Interacting brains coming in sync through their minds: an interbrain neurofeedback study

Interpersonal neural synchrony and mental disorders: unlocking potential pathways for clinical interventions

Introduction

Interpersonal synchronization involves the alignment of behavioral, affective, physiological, and brain states during social interactions. It facilitates empathy, emotion regulation, and prosocial commitment. Mental disorders characterized by social interaction dysfunction, such as Autism Spectrum Disorder (ASD), Reactive Attachment Disorder (RAD), and Social Anxiety Disorder (SAD), often exhibit atypical synchronization with others across multiple levels. With the introduction of the "second-person" neuroscience perspective, our understanding of interpersonal neural synchronization (INS) has improved, however, so far, it has hardly impacted the development of novel therapeutic interventions.

Methods

To evaluate the potential of INS-based treatments for mental disorders, we performed two systematic literature searches identifying studies that directly target INS through neurofeedback (12 publications; 9 independent studies) or brain stimulation techniques (7 studies), following PRISMA guidelines. In addition, we narratively review indirect INS manipulations through behavioral, biofeedback, or hormonal interventions. We discuss the potential of such treatments for ASD, RAD, and SAD and using a systematic database search assess the acceptability of neurofeedback (4 studies) and neurostimulation (4 studies) in patients with social dysfunction.

Results

Although behavioral approaches, such as engaging in eye contact or cooperative actions, have been shown to be associated with increased INS, little is known about potential long-term consequences of such interventions. Few proof-of-concept studies have utilized brain stimulation techniques, like transcranial direct current stimulation or INS-based neurofeedback, showing feasibility and preliminary evidence that such interventions can boost behavioral synchrony and social connectedness. Yet, optimal brain stimulation protocols and neurofeedback parameters are still undefined. For ASD, RAD, or SAD, so far no randomized controlled trial has proven the efficacy of direct INS-based intervention techniques, although in general brain stimulation and neurofeedback methods seem to be well accepted in these patient groups.

Discussion

Significant work remains to translate INS-based manipulations into effective treatments for social interaction disorders. Future research should focus on mechanistic insights into INS, technological advancements, and rigorous design standards. Furthermore, it will be key to compare interventions directly targeting INS to those targeting other modalities of synchrony as well as to define optimal target dyads and target synchrony states in clinical interventions.

A dual-brain therapeutic approach using noninvasive brain stimulation based on two-person neuroscience: A perspective review

Our actions and decisions in everyday life are heavily influenced by social interactions, which are dynamic feedback loops involving actions, reactions, and internal cognitive processes between individual agents. Social interactions induce interpersonal synchrony, which occurs at different biobehavioral levels and comprises behavioral, physiological, and neurological activities. Hyperscanning-a neuroimaging technique that simultaneously measures the activity of multiple brain regions-has provided a powerful second-person neuroscience tool for investigating the phase alignment of neural processes during interactive social behavior. Neural synchronization, revealed by hyperscanning, is a phenomenon called inter-brain synchrony- a process that purportedly facilitates social interactions by prompting appropriate anticipation of and responses to each other's social behaviors during ongoing shared interactions. In this review, I explored the therapeutic dual-brain approach using noninvasive brain stimulation to target inter-brain synchrony based on second-person neuroscience to modulate social interaction. Artificially inducing synchrony between the brains is a potential adjunct technique to physiotherapy, psychotherapy, and pain treatment- which are strongly influenced by the social interaction between the therapist and patient. Dual-brain approaches to personalize stimulation parameters must consider temporal, spatial, and oscillatory factors. Multiple data fusion analysis, the assessment of inter-brain plasticity, a closed-loop system, and a brain-to-brain interface can support personalized stimulation.

Mobile fNIRS for exploring inter-brain synchrony across generations and time

While still relatively rare, longitudinal hyperscanning studies are exceptionally valuable for documenting changes in inter-brain synchrony, which may in turn underpin how behaviors develop and evolve in social settings. The generalizability and ecological validity of this experimental approach hinges on the selected imaging technique being mobile-a requirement met by functional near-infrared spectroscopy (fNIRS). fNIRS has most frequently been used to examine the development of inter-brain synchrony and behavior in child-parent dyads. In this position paper, we contend that dedicating attention to longitudinal and intergenerational hyperscanning stands to benefit the fields of social and cognitive neuroscience more broadly. We argue that this approach is particularly relevant for understanding the neural mechanisms underpinning intergenerational social dynamics, and potentially for benchmarking progress in psychological and social interventions, many of which are situated in intergenerational contexts. In line with our position, we highlight areas of intergenerational research that stand to be enhanced by longitudinal hyperscanning with mobile devices, describe challenges that may arise from measuring across generations in the real world, and offer potential solutions.

