Facial representations of complex affective states combining pain and a negative emotion.

Pain is rarely communicated alone, as it is often accompanied by emotions such as anger or sadness. Communicating these affective states involves shared representations. However, how an individual conceptually represents these combined states must first be tested. The objective of this study was to measure the interaction between pain and negative emotions on two types of facial representations of these states, namely visual (i.e., interactive virtual agents; VAs) and sensorimotor (i.e., one's production of facial configurations). Twenty-eight participants (15 women) read short written scenarios involving only pain or a combined experience of pain and a negative emotion (anger, disgust, fear, or sadness). They produced facial configurations representing these experiences on the faces of the VAs and on their face (own production or imitation of VAs). The results suggest that affective states related to a direct threat to the body (i.e., anger, disgust, and pain) share a similar facial representation, while those that present no immediate danger (i.e., fear and sadness) differ. Although visual and sensorimotor representations of these states provide congruent affective information, they are differently influenced by factors associated with the communication cycle. These findings contribute to our understanding of pain communication in different affective contexts.

Improving feeling of control and trust in interpreter-mediated mental health consultations.

Language barriers are among the most critical factors in health care disparities. Low language proficiency is consistently associated with a high prevalence and severity of mental health disorder symptoms. Despite the advantages of working with an interpreter, most practitioners report difficulties, especially with trust and the feeling of control. The main objective of this exploratory qualitative intervention research is to examine the impact of training when working with interpreters and their inclusion in follow-ups. This impact is evaluated in the changes in feelings of control and trust for the practitioners who received the training, for the trained interpreters included in follow-ups and for the patients of these follow-ups. Semistructured interviews were conducted with individuals involved in five follow-ups at four public mental health clinics in Paris, France. The project had two phases: before (N = 18) and a few months after (N = 12) the training. Interviews were transcribed and thematically analyzed. Before the training, practitioners perceived the potential for collaboration with interpreters and the complexity of triadic consultations. Interpreters expressed irritation and disappointment at the lack of recognition, and patients seemed confident because they had already built a relationship with practitioners. After the training and inclusion of interpreters, trust is better established between interpreters and practitioners, which has substantial effects. All the protagonists state that trust positively impacts the relationship with patients and the therapeutic process. Although some practitioners still doubt the sessions' control, the intervention helps them to gain knowledge and critically examines their clinical modus operandi. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

[Basic, Clinical and Social Perspectives on the Use of Virtual Characters in Mental Health]. / Perspectives fondamentale, clinique et sociétale de l'utilisation des personnages virtuels en santé mentale.

Along other breakthroughs in computer sciences, such as artificial intelligence, virtual characters (i.e. digitally represented characters featuring a human appearance or not) are foreseen as potential providers of mental healthcare services. However, their current use in clinical practice is marginal and limited to an assistive role to help clinicians in their practices. Safety and efficiency concerns, as well as a general lack of knowledge and experience, may explain this discrepancy between the expected (sometimes futuristic) and current use of virtual characters. An overview of recent evidence would help pinpoint the main concerns and challenges pertaining to their use in mental healthcare. Objective This paper aims to inform relevant actors, including clinicians, on the potential of virtual characters in mental healthcare practices and to raise awareness on societal challenges regarding their use. Method A narrative literature review was conducted to summarize basic and clinical research findings, and to outline an in-depth discussion on various societal caveats related to the inclusion of virtual characters. Results Basic studies highlight several characteristics of the virtual characters that seem to influence patient-clinician interactions. These characteristics can be classified into two categories: perceptual (e.g. realism) and social features (i.e. attribution of social categories such as gender). To this day, many interventions and/or assessments using virtual characters have shown various levels of efficiency in mental health, and certain elements of a therapeutic relationship (e.g. alliance and empathy) may even be triggered during an interaction with a virtual character. To develop and increase the use of virtual characters, numerous socioeconomic and ethical issues must be examined. Although the accessibility and the availability of virtual characters are an undeniable advantage for their use in mental healthcare, some inequities about their application remain. In addition, the accumulation of biometric data (e.g. heart rate) could provide valuable information to clinicians and could help develop autonomous virtual characters, which raises concerns over issues of security and privacy. This paper proposes some recommendations to avoid such undesirable outcomes. Conclusion Due to their promising features, the inclusion of virtual characters will no doubt be increasingly prevalent in mental healthcare services. All involved actors should thus be informed about specific challenges raised by such breakthroughs. They should also actively participate in discussions regarding the development of virtual characters in order to adopt unified recommendations for their safe and ethical use in mental healthcare.

