9.32 ± 3.70 years in foster care) and 32 non-care leavers were recruited through opportunity sampling (mean age = 21.25 ± 1.74 years). Participants completed a range of psychophysical somatosensory tests. First, they rated the pleasantness of CT-optimal (3 cm/s) and non-CT-optimal (0.3 and 30 cm/s) stroking touch applied to their forearm, both robotically and by an experimenter. They also made vicarious ratings of the anticipated pleasantness of social tactile interactions depicted in a series of videos. Finally, they filled in the Childhood Trauma Questionnaire (CTQ) and the Touch Experiences and Attitudes Questionnaire (TEAQ). As expected, care leavers reported significantly higher levels of childhood trauma than the control group. They also reported significantly lower levels of positive childhood touch compared to non-care leavers, but their attitudes and experiences of current intimate and affiliative touch did not differ. Across all psychophysical tests, care leavers showed specific reduction in sensitivity to the affective value of CT targeted 3 cm/s touch. The results of this study support the hypothesis that a lack of nurturing touch in early developmental periods leads to blunted sensitivity to the specific social value of affective touch. Future research should investigate the neural and physiological mechanisms underlying the observed effect.

Calming Effects of Touch in Human, Animal, and Robotic Interaction-Scientific State-of-the-Art and Technical Advances

Small everyday gestures such as a tap on the shoulder can affect the way humans feel and act. Touch can have a calming effect and alter the way stress is handled, thereby promoting mental and physical health. Due to current technical advances and the growing role of intelligent robots in households and healthcare, recent research also addressed the potential of robotic touch for stress reduction. In addition, touch by non-human agents such as animals or inanimate objects may have a calming effect. This conceptual article will review a selection of the most relevant studies reporting the physiological, hormonal, neural, and subjective effects of touch on stress, arousal, and negative affect. Robotic systems capable of non-social touch will be assessed together with control strategies and sensor technologies. Parallels and differences of human-to-human touch and human-to-non-human touch will be discussed. We propose that, under appropriate conditions, touch can act as (social) signal for safety, even when the interaction partner is an animal or a machine. We will also outline potential directions for future research and clinical relevance. Thereby, this review can provide a foundation for further investigations into the beneficial contribution of touch by different agents to regulate negative affect and arousal in humans.

Hedonic Responses to Touch are Modulated by the Perceived Attractiveness of the Caresser

Previous research has shown that a specific type of C fiber, the C tactile afferents, are involved in detecting gentle, dynamic tactile stimuli on the skin, giving rise to affective responses in the central nervous system. Despite building on such bottom-up information flow, the hedonic perception and the physiological consequences of affective touch are influenced by various sources of top-down information. In the present study we investigated how perception of affective touch is influenced by the attractiveness of hypothetical caressers. Participants were stroked on the arm and the palm while looking at photos of high attractive and low attractive opposite-gender faces, and were instructed to imagine those people as the caressers. In a control condition no photo was paired with the touch. The stroking stimulation was delivered with a soft brush either on the forearm or on the palm, and either with a slower or faster speed. Participants rated the pleasantness of each stimulation, while electrocardiographic recordings were made to extract heart rate variability data. Results showed that participants preferred touch stimuli paired with high attractive faces; they also preferred palm stroking and slower stroking speed. Like subjective pleasantness ratings, heart rate variability responses to affective touch (slow) were higher for high attractive than for low attractive caressers, but were not selective for arm or palm stroking. Overall, the present study confirms that contextual social information plays a major role in affective touch experiences, influencing not only the hedonic quality of the experience but also the physiological state of the body.

Standardized massage interventions as protocols for the induction of psychophysiological relaxation in the laboratory: a block randomized, controlled trial

Health and disease are strongly linked to psychophysiological states. While stress research strongly benefits from standardized stressors, no established protocol focuses on the induction of psychophysiological relaxation. To maintain health, functioning regenerative systems are however likely as important as functioning stress systems. Thus, the identification of validated relaxation paradigms is needed. Here, we investigated whether standardized massages are capable of reliably inducing physiological and psychological states of relaxation. Relaxation was indicated by changes in high frequency heart rate variability (HF-HRV), a vagally-mediated heart rate variability component, and repeated ratings of subjective relaxation, and stress levels. Sixty healthy women were randomly assigned to a vagus nerve massage (n = 19), a soft shoulder massage (n = 22), or a resting control group (n = 19). During the intervention, HF-HRV and subjective relaxation increased, while subjective stress decreased significantly in all groups. Both massage interventions elicited significantly higher HF-HRV compared to the control group. Accordingly, both massage protocols increased psychophysiological relaxation, and may serve as useful tools in future research. However, future work will have to determine which of several protocols might be used as a gold standard to induce a psychophysiological state of relaxation in the laboratory.