Delta-Alpha EEG pattern reflects the interoceptive focus effect on interpersonal motor synchronization

Little is known about how the modulation of the interoceptive focus impacts the neural correlates of high-level social processes, such as synchronization mechanisms. Therefore, the current study aims to explore the intraindividual electrophysiological (EEG) patterns induced by the interoceptive focus on breath when performing cognitive and motor tasks requiring interpersonal synchronization. A sample of 28 healthy caucasian adults was recruited and asked to perform two tasks requiring interpersonal synchronization during two distinct conditions: while focusing on the breath or without the focus on the breath. EEG frequency bands (delta, theta, alpha, and beta band) were recorded from the frontal, temporo-central, and parieto-occipital regions of interest. Significant results were observed for the delta and alpha bands. Notably, higher mean delta values and alpha desynchronization were observed in the temporo-central area during the focus on the breath condition when performing the motor compared to the cognitive synchronization task. Taken together these results could be interpreted considering the functional meaning of delta and alpha band in relation to motor synchronization. Indeed, motor delta oscillations shape the dynamics of motor behaviors and motor neural processes, while alpha band attenuation was previously observed during generation, observation, and imagery of movement and is considered to reflect cortical motor activity and action-perception coupling. Overall, the research shows that an EEG delta-alpha pattern emerges in the temporo-central areas at the intra-individual level, indicating the attention to visceral signals, particularly during interpersonal motor synchrony.

Inter-brain plasticity as a biological mechanism of change in psychotherapy: A review and integrative model

Recent models of psychopathology and psychotherapy highlight the importance of interpersonal factors. The current review offers a biological perspective on these interpersonal processes by examining inter-brain synchrony—the coupling of brain activity between people interacting with one another. High inter-brain synchrony is associated with better relationships in therapy and in daily life, while deficits in the ability to achieve inter-brain synchrony are associated with a variety of psychological and developmental disorders. The review suggests that therapy improves patients’ ability to achieve such synchrony through inter-brain plasticity—a process by which recurring exposure to high inter-brain synchrony leads to lasting change in a person’s overall ability to synchronize. Therapeutic sessions provide repeated situations with high inter-brain synchrony. This can lead to a long-term increase in the ability to synchronize, first with the therapist, then generalized to other interpersonal relationships, ultimately leading to symptom reduction. The proposed inter-brain plasticity model offers a novel biological framework for understanding relational change in psychotherapy and its links to various forms of psychopathology and provides testable hypotheses for future research. Understanding this mechanism may help improve existing psychotherapy methods and develop new ones.

In touch: Cardiac and respiratory patterns synchronize during ensemble singing with physical contact

Musical ensemble performances provide an ideal environment to gain knowledge about complex human interactions. Network structures of synchronization can reflect specific roles of individual performers on the one hand and a higher level of organization of all performers as a superordinate system on the other. This study builds on research on joint singing, using hyperscanning of respiration and heart rate variability (HRV) from eight professional singers. Singers performed polyphonic music, distributing their breathing within the same voice and singing without and with physical contact: that is touching each other's shoulder or waist. The idea of singing with touch was motivated by historical depictions of ensemble performances that showed singers touching each other. It raises the question of the potential benefit of touch for group performances. From a psycho-physiological point of view, physical contact should increase the synchronization of singing coordination. The results confirm previous findings on synchronization of respiration and HRV during choir singing and extend those findings to a non-homophonic musical repertoire while also revealing an increase in synchronization in respiration during physical contact. These effects were significant across different frequency ranges. The effect of physical contact was stronger when all singers were singing in comparison to the partial ensemble. Importantly, the synchronization could not be fully explained by the singing action (i.e., singing the same voice, or singing vs. listening) or by the standing position or touch. This finding suggests a higher level of organization of all singers, forming a superordinate system.

