Handholding reduces the recovery of threat memories and magnifies prefrontal hemodynamic responses.

Human touch is a powerful means of social and affective regulation, promoting safety behaviors. Yet, despite its importance across human contexts, it remains unknown how touch can promote the learning of new safety memories and what neural processes underlie such effects. The current study used measures of peripheral physiology and brain activity to examine the effects of interpersonal touch during safety learning (extinction) on the recovery of previously learned threat. We observed that handholding during extinction significantly reduced threat recovery, which was reflected in enhanced prefrontal hemodynamic responses. This effect was absent when learners were instructed to hold a rubber ball, independent of the presence of their partners. Our findings indicate that social touch contributes to safety learning, potentially influencing threat memories via prefrontal circuitry.

Does attachment in adolescence predict neural responses to handholding in adulthood? A functional magnetic resonance imaging study.

Objective: Early life experiences, including attachment-related experiences, inform internal working models that guide adult relationship behaviors. Few studies have examined the association between adolescent attachment and adult relationship behavior on a neural level. The current study examined attachment in adolescence and its associations with neural correlates of relationship behaviors in adulthood. Method: 85 participants completed the Adult Attachment Interview (AAI) at age 14. Ten years later, at age 24, participants underwent functional brain image when participants were under the threat of electric shock alone, holding the hand of a stranger, or their partner. Results: We found that adolescents who were securely attached at age 14 showed increased activation in regions commonly associated with cognitive, affective, and reward processing when they held the hand of their partner and stranger compared to being alone. Adolescents with higher preoccupied attachment scores showed decreased activation in similar regions only during the stranger handholding condition compared to being alone. Conclusions: These findings suggest that adolescent attachment predicts adult social relationship behaviors on a neural level, in regions largely consistent with previous literature. Broadly, this study has implications for understanding long-term links between attachment and adult relationship behaviors and has potential for informing intervention.

Hand-Holding's Effect on Children's Pain Perception and Anxiety during Dental Anesthetic Injections.

Local anesthetic injections are an essential tool in dentistry, particularly in pediatric dentistry. The needle penetrating the tissue can cause stress, anxiety, and pain. Studies have shown that using touch may alleviate pain and reduce patient anxiety. Yet, this has not been tested in pediatric dental patients. Therefore, this study examined the effect of hand-holding on children undergoing local anesthetic injections. Its effect on children's pain perception was tested, with the hypothesis that pain perception would be lower for children whose hand was held by an assistant. Additionally, the study examined whether hand-holding would affect children's anxiety levels and cooperation. Fifty-five children, who underwent dental treatment within the Department of Pediatric Dentistry at Tel Aviv University, were recruited. The patients were randomly divided into two groups. In the study group, the assistant gently placed her hand on the patient's hand during the anesthetic injection. In the control group, the same treatment was performed without the hand being placed by the assistant. After the anesthetic injection, the child's pain and anxiety levels were assessed using visual analog scales (VAS). The patients' pulse was measured. The level of cooperation was evaluated using the "Frankl" scale. Interestingly, although the trends aligned with this study's hypotheses, no significant effect of hand-holding on pain, anxiety, or cooperation during anesthetic injections was found.

The value of handholding during intravitreal injections.

BACKGROUND: Repeated intravitreal injections (IVI) have become the therapeutic standard of care for multiple retinal conditions. Reducing discomfort and anxiety around IVIs is important to ensure ongoing patient compliance with therapy. AIMS: The study aimed to investigate if handholding during an IVI reduces patient anxiety, and to ascertain if their anxiety lessens following repeated therapy. METHODS: Patients attending for IVIs were asked preoperatively to plot their anxiety level using the visual analogue scale for anxiety (VASA) from 0-10. They were randomised into three groups: Hand-Held-Skin-to-Skin (HHS), Hand-Held-Skin-to-Glove (HHG) and Hand-not-Held (HNH) during IVI. Post-IVI, patients were asked to recall and plot their experienced level of anxiety at the time of their first injection (First Injection Anxiety, FIA) on the 0-10 visual analogue scale for anxiety. Both hand-held cohorts were also asked their preference for handholding for future injections. RESULTS: In total, 195 patients were surveyed: HHS, n = 67; HHG, n = 58 and HNH, n = 70. A total of 98% of respondents in both Hand-Held cohorts stated they found the intervention useful in reducing anxiety, with 97% saying they would like their hand held for subsequent IVIs. Patients' anxiety levels significantly reduced when their hand was held gloved or ungloved for IVIs (p = 0.007). IVI associated anxiety did not lessen with repeated therapy. CONCLUSION: Patient stress levels are considerably reduced when their hand is held during IVI. Handholding is a useful intervention throughout the patient journey and not solely at the time of initiation of treatment.

