Virtual reality vs. tablet for procedural comfort using an identical game in children undergoing venipuncture: a randomized clinical trial.

Introduction: Recent research has explored the effectiveness of interactive virtual experiences in managing pain and anxiety in children during routine medical procedures, compared to conventional care methods. However, the influence of the specific technology used as an interface, 3-dimensions (D) immersive virtual reality (VR) vs. 2D touch screens, during pediatric venipuncture, remains unexamined. This study aimed to determine if immersive VR is more effective than a tablet in reducing pain and anxiety during short procedures. Methods: An interactive game was designed by clinicians and psychologists, expert in pain theory, hypnosis, and procedural pain and anxiety relief, and was tailored for both VR and tablet use. Fifty patients were randomly assigned to either the Tablet or VR group. The primary outcome measures were pain and anxiety levels during the procedure. Secondary outcome measures included the need for physical restraint, duration of the procedure, enjoyment levels, and satisfaction ratings from both parents and nurses. Results: Participants, in both groups, had low levels of pain and anxiety. Physical restraint was infrequently used, procedures were brief, and high satisfaction levels were reported by patients, parents, and nurses. Discussion: This study suggests that the type of technology used as a support for the game has a minimal effect on the child's experience, with both groups reporting low pain and anxiety levels, minimal physical restraint, and high enjoyment. Despite immersive VR's technological advancements, this study underscores the value of traditional tablets with well-designed interactive games in enhancing children's wellbeing during medical procedures. Clinical Trial Registration: [ClinicalTrials.gov], identifier [NCT05065307].

Perceived Hospital Preparedness Is Negatively Associated With Pandemic-Induced Psychological Vulnerability in Primary Care Employees: A Multicentre Cross-Sectional Observational Study.

OBJECTIVE: The COVID-19 pandemic had a profound negative impact on the psychological wellbeing of healthcare providers (HPs), but little is known about the factors that positively predict mental health of primary care staff during these dire situations. METHODS: We conducted an online questionnaire survey among 702 emergency department workers across 10 hospitals in Switzerland and Belgium following the first COVID-19 wave in 2020, to explore their psychological vulnerability, perceived concerns, self-reported impact and level of pandemic workplace preparedness. Participants included physicians, nurses, psychologists and nondirect care employees (administrative staff). We tested for predictors of psychological vulnerability through both an exploratory cross-correlation with rigorous correction for multiple comparisons and model-based path modelling. RESULTS: Findings showed that the self-reported impact of COVID-19 at work, concerns about contracting COVID-19 at work, and a lack of personal protective equipment were strong positive predictors of Depression, Anxiety, and Stress, and low Resilience. Instead, knowledge of the degree of preparedness of the hospital/department, especially in the presence of a predetermined contingency plan for an epidemic and training sessions about protective measures, showed the opposite effect, and were associated with lower psychological vulnerability. All effects were confirmed after accounting for confounding factors related to gender, age, geographical location and the role played by HPs in the hospital/department. CONCLUSIONS: Difficult working conditions during the pandemic had a major impact on the psychological wellbeing of emergency department HPs, but this effect might have been lessened if they had been informed about adequate measures for minimizing the risk of exposure.

Influence of transient emotional episodes on affective and cognitive theory of mind.

Our emotions may influence how we interact with others. Previous studies have shown an important role of emotion induction in generating empathic reactions towards others' affect. However, it remains unclear whether (and to which extent) our own emotions can influence the ability to infer people's mental states, a process associated with Theory of Mind (ToM) and implicated in the representation of both cognitive (e.g. beliefs and intentions) and affective conditions. We engaged 59 participants in two emotion-induction experiments where they saw joyful, neutral and fearful clips. Subsequently, they were asked to infer other individuals' joy, fear (affective ToM) or beliefs (cognitive ToM) from verbal scenarios. Using functional magnetic resonance imaging, we found that brain activity in the superior temporal gyrus, precuneus and sensorimotor cortices were modulated by the preceding emotional induction, with lower response when the to-be-inferred emotion was incongruent with the one induced in the observer (affective ToM). Instead, we found no effect of emotion induction on the appraisal of people's beliefs (cognitive ToM). These findings are consistent with embodied accounts of affective ToM, whereby our own emotions alter the engagement of key brain regions for social cognition, depending on the compatibility between one's own and others' affect.

