Words hurt: common and distinct neural substrates underlying nociceptive and semantic pain.

Introduction: Recent studies have shown that processing semantic pain, such as words associated with physical pain, modulates pain perception and enhances activity in regions of the pain matrix. A direct comparison between activations due to noxious stimulation and processing of words conveying physical pain may clarify whether and to what extent the neural substrates of nociceptive pain are shared by semantic pain. Pain is triggered also by experiences of social exclusion, rejection or loss of significant others (the so-called social pain), therefore words expressing social pain may modulate pain perception similarly to what happens with words associated with physical pain. This event-related fMRI study aims to compare the brain activity related to perceiving nociceptive pain and that emerging from processing semantic pain, i.e., words related to either physical or social pain, in order to identify common and distinct neural substrates. Methods: Thirty-four healthy women underwent two fMRI sessions each. In the Semantic session, participants were presented with positive words, negative pain-unrelated words, physical pain-related words, and social pain-related words. In the Nociceptive session, participants received cutaneous mechanical stimulations that could be either painful or not. During both sessions, participants were asked to rate the unpleasantness of each stimulus. Linguistic stimuli were also rated in terms of valence, arousal, pain relatedness, and pain intensity, immediately after the Semantic session. Results: In the Nociceptive session, the 'nociceptive stimuli' vs. 'non-nociceptive stimuli' contrast revealed extensive activations in SI, SII, insula, cingulate cortex, thalamus, and dorsolateral prefrontal cortex. In the Semantic session, words associated with social pain, compared to negative pain-unrelated words, showed increased activity in most of the same areas, whereas words associated with physical pain, compared to negative pain-unrelated words, only activated the left supramarginal gyrus and partly the postcentral gyrus. Discussion: Our results confirm that semantic pain partly shares the neural substrates of nociceptive pain. Specifically, social pain-related words activate a wide network of regions, mostly overlapping with those pertaining to the affective-motivational aspects of nociception, whereas physical pain-related words overlap with a small cluster including regions related to the sensory-discriminative aspects of nociception. However, most regions of overlap are differentially activated in different conditions.

Perceptions of Death Among Patients with Advanced Cancer Receiving Early Palliative Care and Their Caregivers: Results from a Mixed-Method Analysis.

BACKGROUND: Oncologists are often concerned that talking about death with patients may hinder their relationship. However, the views of death held by patients have not been thoroughly investigated. This study aimed to describe the perception of death among patients with advanced cancer receiving early palliative care (EPC) and their caregivers. MATERIAL AND METHODS: Qualitative and quantitative analyses were performed on 2 databases: (a) transcripts of open-ended questionnaires administered to 130 cancer patients receiving EPC with a mean age of 68.4 years and to 115 primary caregivers of patients on EPC with a mean age of 56.8; (b) texts collected from an Italian forum, containing instances of web-mediated interactions between patients and their caregivers. RESULTS: Quantitative analysis shows that: (a) patients and caregivers are not afraid of speaking about death; (b) patients and caregivers on EPC use the word "death" significantly more than patients on standard oncology care (SOC) and their caregivers (P < .0001). For both participants on EPC and SOC, the adjectives and verbs associated with the word "death" have positive connotations; however, these associations are significantly more frequent for participants on EPC (verbs, Ps < .0001; adjectives, Ps < .003). Qualitative analysis reveals that these positive connotations refer to an actual, positive experience of the end of life in the EPC group and a wish or a negated event in the SOC group. CONCLUSIONS: EPC interventions, along with proper physician-patient communication, may be associated with an increased acceptance of death in patients with advanced cancer and their caregivers.

Investigating the impact of offer frame manipulations on responders playing the ultimatum game.