Pleasantness Only?

Abstract. When gently stroked with velocities between 0.1 and 30 cm/s, participants typically rate velocities around 3 cm/s as most pleasant, and the ratings follow an inverted u-shape. This pleasantness curve correlates often, but not always, with the firing rate of unmyelinated C-tactile (CT) afferents, leading to the notion that CT afferents code for the hedonic or emotional aspect of gentle touch. However, there is also evidence that CT firing does not necessarily equal pleasantness, and the range of attributes that CT afferents code for is not known. Here, participants were stroked with different velocities assumed to activate CT afferents to a different extent while they rated the touch on several sensory and emotional attributes. We expected an inverted u-shaped rating curve for pleasantness and other emotional attributes, but not for sensory attributes. Inverted u-shaped rating patterns were found for the emotional attributes “pleasant” and “not burdensome,” but also for the sensory attribute “rough.” CT-directed stimulation is thus not only experienced as hedonic. The sensations arising from CTs together with all other types of mechanoreceptors might be centrally integrated into a percept that represents those aspects which are most salient for the stimulation at hand.

Individual Variability of Pleasantness Ratings to Stroking Touch Over Different Velocities

Many studies have investigated the perception of tactile pleasantness over a range of stroking velocities. On average, pleasantness is low at slow (e.g. 0.3 cm/s) and fast (e.g. 30 cm/s) stroking velocities, but is rated highest at velocities between 1 and 10 cm/s. On a group level, this results in an inverted-U shape pleasantness ratings curve, which is described statistically by a negative quadratic equation. We reanalyzed the data from five earlier studies to investigate whether the inverted-U shape pleasantness curve at the group level is also present at the level of the individual, - a precondition for using tactile pleasantness perception as a diagnostic marker. We pooled the data from five studies with a total of 127 participants. Each study included a 'standard condition' of stroking on the dorsal forearm over different velocities (0.3, 1, 3, 10, 30 cm/s) and participants rated the pleasantness. Factors other than stroking velocity were also varied in these studies. On the whole-group level and in each study, pleasantness ratings produced a significant negative quadratic pleasantness curve over the stroking velocities. In individual participants, ratings varied greatly and only 42% of the participants showed a significant negative quadratic curve. The steepness of the inverted-U correlated only moderately across other experimental conditions, showing that the experimental circumstances can influence pleasantness ratings. Our findings have important implications for future work, where differences in the tactile pleasantness curve should not be used to predict or diagnose issues at an individual level.

Infants discriminate the source of social touch at stroking speeds eliciting maximal firing rates in CT-fibers

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Infants’ cardiac response to touch varies depending on its social source.

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This effect occurs only for velocities yielding maximal firing rates in CTs.

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Infants’ responses to touch do not just depend upon its mechanical properties.

The evaluation of interpersonal touch is heavily influenced by its source. For example, a gentle stroke from a loved one is generally more pleasant than the same tactile stimulation from a complete stranger. Our study tested the early ontogenetic roots of humans’ sensitivity to the source of interpersonal touch. We measured the heart rate of three groups of nine-month-olds while their legs were stroked with a brush. The participants were stroked at a different speed in each group (0.3 cm/s, 3 cm/s, 30 cm/s). Depending on the Identity condition (stranger vs. parent), the person who acted as if she was stroking the infant’s leg was either an unfamiliar experimenter or the participant’s caregiver. In fact, the stimulation was always delivered by a second experimenter blind to the Identity condition. Infants’ heart rate decreased more in reaction to strokes when their caregiver rather than a stranger acted as the source of the touch. This effect was found only for tactile stimulations whose velocity (3 cm/s) is known to elicit maximal mean firing rates in a class of afferents named C-tactile fibers (CTs). Thus, the infants’ reaction to touch is modulated not just by its mechanical properties but also by its social source.