Healthcare experience affects pain-specific responses to others' suffering in the anterior insula.

Medical students and professional healthcare providers often underestimate patients' pain, together with decreased neural responses to pain information in the anterior insula (AI), a brain region implicated in self-pain processing and negative affect. However, the functional significance and specificity of these neural changes remains debated. Across two experiments, we recruited university medical students and emergency nurses to test the role of healthcare experience on the brain reactivity to other's pain, emotions, and beliefs, using both pictorial and verbal cues. Brain responses to self-pain was also assessed and compared with those to observed pain. Our results confirmed that healthcare experience decreased the activity in AI in response to others' suffering. This effect was independent from stimulus modality (pictures or texts), but specific for pain, as it did not generalize to inferences about other mental or affective states. Furthermore, representational similarity and multivariate pattern analysis revealed that healthcare experience impacted specifically a component of the neural representation of others' pain that is shared with that of first-hand nociception, and related more to AI than to other pain-responsive regions. Taken together, our study suggests a decreased propensity to appraise others' suffering as one's own, associated with a reduced recruitment of pain-specific information in AI. These findings provide new insights into neural mechanisms leading to pain underestimation by caregivers in clinical settings.

Cognitive exertion affects the appraisal of one's own and other people's pain.

Correctly evaluating others' pain is a crucial prosocial ability. In both clinical and private settings, caregivers assess their other people's pain, sometimes under the effect of poor sleep and high workload and fatigue. However, the effect played by such cognitive strain in the appraisal of others' pain remains unclear. Fifty participants underwent one of two demanding tasks, involving either working memory (Experiment 1: N-Back task) or cognitive interference (Experiment 2: Stroop task). After each task, participants were exposed to painful laser stimulations at three intensity levels (low, medium, high), or video-clips of patients experiencing three intensity levels of pain (low, medium, high). Participants rated the intensity of each pain event on a visual analogue scale. We found that the two tasks influenced rating of both one's own and others' pain, by decreasing the sensitivity to medium and high events. This was observed either when comparing the demanding condition to a control (Stroop), or when modelling linearly the difficulty/performance of each depleting task (N-Back). We provide converging evidence that cognitive exertion affects the subsequent appraisal of one's own and likewise others' pain.

Distraction and cognitive control independently impact parietal and prefrontal response to pain.

Previous studies have found that distracting someone through a challenging activity leads to hypoalgesia, an effect mediated by parietal and prefrontal processes. Other studies suggest that challenging activities affect the ability to regulate one's aching experiences, due to the partially common neural substrate between cognitive control and pain at the level of the medial prefrontal cortex. We investigated the effects of distraction and cognitive control on pain by delivering noxious stimulations during or after a Stroop paradigm (requiring high cognitive load) or a neutral condition. We found less-intense and unpleasant subjective pain ratings during (compared to after) task execution. This hypoalgesia was associated with enhanced activity at the level of the dorsolateral prefrontal cortex and the posterior parietal cortex, which also showed negative connectivity with the insula. Furthermore, multivariate pattern analysis revealed that distraction altered the neural response to pain, by making it more similar to that associated with previous Stroop tasks. All these effects were independent of the nature of the task, which, instead, led to a localized neural modulation around the anterior cingulate cortex. Overall, our study underscores the role played by two facets of human executive functions, which exert an independent influence on the neural response to pain.

Dysfunctional cerebello-cerebral network associated with vocal emotion recognition impairments.