The present study was designed to test the impact of frame manipulations on the decision-making of responders playing the ultimatum game. Experiment 1 investigated responders' event-related potentials (ERPs) measured in response to the offers as a function of the frame (i.e., negative: "the proposer keeps" versus positive: "the proposer offers"). While no difference in acceptation rate was found as a function of the offer's frame, electrophysiological results suggest that the stronger negative affective response to the offers in the negative frame (N400) was successfully reappraised by the responders (P600), possibly explaining why the offer frame manipulation did not modulate acceptation rates. No framing effect was found when the ultimatum game was played in its one-shot version (Experiment 2), suggesting that repeated measurements did not affect responders' behavior. However, an offer framing effect was found in female (but not in male) responders, when the complexity of the game statement increased, presumably recruiting more cognitive resources and taxing the reappraisal process (Experiment 3). Taken together, these results suggest that framing manipulations are associated with complex affective and cognitive processes, supporting the cognitive-affective tradeoff model.

Perceptions of Hope Among Bereaved Caregivers of Cancer Patients Who Received Early Palliative Care: A Content and Lexicographic Analysis.

BACKGROUND: Oncologists' fear of taking away hope from patients when proposing early palliative care (EPC) is a barrier to the implementation of this model. This study explores hope perceptions among bereaved caregivers of onco-hematologic patients who received EPC. MATERIALS AND METHODS: Open-ended questionnaires were administered to 36 primary caregivers of patients who received EPC (26 solid and 10 hematologic cancer patients; mean age: 51.4 years, range age: 20-74), at 2 cancer centers, 2 months to 3 years after a patient death. Definitions of hope in the caregivers' narratives were analyzed through a directed approach to content analysis. Results were complemented with automated lexicographic analysis. RESULTS: Caregivers perceived hope mainly as resilience and as expectations based on what they were told about the patients' clinical conditions. Their hope was bolstered by trusting relationships with the healthcare teams. EPC interventions were recalled as the major support for hope, both during the illness and after the death of the patient. The automated quantitative lexical analysis provided deeper insights into the links between hope, truth, and trust. CONCLUSIONS: Our findings suggest that telling the truth about an incurable onco-hematologic disease and beginning EPC might be the combination of factors triggering hope in the setting of incurable cancer.

Changes in Cancer Patients' and Caregivers' Disease Perceptions While Receiving Early Palliative Care: A Qualitative and Quantitative Analysis.

BACKGROUND: Little is known about the underlying mechanisms through which early palliative care (EPC) improves multiple outcomes in patients with cancer and their caregivers. The aim of this study was to qualitatively and quantitatively analyze patients' and caregivers' thoughts and emotional and cognitive perceptions about the disease prior to and during the EPC intervention, and in the end of life, following the exposure to EPC. MATERIALS AND METHODS: Seventy-seven patients with advanced cancer and 48 caregivers from two cancer centers participated in semistructured interviews. Their reports were qualitatively and quantitatively analyzed by the means of the grounded theory and a text-analysis program. RESULTS: Participants reported their past as overwhelmed by unmanaged symptoms, with detrimental physical and psychosocial consequences. The EPC intervention allowed a prompt resolution of symptoms and of their consequences and empowerment, an appreciation of its multidimensional approach, its focus on the person and its environment, and the need for EPC for oncologic populations. Patients reported that conversations with the EPC team increased their acceptance of end of life and their expectation of a painless future. Quantitative analysis revealed higher use of Negative Affects (p < .001) and Biological Processes words (p < .001) when discussing the past; Agency words when discussing the present (p < .001); Positive Affects (p < .001), Optimism (p = .002), and Insight Thinking words (p < .001) when discussing the present and the future; and Anxiety (p = .002) and Sadness words (p = .003) when discussing the future. CONCLUSION: Overall, participants perceived EPC to be beneficial. Our findings suggest that emotional and cognitive processes centered on communication underlie the benefits experienced by participants on EPC. IMPLICATIONS FOR PRACTICE: By qualitative and quantitative analyses of the emotional and cognitive perceptions of cancer patients and their caregivers about their experiences before and during EPC interventions, this study may help physicians/nurses to focus on the disease perception by patients/caregivers and the benefits of EPC, as a standard practice. The analysis of words used by patients/caregivers provides a proxy for their psychological condition and support in tailoring an EPC intervention, based on individual needs. This study highlights that the relationship of the triad EPC team/patients/caregivers may rise as a therapeutic tool, allowing increasing awareness and progressive acceptance of the idea of death.

