In search of the pleasure of moving through bodily re-explorations and interactions with the surroundings: a qualitative study on changed perceptions of physical activity in people with mild multiple sclerosis.

INTRODUCTION: Reduced physical activity (PA) among people with multiple sclerosis (pwMS) with low disability is a significant concern. Developing healthcare to promote PA requires a comprehensive understanding of pwMS's perspectives. PURPOSE: To explore how pwMS with mild disability perceive PA and the impact of individual, professional, social, and environmental aspects on their PA engagement. METHODS: Qualitative, in-depth interviews with 27 pwMS (21 women, 6 men; aged 31-66; EDSS ≤ 3.5) were analyzed via systematic text condensation and informed by enactive theory. RESULTS: Three categories were formed: Perception Shifts after Diagnosis: Participants adapted their perceptions to PA throughout their disease journey. Initial uncertainty concerning bodily capacities, prospects and safety reduced PA. Moving "correctly" during activities was emphasized to facilitate PA levels. Affective Experiences Drive Behavior: Pleasure associated with movement was a highlighted motivator, however, some experienced PA less rewarding after diagnosis. Discomfort and fear were barriers to PA engagement. The Surroundings Influence Perceptions: Participants sought social interactions and outdoor-environments to improve PA. Healthcare professionals were trusted to provide possibilities for PA, but early-stage and tailored follow-up was often lacking. CONCLUSION: This study illuminates changed PA perceptions after MS diagnosis and how affect, shaped by personal, interpersonal, and environmental aspects, drive PA engagement. Moreover, it calls for early follow-up and the implementation of tailored healthcare throughout the disease course to promote PA engagement. Considering these findings, we have put forth a model aimed at fostering a nuanced comprehension of PA in pwMS with mild disabilities. Further development and exploration of this model is needed.

Brain mechanisms discriminating enactive mental simulations of running and plogging.

Enactive cognition emphasizes co-constructive roles of humans and their environment in shaping cognitive processes. It is specifically engaged in the mental simulation of behaviors, enhancing the connection between perception and action. Here we investigated the core network of brain regions involved in enactive cognition as applied to mental simulations of physical exercise. We used a neuroimaging paradigm in which participants (N = 103) were required to project themselves running or plogging (running while picking-up litter) along an image-guided naturalistic trail. Using both univariate and multivariate brain imaging analyses, we find that a broad spectrum of brain activation discriminates between the mental simulation of plogging versus running. Critically, we show that self-reported ratings of daily life running engagement and the quality of mental simulation (how well participants were able to imagine themselves running) modulate the brain reactivity to plogging versus running. Finally, we undertook functional connectivity analyses centered on the insular cortex, which is a key region in the dynamic interplay between neurocognitive processes. This analysis revealed increased positive and negative patterns of insular-centered functional connectivity in the plogging condition (as compared to the running condition), thereby confirming the key role of the insular cortex in action simulation involving complex sets of mental mechanisms. Taken together, the present findings provide new insights into the brain networks involved in the enactive mental simulation of physical exercise.

Behaviour settings as a way to order types of situations for the study of speech aids.

This article revisits the notion of behaviour settings, coined by Roger G. Barker (Barker 1968, Ecol. Psychol. 28, 39-55 (10.1080/10407413.2016.1121744)), as a useful concept for the analysis of situations and communicative needs of persons after larynx removal surgery (laryngectomy). We claim that behaviour settings offer a way to characterize types of situations and types of participation, which, in turn, helps to identify aspects of communication where compensation is needed; these steps are crucial in the design process of reliable and context-sensitive speech aids. Moreover, we advocate complementing the behaviour setting concept as a unit of analysis with modern developments in the cognitive sciences, such as conversational analysis of co-operative actions (Goodwin 2017, Co-operative action (learning in doing: social, cognitive and computational perspectives). Cambridge: Cambridge University Press (10.1017/9781139016735)) and the analysis of multi-perspectival experience (De Jaegher 2021, Phenomenol. Cogn. Sci. 20, 847-870 (10.1007/s11097-019-09634-5)). Such an integration of macro- and micro-level patterns should help discover the relevant relations and values in particular situations. We illustrate our claims with examples from Barker's own work and from our ongoing analyses of the everyday life of persons after laryngectomy. This article is part of the theme issue 'People, places, things, and communities: expanding behaviour settings theory in the twenty-first century'.