Mechanisms supporting the social regulation of neural threat responding with marital partners: A test of the opioid hypothesis.

Positive social contact predicts better health, but the mechanisms for this association remain debated. One way to explore this link is through the social regulation of emotion, particularly anticipatory anxiety. Previous research finds less neural threat response during partner handholding than when people are alone or stranger handholding. Various mechanistic accounts have been forwarded, including the hypothesis that this effect is mediated by endogenous opioid activity. This experiment critically tested the opioid hypothesis in 60 married participants and their partners. The study used a naltrexone opioid blockade in a double-blind placebo control with functional magnetic resonance imaging to determine whether endogenous opioids were necessary for handholding effects. Regulatory effects of supportive handholding manifested in threat network regions during opioid blockade, but not with placebo. Despite a surprising lack of effect in the placebo group, the overall study findings provide initial evidence that endogenous opioids may not be necessary for the social regulation of neural threat responding.

Effect of handholding on heart rate variability in both patients with cancer and their family caregivers: a randomized crossover study.

BACKGROUND: Many family caregivers of patients with cancer feel guilty about self-care. A meaningful relationship with patients reduces such negative feelings and functions as self-care for family caregivers. Moreover, handholding improves autonomic functions in non-cancer patients. However, the effects of handholding on both patients with cancer and family caregivers remain unknown. METHODS: We evaluated the effects of handholding on heart rate variability (HRV) in patients with cancer and their family caregivers. This randomized crossover study divided patients with cancer and their family caregivers into two trial groups: Handholding trial (the family caregiver holds the patient's hand for five minutes) and Beside trial (the family caregiver stays beside the patient without holding their hand). The study included 37 pairs of patients with cancer who received treatment in the cancer department of a university hospital in Japan and their family caregivers (n = 74). The primary end-point was the change in HRV before and during the intervention. RESULTS: The median performance status of the patients was 3. An interaction was observed between trials in the standard deviation of the normal-to-normal interval (SDNN) of HRV for family caregivers (F = 7.669; p = 0.006), and a significant difference in time course was observed between the trials (before p = 0.351; during p = 0.003). No interaction was observed between trials in the SDNN for patients (F = 0.331; p = 0.566). Only a main effect in time course (F = 6.254; p = 0.014) was observed. SDNN increased significantly during the intervention in both trials (Handholding trial: p = 0.002, Beside trial: p = 0.049). CONCLUSIONS: Handholding improves autonomic functions of family caregivers and may function as self-care for family caregivers. TRIAL REGISTRATION: UMIN000020557 . Registered on January 15, 2016.

The social regulation of emotion: Inconsistencies suggest no mediation through ventromedial prefrontal cortex.

Physical touch in the form of holding a loved one's hand attenuates the neural response to threat. Speculation regarding the neural mediation of this effect points to the ventromedial prefrontal cortex (vmPFC), which is known to have inhibitory connections with threat responsive brain regions such as the amygdala. Despite the attractiveness of this hypothesis, a link between the vmPFC and diminished threat during handholding has been difficult to demonstrate empirically. Here we report that in a sample of 110 participants no evidence for vmPFC mediation of the handholding effect was obtained. Indeed, results indicated that connectivity patterns between threat responsive salience network structures and the vmPFC were in the opposite direction one would predict if the vmPFC mediated reductions in neural threat-responding caused by partner handholding. Our findings suggest that the vmPFC does not mediate the regulating effect of physical contact on neural threat responses.