Vocal emotion recognition, a key determinant to analyzing a speaker's emotional state, is known to be impaired following cerebellar dysfunctions. Nevertheless, its possible functional integration in the large-scale brain network subtending emotional prosody recognition has yet to be explored. We administered an emotional prosody recognition task to patients with right versus left-hemispheric cerebellar lesions and a group of matched controls. We explored the lesional correlates of vocal emotion recognition in patients through a network-based analysis by combining a neuropsychological approach for lesion mapping with normative brain connectome data. Results revealed impaired recognition among patients for neutral or negative prosody, with poorer sadness recognition performances by patients with right cerebellar lesion. Network-based lesion-symptom mapping revealed that sadness recognition performances were linked to a network connecting the cerebellum with left frontal, temporal, and parietal cortices. Moreover, when focusing solely on a subgroup of patients with right cerebellar damage, sadness recognition performances were associated with a more restricted network connecting the cerebellum to the left parietal lobe. As the left hemisphere is known to be crucial for the processing of short segmental information, these results suggest that a corticocerebellar network operates on a fine temporal scale during vocal emotion decoding.

Far from the eyes, far from the heart: COVID-19 confinement dampened sensitivity to painful facial features.

In the last 2 years, governments of many countries imposed heavy social restrictions to contain the spread of the COVID-19 virus, with consequent increase of bad mood, distress, or depression for the people involved. Few studies investigated the impact of these restrictive measures on individual social proficiency, and specifically the processing of emotional facial information, leading to mixed results. The present research aimed at investigating systematically whether, and to which extent, social isolation influences the processing of facial expressions. To this end, we manipulated the social exclusion experimentally through the well-known Cyberball game (within-subject factor), and we exploited the occurrence of the lockdown for the Swiss COVID-19 first wave by recruiting participants before and after being restricted at home (grouping factor). We then tested whether either form of social segregation influenced the processing of pain, disgust, or neutral expressions, across multiple tasks probing access to different components of affective facial responses (state-specific, shared across states). We found that the lockdown (but not game-induced exclusion) affected negatively the processing of pain-specific information, without influencing other components of the affective facial response related to disgust or broad unpleasantness. In addition, participants recruited after the confinement reported lower scores in empathy questionnaires. These results suggest that social isolation affected negatively individual sensitivity to other people's affect and, with specific reference to the processing of facial expressions, the processing of pain-diagnostic information.

The effect of uncertainty on pain decisions for self and others.

BACKGROUND: Estimating others' pain is a challenging inferential process, associated with a high degree of uncertainty. While much is known about uncertainty's effect on self-regarding actions, its impact on other-regarding decisions for pain have yet to be characterized. AIM: The present study exploited models of probabilistic decision-making to investigate how uncertainty influences the valuation and assessment of another's pain. MATERIALS & METHODS: We engaged 63 dyads (43 strangers and 20 romantic couples) in a task where individual choices affected the pain delivered to either oneself (the agent) or the other member of the dyad. At each trial, agents were presented with cues predicting a given pain intensity with an associated probability of occurrence. Agents either chose a sure (mild decrease of pain) or risky (50% chance of avoiding pain altogether) management option, before bidding on their choice. A heat stimulation was then issued to the target (self or other). Decision-makers were then asked to rate the pain administered to the target. RESULTS: We found that the higher the expected pain, the more risk-averse agents became, in line with findings in value-based decision-making. Furthermore, agents gambled less on another individual's pain (especially strangers) and placed higher bids on pain relief than they did for themselves. Most critically, the uncertainty associated with expected pain dampened ratings made for strangers' pain. This contrasted with the effect on an agent's own pain, for which risk had a marginal hyperalgesic effect. DISCUSSION & CONCLUSION: Overall, our results suggested that risk selectively affects decision-making on a stranger's suffering, both at the level of assessment and treatment selection, by (1) leading to underestimation, (2) privileging sure options and (3) altruistically allocating more money to insure the treatment's success. SIGNIFICANCE: Uncertainty biases decision-making but it is unclear if it affects choice behavior on pain for others. In examining this question, we found individuals were generally risk-seeking when faced with looming pain, but more so for self; and assigned higher monetary values and subjective ratings on another's pain. However, uncertainty dampened agents' assessment of a stranger's pain, suggesting latent variables may contradict overt altruism. This bias may underlie pain underestimation in clinical settings.