Different semantic and affective meaning of the words associated to physical and social pain in cancer patients on early palliative/supportive care and in healthy, pain-free individuals.

Early palliative/supportive care (ePSC) is a medical intervention focused on patient's needs, that integrates standard oncological treatment, shortly after a diagnosis of advanced/metastatic cancer. ePSC improves the appropriate management of cancer pain. Understanding the semantic and emotional impact of the words used by patients to describe their pain may further improve its assessment in the ePSC setting. Psycholinguistics assumes that the semantic and affective properties of words affect the ease by which they are processed and comprehended. Therefore, in this cross-sectional survey study we collected normative data about the semantic and affective properties of words associated to physical and social pain, in order to investigate how patients with cancer pain on ePSC process them compared to healthy, pain-free individuals. One hundred ninety patients and 124 matched controls rated the Familiarity, Valence, Arousal, Pain-relatedness, Intensity, and Unpleasantness of 94 words expressing physical and social pain. Descriptive and inferential statistics were performed on ratings in order to unveil patients' semantic and affective representation of pain and compare it with those from controls. Possible effects of variables associated to the illness experience were also tested. Both groups perceived the words conveying social pain as more negative and pain-related than those expressing physical pain, confirming previous evidence of social pain described as worse than physical pain. Patients rated pain words as less negative, less pain-related, and conveying a lower intense and unpleasant pain than controls, suggesting either an adaptation to the pain experience or the role played by ePSC in improving patients' ability to cope with it. This exploratory study suggests that a chronic pain experience as the one experienced by cancer patients on ePSC affects the semantic and affective representation of pain words.

Author Correction: A consensus-based transparency checklist.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

The Comprehension of Metaphorical Descriptions Conveying Gender Stereotypes. An Exploratory Study.

In this adjective elicitation study, we investigated the comprehension of Italian sentences where a metaphorically intended noun (e.g., butterfly, nightmare) was used to describe a gender-stereotyped or stereotype-neutral individual (e.g., flute player, engineer, person). Specifically, we explored whether and to what extent meaning availability and the affective valence of these metaphorical descriptions (e.g., This flute player is a butterfly) varied as a function of the stereotypical or stereotype-neutral nature of the sentential subject, the male vs. female direction of the stereotype, and the grammatical gender marked in the subject noun phrase. Our goals were to test whether the meaning of metaphorical descriptions was equally available regardless of the presence and direction of the gender stereotype and of the grammatical gender of the subject, and whether the adjectives expressing the sentential meaning had the same affective valence no matter who was the subject. The results showed that it was easier (i.e., more adjectives came up to mind) to express the sentence meaning when the sentences described male stereotyped individuals than female stereotyped or stereotype-neutral individuals. The adjective valence did not significantly change according to the subject type. Participants produced adjectives with the wrong grammatical gender more often for males in stereotypically female occupations than for females in stereotypically male occupations. These gender errors occurred also when the sentences described females engaged in stereotypically female occupations. Overall, these results extend to metaphorical descriptions previous findings showing that a social group (males) is seen as more normative than another (females), and acts as the unmarked normative group.

Idiomatic expressions evoke stronger emotional responses in the brain than literal sentences.

