Medical education and distrust modulate the response of insular-cingulate network and ventral striatum in pain diagnosis.

Healthcare providers often underestimate patients' pain, sometimes even when aware of their reports. This could be the effect of experience reducing sensitivity to others pain, or distrust toward patients' self-evaluations. Across multiple experiments (375 participants), we tested whether senior medical students differed from younger colleagues and lay controls in the way they assess people's pain and take into consideration their feedback. We found that medical training affected the sensitivity to pain faces, an effect shown by the lower ratings and highlighted by a decrease in neural response of the insula and cingulate cortex. Instead, distrust toward the expressions' authenticity affected the processing of feedbacks, by decreasing activity in the ventral striatum whenever patients' self-reports matched participants' evaluations, and by promoting strong reliance on the opinion of other doctors. Overall, our study underscores the multiple processes which might influence the evaluation of others' pain at the early stages of medical career.

The role of interoception in understanding others' affect. Dissociation between superficial and detailed appraisal of facial expressions.

Embodied models of social cognition argue that others' emotional states are processed by re-enacting a representation of the same state in the observer, along with associated somatic and physiological responses. In this framework, previous studies tested whether a strong sensitivity to interoceptive signals (i.e., inputs arising from within one's body) facilitates the understanding of others' affect, leading to mixed results. Such heterogeneity in the literature could reflect methodological differences in paradigms employed, with some probing classification of a precise condition, and others requiring the assessment of supra-ordinal dimensions orthogonal to many states. Here, we engaged fifty young women in a study where they evaluated others' naturalistic facial reactions to painful and disgusting stimuli of comparable unpleasantness. Separately, we measured their interoceptive abilities through a well-known heartbeat counting task. We found that individuals that were more accurate in tracking their heartbeats across time were also more prone to judge facial expressions as more unpleasant (supra-ordinal assessment). However, when specifically asked to discriminate between comparably-unpleasant pain and disgust (state-specific assessment), participants' performance was not influenced by their interoceptive abilities. Although confined to a female sample, this study extends our knowledge on the role of interoception in the understanding of others, which influences only the evaluation of general features such as unpleasantness (common between pain and disgust), without extending to the appraisal of a precise state. This finding supports multi-componential models of social cognition, suggesting that only part of our ability to assess others' affect is mediated by a representation of one's affective/somatic responses.

Affordances after spinal cord injury.

Spinal cord injury can cause cognitive impairments even when no cerebral lesion is appreciable. As patients are forced to explore the environment in a non-canonical position (i.e., seated on a wheelchair), a modified relation with space can explain motor-related cognitive differences compared to non-injured individuals. Peripersonal space is encoded in motor terms, that is, in relation to the representation of action abilities and is strictly related to the affordance of reachability. In turn, affordances, the action possibilities suggested by relevant properties of the environment, are related to the perceiver's peripersonal space and motor abilities. One might suppose that these motor-related cognitive abilities are compromised when an individual loses the ability to move. We shed light on this issue in 10 patients with paraplegia and 20 matched controls. All have been administered an affordances-related reachability judgement task adapted from Costantini, Ambrosini, Tieri, Sinigaglia, and Committeri (2010, Experimental Brain Research, 207, 95) and neuropsychological tests. Our findings demonstrate that patients and controls show the same level of accuracy in estimating the location of their peripersonal space boundaries, but only controls show the typical overestimation of reaching range. Secondly, patients show a higher variability in their judgements than controls. Importantly, this finding is related to the patients' ability to perform everyday tasks. Finally, patients are not faster in making their judgements on reachability in peripersonal space, while controls are. Our results suggest that not moving freely or as usual in the environment impact decoding of action-related properties even when the upper limbs are not compromised.