Cognitive and affective theory of mind double dissociation after parietal and temporal lobe tumours.

Extensive neuroimaging literature suggests that understanding others' thoughts and emotions engages a wide network encompassing parietal, temporal and medial frontal brain areas. However, the causal role played by these regions in social inferential abilities is still unclear. Moreover very little is known about theory of mind deficits in brain tumours and whether potential anatomical substrates are comparable to those identified in functional MRI literature. This study evaluated the performance of 105 tumour patients, before and immediately after brain surgery, on a cartoon-based non-verbal task evaluating cognitive (intention attribution) and affective (emotion attribution) theory of mind, as well as a non-social control condition (causal inference). Across multiple analyses, we found converging evidence of a double dissociation between patients with right superior parietal damage, selectively impaired in intention attribution, and those with right anteromedial temporal lesion, exhibiting deficits only in emotion attribution. Instead, patients with damage to the frontal cortex were impaired in all kinds of inferential processes, including those from the non-social control conditions. Overall, our data provide novel reliable causal evidence of segregation between different aspects of the theory of mind network from both the cognitive and also the anatomical point of view.

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.

Deficits in cognitive and affective theory of mind relate to dissociated lesion patterns in prefrontal and insular cortex.

Neuroimaging studies suggest that understanding emotions in others engages brain regions partially common to those associated with more general cognitive Theory-of-Mind (ToM) functions allowing us to infer people's beliefs or intentions. However, neuropsychological studies on brain-damaged patients reveal dissociations between the ability to understand others' emotions and ToM. This discrepancy might underlie the fact that neuropsychological investigations often correlate behavioural impairments only to the lesion site, without considering the impact that the insult might have on other interconnected brain structures. Here we took a network-based approach, and investigated whether deficits in understanding people's emotional and cognitive states relate to damage to similar or differential structures. By combining information from 40 unilateral stroke damaged patients, with normative connectome data from 92 neurotypical individuals, we estimated lesion-induced dysfunctions across the whole brain, and modeled them in relation to patients' behavior. We found a striking dissociation between networks centered in the insular and prefrontal cortex, whose dysfunctions led to selective impairments in understanding emotions and beliefs respectively. Instead, no evidence was observed for neural structures shared between the two conditions. Overall, our data provide novel evidence of segregation between brain networks subserving social inferential abilities.

Atypical processing of social anticipation and feedback in borderline personality disorder.

BACKGROUND-: Borderline personality disorder (BPD) is characterized by maladaptive social functioning, and widespread negativity biases. The neural underpinnings of these impairments remain elusive. We thus tested whether BPD patients show atypical neural activity when processing social (compared to non-social) anticipation, feedback, and particularly, how they relate to each other. METHODS-: We acquired functional MRI data from 21 BPD women and 24 matched healthy controls (HCs) while they performed a task in which cues and feedbacks were either social (neutral faces for cues; happy or angry faces for positive and negative feedbacks, respectively) or non-social (dollar sign; winning or losing money for positive and negative feedbacks, respectively). This task allowed for the analysis of social anticipatory cues, performance-based feedback, and their interaction. RESULTS-: Compared to HCs, BPD patients expressed increased activation in the superior temporal sulcus during the processing of social cues, consistent with elevated salience associated with an upcoming social event. BPD patients also showed reduced activation in the amygdala while processing evaluative social feedback. Importantly, perigenual anterior cingulate cortex (pgACC) activity during the presentation of the social cue correlated with reduced amygdala activity during the presentation of the negative social feedback in the BPD patients. CONCLUSIONS-: These neuroimaging results clarify how BPD patients express altered responses to different types of social stimuli (i.e. social anticipatory cues and evaluative feedback) and uncover an atypical relationship between frontolimbic regions (pgACC-amygdala) over the time span of a social interaction. These findings may help to explain why BPD patients suffer from pervasive difficulties adapting their behavior in the context of interpersonal relationships and should be considered while designing better-targeted interventions.