A dual-brain approach for understanding the neuralmechanisms that underlie the comforting effects of social touch.

Across different cultures, social touch is used to alleviate distress. Here we adopt a dual-brain approach with fMRI to examine whether social touch involves similar activations between the suffering 'target' and the empathizer in brain regions related to emotional sharing such as the observation-execution (mirror) network. To inspect the neural underpinnings of the effects of social touch on pain, we scanned romantic couples during a task that required one partner (the empathizer) to hold the target's hand as the latter experienced painful thermal stimulation. Empathizers and target participants were scanned sequentially, in two counterbalanced phases. Results revealed that hand-holding reduced the pain of the target participant, compared to the severity of pain in a control condition (holding a rubber ball). Importantly, during social touch we found striking shared activations between the target and empathizer in the inferior parietal lobule (IPL), a region related to the observation-execution network. The brain-to-brain analysis further revealed a positive correlation of IPL activation levels between the target and the empathizer. Finally, psychophysiological interaction (PPI) analysis in the target showed that the IPL activity during social touch was positively coupled with activity in the dorsomedial prefrontal cortex, a region that has been implicated in emotion regulation, suggesting that the interaction between the observation-execution network and emotion regulation network may contribute to pain reduction during social touch.

Hand-Holding during Cystoscopy Decreases Patient Anxiety, Pain, and Dissatisfaction: A Pilot Randomized Controlled Trial.

OBJECTIVE: Often a sick or an anxious person can experience pain or anxiety relief if another person holds his or her hand. In this study, we conducted investigations to determine whether hand-holding during cystoscopy decreases patient anxiety, pain, and dissatisfaction while at the same time increasing patient comfort and tolerance during the procedure. PATIENTS AND METHODS: Eighty-six male patients who underwent flexible cystoscopy between November 2015 and March 2017 were randomized as follows: hand-holding (group I, n = 43) or non-hand-holding (group II, n = 43) during the procedure. Before flexible cystoscopy, lidocaine gel was instilled in the urethra. Patients' anxiety levels were quantified using the State-Trait Anxiety Inventory. A visual analog scale (0-10) was used for self-assessment of satisfaction, discomfort, and willingness to undergo repeat cystoscopy. RESULTS: Demographic characteristics, mean age, procedure duration, procedure indications, and preprocedural analyses did not differ significantly between the 2 groups. In group I, the postprocedural mean anxiety level, pain score, heart rate, and systolic blood pressure were significantly lower compared with those in group II (p = 0.009, p = 0.003, p = 0.022, and p = 0.014, respectively). In group I, postprocedural mean satisfaction score were higher, and patients were more likely to undergo a repeat cystoscopy, compared with those in group II (p = 0.001 and p = 0.004, respectively). CONCLUSIONS: Hand-holding during cystoscopy significantly reduced patients' feelings of anxiety, pain, discomfort, and dissatisfaction. Hand-holding served as a simple, inexpensive, and effective adjunct to sedation during cystoscopy.

Relationship status and perceived support in the social regulation of neural responses to threat.

Strong social ties correspond with better health and well being, but the neural mechanisms linking social contact to health remain speculative. This study extends work on the social regulation of brain activity by supportive handholding in 110 participants (51 female) of diverse racial and socioeconomic origins. In addition to main effects of social regulation by handholding, we assessed the moderating effects of both perceived social support and relationship status (married, cohabiting, dating or platonic friends). Results suggest that, under threat of shock, handholding by familiar relational partners attenuates both subjective distress and activity in a network associated with salience, vigilance and regulatory self-control. Moreover, greater perceived social support corresponded with less brain activity in an extended network associated with similar processes, but only during partner handholding. In contrast, we did not observe any regulatory effects of handholding by strangers, and relationship status did not moderate the regulatory effects of partner handholding. These findings suggest that contact with a familiar relational partner is likely to attenuate subjective distress and a variety of neural responses associated with the presence of threat. This effect is likely enhanced by an individual's expectation of the availability of support from their wider social network.