Recent neuroscientific research shows that metaphors engage readers at the emotional level more strongly than literal expressions. What still remains unclear is what makes metaphors more engaging, and whether this generalises to all figurative expressions, no matter how conventionalised they are. This fMRI study aimed to investigate whether idiomatic expressions - the least creative part of figurative language - indeed trigger a higher affective resonance than literal expressions, and to explore possible interactions between activation in emotion-relevant neural structures and regions associated with figurative language processing. Participants silently read for comprehension a set of emotionally positive, negative and neutral idioms embedded in short sentences, and similarly valenced literal sentences. As in studies on metaphors, we found enhanced activation of the left inferior frontal gyrus and left amygdala in response to idioms, indexing stronger recruitment of executive control functions and enhanced emotional engagement, respectively. This suggests that the comprehension of even highly conventionalised and familiar figurative expressions, namely idioms, recruits regions involved in emotional processing. Furthermore, increased activation of the IFG interacted positively with activation in the amygdala, suggesting that the stronger cognitive engagement driven by idioms may in turn be coupled with stronger involvement at the emotional level.

The psycholinguistic and affective structure of words conveying pain.

Despite the flourishing research on the relationships between affect and language, the characteristics of pain-related words, a specific type of negative words, have never been systematically investigated from a psycholinguistic and emotional perspective, despite their psychological relevance. This study offers psycholinguistic, affective, and pain-related norms for words expressing physical and social pain. This may provide a useful tool for the selection of stimulus materials in future studies on negative emotions and/or pain. We explored the relationships between psycholinguistic, affective, and pain-related properties of 512 Italian words (nouns, adjectives, and verbs) conveying physical and social pain by asking 1020 Italian participants to provide ratings of Familiarity, Age of Acquisition, Imageability, Concreteness, Context Availability, Valence, Arousal, Pain-Relatedness, Intensity, and Unpleasantness. We also collected data concerning Length, Written Frequency (Subtlex-IT), N-Size, Orthographic Levenshtein Distance 20, Neighbor Mean Frequency, and Neighbor Maximum Frequency of each word. Interestingly, the words expressing social pain were rated as more negative, arousing, pain-related, and conveying more intense and unpleasant experiences than the words conveying physical pain.

Cognitive and Personality Components Underlying Spoken Idiom Comprehension in Context. An Exploratory Study.

In this exploratory study, we investigated whether and to what extent individual differences in cognitive and personality variables are associated with spoken idiom comprehension in context. Language unimpaired participants were enrolled in a cross-modal lexical decision study in which semantically ambiguous Italian idioms (i.e., strings with both a literal and an idiomatic interpretation as, for instance, break the ice), predictable or unpredictable before the string offset, were embedded in idiom-biasing contexts. To explore the contributions of different cognitive and personality components, participants also completed a series of tests respectively assessing general speed, inhibitory control, short-term and working memory, cognitive flexibility, crystallized and fluid intelligence, and personality. Stepwise regression analyses revealed that online idiom comprehension was associated with the participants' working memory, inhibitory control and crystallized verbal intelligence, an association modulated by idiom type. Also personality-related variables (State Anxiety and Openness to Experience) were associated with idiom comprehension, although in marginally significant ways. These results contribute to the renewed interest on how individual variability modulates language comprehension, and for the first time document contributions of individual variability on lexicalized, high frequency multi-word expressions as idioms adding new knowledge to the existing evidence on metaphor and sarcasm.

Basic composition and enriched integration in idiom processing: An EEG study.

We investigated the extent to which the literal meanings of the words forming literally plausible idioms (e.g., break the ice) are semantically composed and how the idiomatic meaning is integrated in the unfolding sentence representation. Participants read ambiguous idiom strings embedded in highly predictable, literal, and idiomatic contexts while their EEG was recorded. Control sentences only contained the idiom-final word whose cloze values were as high as in literal and idiomatic contexts. Event-related potentials data showed that differences in the amplitude of a frontal positivity (PNP) emerged at the beginning and at the end of the idiom strings, with the idiomatic context condition associated with more positive voltages. The time frequency analysis of the EEG showed an increase in power of the middle gamma frequency band only in the literal context condition. These findings suggest that sentence revision mechanisms, associated with the frontal PNP, are involved in idiom meaning integration, and that the literal semantic composition of the idiomatic constituents, associated with changes in gamma frequency, is not carried out after idiom recognition. (PsycINFO Database Record

The Responders' Gender Stereotypes Modulate the Strategic Decision-Making of Proposers Playing the Ultimatum Game.