Sensory-specific predictive models in the human anterior insula.

Expectations affect the subjective experience of pain by increasing sensitivity to noxious events, an effect underlain by brain regions such as the insula. However, it has been debated whether these neural processes operate on pain-specific information or on more general signals encoding expectation of unpleasant events. To dissociate these possibilities, two independent studies ( Sharvit et al., 2018, Pain; Fazeli and Büchel, 2018, J. Neurosci) implemented a cross-modal expectancy paradigm, testing whether responses to pain could also be modulated by the expectation of similarly unpleasant, but painless, events. Despite their differences, the two studies report remarkably convergent (and in some cases complementary) findings. First, the middle-anterior insula response to noxious stimuli is modulated only by expectancy of pain but not of painless adverse events, suggesting coding of pain-specific information. Second, sub-portions of the middle-anterior insula mediate different aspects of pain predictive coding, related to expectancy and prediction error. Third, complementary expectancy effects are also observed for other negative experiences (i.e., disgust), suggesting that the insular cortex holds prospective models of a wide range of events concerning their sensory-specific features. Taken together, these studies have strong theoretical implications on the functional properties of the insular cortex.

Does my pain affect your disgust? Cross-modal influence of first-hand aversive experiences in the appraisal of others' facial expressions.

BACKGROUND: Embodied models of social cognition argue that others' affective states are processed by re-enacting a sensory-specific representation of the same state in the observer. However, neuroimaging studies suggest that a reliable part of the representation shared between self and others is supramodal and relates to dimensions such as Unpleasantness or arousal, common to qualitatively different experiences. Here we investigated whether representations of first-hand pain and disgust influenced the subsequent evaluation of facial expressions in Modality-specific fashion, or in terms of Unpleasantness or arousal. METHODS: Thirty volunteers were subjected to thermal painful and olfactory disgusting events, and subsequently were asked to classify computer-generated faces expressing pain (characterized by high Unpleasantness and arousal), disgust (high Unpleasantness and low arousal), surprise (low Unpleasantness and high arousal) and hybrid combinations thereof. RESULTS: Thermal and olfactory events were associated with comparable Unpleasantness ratings and heart rate (but stronger galvanic response was found for painful temperatures). Furthermore, we found that the appraisal of facial expressions was biased by the prior stimulus, with more frequent pain classifications following thermal stimuli, and more frequent disgust classifications following olfactory stimuli. Critically, this modulation was cross-modal in nature, as each first-hand stimulation influenced in comparable fashion facial traits diagnostic of both pain and disgust, without instead generalizing to features of surprise. CONCLUSION: Overall, these data support the presence of shared coding between one's aversive experiences and the appraisal of others' facial responses, which is best describable as supramodal representation of the Unpleasantness of the experience. SIGNIFICANCE: These results extend previous findings about common representational coding between the experience of first-hand and others' pain. In particular, they highlight that reliable part of the information shared is supramodal in nature and relates to a broad dimension of Unpleasantness common also to painless aversive states such as disgust.

Physical pain recruits the nucleus accumbens during social distress in borderline personality disorder.

Patients with borderline personality disorder (BPD) often engage in dangerous self-injurious behaviors (SIBs) as a maladaptive technique to decrease heightened feelings of distress (e.g. negative feelings caused by social exclusion). The reward system has recently been proposed as a plausible neural substrate, which may influence the interaction between social distress and physical pain processing in patients that engage in SIBs. Using functional magnetic resonance imaging (fMRI) in 20 adult BPD patients with a history of SIBs and 23 healthy controls (HCs), we found a hyper-activation of the nucleus accumbens (NAcc) and amygdala when painful stimuli were presented to BPD patients (but not HCs) in a state of heightened distress, induced via social exclusion. This differential NAcc activity was mediated by anxious attachment style, which is a key developmental feature of the disorder. Altogether, these results suggest a neural mechanism underlying the pathophysiology of SIBs in these patients, which is likely reinforced via the reward system.