Exploring how healthcare teams balance the neurodynamics of autonomous and collaborative behaviors: a proof of concept

Team members co-regulate their activities and move together at the collective level of behavior while coordinating their actions toward shared goals. In parallel with team processes, team members need to resolve uncertainties arising from the changing task and environment. In this exploratory study we have measured the differential neurodynamics of seven two-person healthcare teams across time and brain regions during autonomous (taskwork) and collaborative (teamwork) segments of simulation training. The questions posed were: (1) whether these abstract and mostly integrated constructs could be separated neurodynamically; and, (2) what could be learned about taskwork and teamwork by trying to do so? The taskwork and teamwork frameworks used were Neurodynamic Information (NI), an electroencephalography (EEG) derived measure shown to be a neurodynamic proxy for the pauses and hesitations associated with individual uncertainty, and inter-brain EEG coherence (IBC) which is a required component of social interactions. No interdependency was observed between NI and IBC, and second-by-second dynamic comparisons suggested mutual exclusivity. These studies show that proxies for fundamental properties of teamwork and taskwork can be separated neurodynamically during team performances of ecologically valid tasks. The persistent expression of NI and IBC were not simultaneous suggesting that it may be difficult for team members to maintain inter-brain coherence while simultaneously reducing their individual uncertainties. Lastly, these separate dynamics occur over time frames of 15–30 s providing time for real-time detection and mitigation of individual and collaborative complications during training or live patient encounters.

Neural Synchrony and Network Dynamics in Social Interaction: A Hyper-Brain Cell Assembly Hypothesis

Mounting neurophysiological evidence suggests that interpersonal interaction relies on continual communication between cell assemblies within interacting brains and continual adjustments of these neuronal dynamic states between the brains. In this Hypothesis and Theory article, a Hyper-Brain Cell Assembly Hypothesis is suggested on the basis of a conceptual review of neural synchrony and network dynamics and their roles in emerging cell assemblies within the interacting brains. The proposed hypothesis states that such cell assemblies can emerge not only within, but also between the interacting brains. More precisely, the hyper-brain cell assembly encompasses and integrates oscillatory activity within and between brains, and represents a common hyper-brain unit, which has a certain relation to social behavior and interaction. Hyper-brain modules or communities, comprising nodes across two or several brains, are considered as one of the possible representations of the hypothesized hyper-brain cell assemblies, which can also have a multidimensional or multilayer structure. It is concluded that the neuronal dynamics during interpersonal interaction is brain-wide, i.e., it is based on common neuronal activity of several brains or, more generally, of the coupled physiological systems including brains.

Probing associations between interbrain synchronization and interpersonal action coordination during guitar playing

Playing music in an ensemble is a highly coordinated human action involving musicians' brain-body interactions at different levels of physical and cortical organization in time and space. It has been suggested that interbrain phase synchronization plays an essential role in musical interaction. In this study, we aimed to explore associations between interbrain synchronization and interpersonal action coordination, using electroencephalographic recordings of the brain activity of guitarists playing in a duet as well as the acoustic recordings of their music. By applying phase synchronization algorithms to the musicians' brain activities and the sounds produced during guitar playing, we show that synchronous brain activity is strongly related to instrument sounds and behavioral play-onset synchrony, as indicated by phase alignment in relation to the time differences in play onsets and an angular-linear correlation between phase and time differences across trials and guitarist pairs. Interestingly, this correlation was especially strong in the first part of the music piece, when the guitarists seem to adjust their coordinated play onsets and brain rhythms actively. This suggests that the methods capturing intra- and interbrain synchronization and its relations to coordinated playing provide crucial information about the underlying mechanisms of interpersonal action coordination.

Interactive brains, social minds: Neural and physiological mechanisms of interpersonal action coordination

It is now widely accepted that inter-brain synchronization is an important and inevitable mechanism of interpersonal action coordination and social interaction behavior. This review of the current literature focuses first on the forward model for interpersonal action coordination and functional system theory for biological systems, two broadly similar concepts for adaptive system behavior. Further, we review interacting-brain and/or hyper-brain dynamics studies, to show the interplay between intra- and inter-brain connectivity resulting in hyper-brain network structure and network topology dynamics, and consider the functioning of interacting brains as a superordinate system. The concept of a superordinate system, or superorganism, is then evaluated with respect to neuronal and physiological systems group dynamics, which show further accompanying mechanisms of interpersonal interaction. We note that fundamental problems need to be resolved to better understand the neural mechanisms of interpersonal action coordination.