Despite the wealth of studies investigating factors affecting decisions, not much is known about the impact of stereotypical beliefs on strategic economic decision-making. In the present study, we used the ultimatum game paradigm to investigate how participants playing as proposer modulate their strategic economic behavior, according to their game counterparts' stereotypical identity (i.e., responders). The latter were introduced to the participants using occupational role nouns stereotypically marked with gender paired with feminine or masculine proper names (e.g., linguist-Anna; economist-David; economist-Cristina; linguist-Leonardo). When playing with male-stereotyped responders, proposers quickly applied the equity rule, behaving fairly, while they adopted a strategic behavior with responders characterized by female stereotypes. They were also longer to make their offers to female than to male responders but both kinds of responders received comparable offers, suggesting a greater cognitive effort to treat females as equally as males. The present study explicitly demonstrates that gender stereotypical information affect strategic economic decision-making and highlights a possible evolution of gender discrimination into a more insidious discrimination toward individuals with female characteristics.

When emotions are expressed figuratively: Psycholinguistic and Affective Norms of 619 Idioms for German (PANIG).

Despite flourishing research on the relationship between emotion and literal language, and despite the pervasiveness of figurative expressions in communication, the role of figurative language in conveying affect has been underinvestigated. This study provides affective and psycholinguistic norms for 619 German idiomatic expressions and explores the relationships between affective and psycholinguistic idiom properties. German native speakers rated each idiom for emotional valence, arousal, familiarity, semantic transparency, figurativeness, and concreteness. They also described the figurative meaning of each idiom and rated how confident they were about the attributed meaning. The results showed that idioms rated high in valence were also rated high in arousal. Negative idioms were rated as more arousing than positive ones, in line with results from single words. Furthermore, arousal correlated positively with figurativeness (supporting the idea that figurative expressions are more emotionally engaging than literal expressions) and with concreteness and semantic transparency. This suggests that idioms may convey a more direct reference to sensory representations, mediated by the meanings of their constituting words. Arousal correlated positively with familiarity. In addition, positive idioms were rated as more familiar than negative idioms. Finally, idioms without a literal counterpart were rated as more emotionally valenced and arousing than idioms with a literal counterpart. Although the meanings of ambiguous idioms were less correctly defined than those of unambiguous idioms, ambiguous idioms were rated as more concrete than unambiguous ones. We also discuss the relationships between the various psycholinguistic variables characterizing idioms, with reference to the literature on idiom structure and processing.

Gender stereotypes across the ages: On-line processing in school-age children, young and older adults.

Most research to date on implicit gender stereotyping has been conducted with one age group - young adults. The mechanisms that underlie the on-line processing of stereotypical information in other age groups have received very little attention. This is the first study to investigate real time processing of gender stereotypes at different age levels. We investigated the activation of gender stereotypes in Italian in four groups of participants: third- and fifth-graders, young and older adults. Participants heard a noun that was stereotypically associated with masculine (preside "headmaster") or feminine roles (badante "social care worker"), followed by a male (padre "father") or female kinship term (madre "mother"). The task was to decide if the two words - the role noun and the kinship term - could describe the same person. Across all age groups, participants were significantly faster to respond, and significantly more likely to press 'yes,' when the gender of the target was congruent with the stereotypical gender use of the preceding prime. These findings suggest that information about the stereotypical gender associated with a role noun is incorporated into the mental representation of this word and is activated as soon as the word is heard. In addition, our results show differences between male and female participants of the various age groups, and between male- and female-oriented stereotypes, pointing to important gender asymmetries.

Neural Adaptation Effects in Conceptual Processing.