Beyond unpleasantness. Social exclusion affects the experience of pain, but not of equally-unpleasant disgust.

Seminal theories posit that social and physical suffering underlie partly-common representational code. It is unclear, however, if this shared information reflects a modality-specific component of pain, or alternatively a supramodal code for properties common to many aversive experiences (unpleasantness, salience, etc.). To address this issue, we engaged participants in a gaming experience in which they were excluded or included by virtual players. After each game session, participants were subjected to comparably-unpleasant painful or disgusting stimuli. Subjective reports and cardiac responses revealed a reduced sensitivity to pain following exclusion relative to inclusion, an effect which was more pronounced in those participants who declared to feel more affected by the gaming manipulation. Such modulation was not observed for disgust. These findings indicate that the relationship between social and physical suffering does not generalize to disgust, thus suggesting a shared representational code at the level of modality-specific components of pain.

The good, the bad, and the suffering. Transient emotional episodes modulate the neural circuits of pain and empathy.

People's sensitivity to first-hand pain is affected by their ongoing emotions, with positive states (joy, amusement) exerting analgesic-like effects, and negative states (sadness, fear) often enhancing the subjective experience. It is however less clear how empathetic responses to others' pain are affected by one's own emotional state. Following embodied accounts that posit a shared representational code between self and others' states, it is plausible that pain empathy might be influenced by emotions in the same way as first-hand pain. Alternatively, other theories in psychology suggest that social resources (including empathetic reactions) might be enhanced by positive states, but inhibited by negative states, as only in the former case, one's mindset is sufficiently broad to take into consideration others' needs. To disambiguate between these opposing predictions, we conducted two experiments in which volunteers observed positive, neutral, or negative video clips, and subsequently either received painful thermal stimuli on their own body (first-hand pain), or observed images of wounded hands (others' pain). We measured subjective pain ratings as well as physiological responses and brain activity using fMRI. We found that, contrary to the case of first-hand pain, others' pain produced weaker galvanic responses and lower neural activity in anterior insula and middle cingulate cortex following negative (relative to neutral and positive) videos. Such inhibition was partially counteracted by personal empathy traits, as individuals with higher scores retained greater sensitivity to others' pain after negative emotion induction, in both behavioral and neural responses in medial prefrontal cortex. Furthermore, multivoxel pattern analysis confirmed similar neural representation for first-hand and others' pain in anterior insula, with representation similarity increasing the more the video preceding the observation of others' suffering was positive. These findings speak against the idea that emotion induction affects first-hand and others' pain in an isomorphic way, but rather supports the idea that contrary to negative emotions, positive emotions favors a broader access to social resources.

Functional organization of face processing in the human superior temporal sulcus: a 7T high-resolution fMRI study.

The superior temporal sulcus (STS) is a major component of the human face perception network, implicated in processing dynamic changeable aspects of faces. However, it remains unknown whether STS holds functionally segregated subdivisions for different categories of facial movements. We used high-resolution functional magnetic resonance imaging (fMRI) at 7T in 16 volunteers to compare STS activation with faces displaying angry or happy expressions, eye-gaze shifts and lip-speech movements. Combining univariate and multivariate analyses, we show a systematic topological organization within STS, with gaze-related activity predominating in the most posterior and superior sector, speech-related activity in the anterior sector and emotional expressions represented in the intermediate middle STS. Right STS appeared to hold a finer functional segregation between all four types of facial movements, and best discriminative abilities within the face-selective posterior STS (pSTS). Conversely, left STS showed greater overlap between conditions, with a lack of distinction between mouth movements associated to speech or happy expression and better discriminative abilities (for gaze and speech vs emotion conditions) outside pSTS. Differential sensitivity to upper (eye) or lower (mouth) facial features may contribute to, but does not appear to fully account for, these response patterns.