I Can But I Shall Not Always Be Empathic.

Empathy, a core process for social interactions, is the capacity to understand and share others' mental states and emotions. Each individual is thought to have a maximum level of empathy (empathic ability) and a spontaneous tendency to express it (empathic propensity), which can be affected by multiple factors. Two within-subject studies were conducted to assess the malleability of empathy by modulating contextual factors and measuring their interaction with psychological characteristics. In Study 1, 59 healthy adults evaluated their empathy for people showing facial expressions of pain following different instructions: Passive Observation and Instruction to Actively Empathize. In Study 2, 56 healthy adults performed a similar task under two conditions: Passive Observation and Observation under a Cognitive Load. The results revealed that empathy was significantly increased in the actively empathizing condition (Study 1) and under a cognitive load, but more importantly for men (Study 2). The level of change between the two conditions was associated with self-reported empathy, autistic, alexithymia and psychopathic traits (Study 1), as well as with working memory capacities and the level of empathy reported in the passive observation condition (Study 2). These findings suggest that an instruction to actively empathize and, surprisingly, a cognitive load can both increase empathy, but not for the same individuals. An instruction to actively empathize seems to increase empathy for individuals with good empathic dispositions, while a cognitive load enhances empathy in people for which empathic propensity is sub-optimal.

Comparison of myocardial ischemia on the ergocycle versus the treadmill in patients with coronary heart disease.

We previously observed an attenuation of exercise-induced myocardial ischemia on the ergocycle during a ramp protocol compared to the standard Bruce protocol treadmill test in patients with coronary heart disease. However, it was uncertain whether decreased ischemia on the ergocycle resulted from the warm-up effect of the more gradual ramp protocol or from the mode of exercise itself (cycling vs running). Sixteen stable patients, aged 64 +/- 5 years, with documented coronary heart disease (> or =70% coronary artery stenosis and/or reversible myocardial perfusion defects) performed 3 symptom-limited exercise tests: the standard Bruce protocol treadmill test and 2 individualized ramp protocols (treadmill and ergocycle). We measured the ischemic threshold (heart rate x systolic blood pressure product at 1-mm ST-segment depression) and oxygen consumption (VO(2)). The ischemic threshold was higher during cycling (ergocycle ramp, 24,009 +/- 5,769 beats/min x mm Hg) compared to running (Bruce treadmill, 20,429 +/- 3,508 beats/min x mm Hg; and ramp treadmill, 19,451 +/- 3,392 beats/min x mm Hg; p <0.001), independently of exercise intensity (VO(2)). The peak VO(2) did not significantly differ among all tests (p = 0.25) despite a greater peak rate-pressure product achieved with the ergocycle (29,378 +/- 6,291 beats/min x mm Hg) compared to either treadmill protocol (Bruce, 26,202 +/- 5,831 beats/min x mm Hg; ramp, 25,654 +/- 6,492 beats/min x mm Hg; p <0.001). In conclusion, the mode of exercise (ergocycle vs treadmill), rather than the type of protocol (ramp vs Bruce), is associated with an attenuation of electrocardiographic parameters of myocardial ischemia, independently of exercise intensity (VO(2)) and myocardial demand (rate-pressure product).

Can prolonged exercise-induced myocardial ischaemia be innocuous?

AIMS: To evaluate the innocuousness of intense and prolonged exercise training above the threshold for myocardial ischaemia (1 mm ST-segment depression). METHODS AND RESULTS: Twenty-two patients with ischaemic heart disease (IHD) were randomized to exercise training either at a target intensity that induced myocardial ischaemia (ischaemic group) or that adhered to current guidelines (control group). Training was progressively increased to 60 min under continuous electrocardiographic (ECG) monitoring. Cardiac troponin T (cTnT) was measured at various intervals. Ambulatory ECG monitoring was performed before and after 6 weeks of training and left ventricular function was evaluated in the ischaemic group after at least 6 weeks of training. The ischaemic group had myocardial ischaemia during the first 20, 40, and 60 min exercise sessions for 12.3 +/- 6.8, 29.0 +/- 12.9, and 49.8 +/- 2.2 min, respectively, with ST-segment depression ranging from 1.0 to 2.1 mm. No patient in either group demonstrated significant arrhythmias or increased cTnT. The ischaemic group had preserved left ventricular function. CONCLUSION: In patients with IHD, prolonged and repeated ischaemic training sessions up to 60 min can be well tolerated without evidence of myocardial injury, significant arrhythmias, or left ventricular dysfunction.