We investigated the conceptual processing of nouns referring to objects characterized by a highly typical color and orientation. We used a go/no-go task in which we asked participants to categorize each noun as referring or not to natural entities (e.g., animals) after a selective adaptation of color-edge neurons in the posterior LV4 region of the visual cortex was induced by means of a McCollough effect procedure. This manipulation affected categorization: the green-vertical adaptation led to slower responses than the green-horizontal adaptation, regardless of the specific color and orientation of the to-be-categorized noun. This result suggests that the conceptual processing of natural entities may entail the activation of modality-specific neural channels with weights proportional to the reliability of the signals produced by these channels during actual perception. This finding is discussed with reference to the debate about the grounded cognition view.

Sex and the money--How gender stereotypes modulate economic decision-making: An ERP study.

In the present event-related potential study, we investigated whether and how participants playing the ultimatum game as responders modulate their decisions according to the proposers' stereotypical identity. The proposers' identity was manipulated using occupational role nouns stereotypically marked with gender (e.g., Teacher; Engineer), paired with either feminine or masculine proper names (e.g., Anna; David). Greater FRN amplitudes reflected the early processing of the conflict between the strategic rule (i.e., earning as much money as possible) and ready-to-go responses (i.e., refusing unequal offers and discriminating proposers according to their stereotype). Responders were found to rely on a dual-process system (i.e., automatic and heuristic-based system 1 vs. cognitively costly and deliberative system 2), the P300 amplitude reflecting the switch from a decision making system to another. Greater P300 amplitudes were found in response to both fair and unfair offers and male-stereotyped proposers' offers reflecting an automatic decision making based on heuristics, while lower P300 amplitudes were found in response to 3€ offers and the female-stereotyped proposers' offers reflecting a more deliberative reasoning. Overall, the results indicate that participants were more motivated to engage in a costly deliberative reasoning associated with an increase in acceptation rate when playing with female-stereotyped proposers, who may have induced more positive and emphatic feelings in the participants than did male-stereotyped proposers. Then, we assume that people with an occupation stereotypically marked with female gender and engaged in an economic negotiation may benefit from their occupation at least in the case their counterparts lose their money if the negotiation fails.

Is the noun ending a cue to grammatical gender processing? An ERP study on sentences in Italian.

Gender-to-ending consistency has been shown to influence grammatical gender retrieval in isolated word presentation. Notwithstanding the wealth of evidence, the exact role and the time course of processing of this distributional information remain unclear. This ERP study investigated if and when the brain detects gender-to-ending consistency in sentences containing Italian determiner-noun pairs. Determiners either agreed or disagreed in gender with the nouns whose endings were reliable or misleading cues to gender (transparent and irregular nouns). Transparent nouns elicited an increased frontal negativity and a late posterior positivity compared to irregular nouns (350-950 ms), suggesting that the system is sensitive to gender-to-ending consistency from relatively early stages of processing. Gender agreement violations evoked a similar LAN-P600 pattern for both types of nouns. The present findings provide evidence for an early detection of reliable gender-related endings during sentence reading.

Is black always the opposite of white? An investigation on the comprehension of antonyms in people with schizophrenia and in healthy participants.

The present investigation sought to expand our understanding of the cognitive processes underlying the recognition of antonyms and to evaluate whether these processes differed in patients with schizophrenia and in healthy controls. Antonymy is the most robust of the lexico-semantic relations and is relevant to both the mental organization of the lexicon and the organization of coherent discourse, as attested by the resurgence of interest in antonymy in the linguistic and psychological domains. In contrast, the vast literature on semantic processing in schizophrenia almost ignored antonymy. In this study, we tested the online comprehension of antonyms in 39 Italian patients with paranoid schizophrenia and in an equal number of pairwise-matched healthy controls. Participants read a definitional sentence fragment (e.g., the opposite of black is), followed by the correct antonym (white) or by a semantically unrelated word (nice), and judged whether or not the target word was correct. Patients were rather accurate in identifying antonyms, but compared to controls, they showed longer response times and higher priming scores, suggesting an exaggerated contextual facilitation. Presumably, this reflects a deficient controlled semantic processing and an overreliance on stored semantic representations.