Deactivation of default mode network during touch

Interpersonal touch possesses a strong affective component, which immediately evokes attention. The neural processing of such touch is moderated by specialized C-tactile nerve fibers in the periphery and results in central activation of somatosensory areas as well as regions involved in social processing, such as the superior temporal gyrus (STG). In the present functional neuroimaging investigation, we tested the hypothesis that the attention grasping effect of interpersonal touch as compared to impersonal touch is reflected in a more-pronounced deactivation of the default mode network (DMN). Using functional magnetic resonance imaging, we investigated the neural processing of interpersonal relative to impersonal touch conditions that were furthermore modulated by stroking velocity in order to target c-tactile nerve fibers to a different extent. A sample of 30 healthy participants (19 women, mean age 40.5 years) was investigated. In the impersonal touch, participants were stroked with a brush on the forearm. In the interpersonal touch condition, the experimenter performed the stroking with the palm of his hand. Interpersonal touch was rated as more pleasant and intense than impersonal touch and led to a stronger blood oxygen level dependent (BOLD) signal increase in the somatosensory cortex SII extending to the superior temporal cortex. Over all touch conditions, this activation was coupled in time to the deactivation of prominent nodes of the DMN. Although deactivation of the DMN was most pronounced for interpersonal touch conditions, the direct comparison did not show significant differences in DMN deactivation between interpersonal and impersonal touch or between different stroking velocities. We therefore conclude that all applied touch conditions deactivate the DMN and the strong connection to areas which code the contextual and social characteristics of affective touch may explain the attention grasping effect of touch.

Validation and psychometric properties of the Russian version of the Touch Experiences and Attitudes Questionnaire (TEAQ-37 Rus)

It has been demonstrated that nurturing and affiliative touch is essential for human emotional and physical well-being throughout our entire life. Within the last 30 years a system of low-threshold mechanosensitive C fibers innervating the hairy skin was discovered and described; this system is hypothesized to represent the neurobiological substrate for the affective and rewarding properties of touch. This discovery opens new perspectives for multidisciplinary research of the role of affiliative social touch in health and disease, and calls for establishing novel psychometric tools assessing individual differences in the domain of affective touch. The main objective of the study was to construct and validate a Russian version of the Touch Experiences and Attitudes Questionnaire (TEAQ), a self-report measure recently developed to quantify individual experience and attitude to social and affective touch. A pool of 117 items was translated into Russian and all the items were assessed for appropriateness for Russian culture (232 participants). After exploring the factor structure (468 participants), we composed a 37-item questionnaire (TEAQ-37 Rus) characterized by good reliability and a clear 5-factor structure, covering the aspects of attitude to intimate touch, attitude to friendly touch, attitude to self-care, current intimate touch experiences, and childhood touch experiences. Confirmatory factor analysis (551 participants) has demonstrated good consistency and reliability of the 5-factor structure of the TEAQ-37 Rus. Cross-validation research demonstrated moderate positive correlations between predisposition to social touch and emotional intelligence; positive correlations with extraversion and openness facets of the Big Five personality model were also found. As predicted, participants with higher TEAQ-37 Rus scores rated all observed kinds of touch as more pleasant, with a particular preference for slow touch. We anticipate that this questionnaire will be a valuable tool for researchers of social touch, touch perception abnormalities, and the importance of touch experiences for emotional and mental health.

Sensitivity to CT-optimal, Affective Touch Depends on Adult Attachment Style

Affective touch supports affiliative bonds and social cognition. In particular, gentle, stroking touch, which has recently been associated with the C Tactile (CT) system, is typically perceived as pleasant and prosocial. However, it remains unknown whether pre-existing models of social relating influence the perception of CT-optimal touch. In this study (N = 44 adults), we examined how individual differences in attachment styles relate to the perception of CT-optimal touch, as well as to a different modality of interoception, namely heartbeat perception. Using the gold-standard assessment of attachment (Adult Attachment Interview), we found that insecure attachment was associated with reduced pleasantness discrimination between CT-optimal vs. non-CT optimal touch. Acknowledging the different traditions in measuring attachment, we also used a well-validated self-report questionnaire that pertains to explicit representations of current close relationships. Using this measure, we found that higher scores in attachment anxiety (but not attachment avoidance) were associated with reduced pleasantness discrimination between CT-optimal vs. non-CT optimal touch. Attachment patterns (in both measures) were not related to cardiac perception accuracy. These results corroborate and extend previous literature on CT-optimal touch and its relation with affiliative bonds and social cognition. Given that attachment was not related to perceived cardiac accuracy, these findings point to the specificity of the relationship between CT-optimal touch and attachment.