Crisis of objectivity: using a personalized network model to understand maladaptive sensemaking in a patient with psychotic, affective, and obsessive-compulsive symptoms.

Introduction: Psychiatric comorbidities have proven a consistent challenge. Recent approaches emphasize the need to move away from categorical descriptions of symptom clusters towards a dimensional view of mental disorders. From the perspective of phenomenological psychopathology, this shift is not enough, as a more detailed understanding of patients' lived experience is necessary as well. One phenomenology-informed approach suggests that we can better understand the nature of psychiatric disorders through personalized network models, a comprehensive description of a person's lifeworld in the form of salient nodes and the relationships between them. We present a detailed case study of a patient with multiple comorbidities, maladaptive coping mechanisms, and adverse childhood experiences. Methods: The case was followed for a period of two years, during which we collected multiple streams of data, ranging from phenomenological interviews, neuropsychological assessments, language analysis, and semi-structured interviews (Examination of Anomalous Self Experience and Examination of Anomalous World Experience). We analytically constructed a personalized network model of his lifeworld. Results: We identified an experiential category "the crisis of objectivity" as the core psychopathological theme of his lifeworld. It refers to his persistent mistrust towards any information that he obtains that he appraises as originating in his subjectivity. We can developmentally trace the crisis of objectivity to his adverse childhood experience, as well as him experiencing a psychotic episode in earnest. He developed various maladaptive coping mechanisms in order to compensate for his psychotic symptoms. Interestingly, we found correspondence between his subjective reports and other sources of data. Discussion: Hernan exhibits difficulties in multiple Research Domain Criteria constructs. While we can say that social sensorimotor, positive valence, and negative valence systems dysfunctions are likely associated with primary deficit (originating in his adverse childhood experience), his cognitive symptoms may be tied to his maladaptive coping mechanisms (although, they might be related to his primary disorder as well).

Enactive behaviour settings: situating agency, normativity and transformation.

Behaviour settings are sociocultural places defined by three main ecological aspects: the affordances of material structures, typical patterns of skilful action and socially situated norms. These aspects explain the observed regularities of human behaviour associated with the material characteristics of places. However, the focus of ecological theories on how individual agents attune their actions to the pre-established order of behaviour settings neglects the agents' active role in sustaining or motivating transformations in this order. We therefore propose an alternative enactive approach to behaviour settings that accounts for the role of agents as active supporters and transformers of behaviour settings. Based on the enactive concepts of agency, normativity and dialectics, we argue that agents, as participants of behaviour settings, simultaneously respond to multiple normative dimensions (e.g. biological, sensorimotor and interactive). To sustain the order of behaviour settings, agents sometimes need to inhibit other normative responses of their bodies, which sometimes is detrimental to one or many aspects of their lives. Nonetheless, agents can collectively trigger the transformation of behaviour settings. This transformation can occur dialectically as tensions between two or more norms to which human bodies respond are resolved, even if new tensions arise and the process of changing behaviour setting continues. This article is part of the theme issue 'People, places, things and communities: expanding behaviour settings theory in the twenty-first century'.

An Ecological Approach to Conceptual Thinking in Material Engagement.

Although post-cognitivist approaches have shaken the status quo by emphasising the dynamic interactions among the brain, the body, and the environment in cognition, mainstream psychological theories continue to view concepts as primarily representational or skull-bound mental phenomena. As a result, the dynamics of action and the possible impact of material culture on conceptual thinking are poorly understood. In this paper, we explore the process and meaning of conceptual thinking from a material engagement perspective. We argue that conceptual thinking is not a matter of forming representations in the head but something we do-a way of engaging with materiality. Conceptual thinking is conceptual thinging, namely a kind of unmediated practical knowledge that individuals put into play when they engage, in a general way, with and through the world. In this sense, we propose that conceptual thinking is instantiated in the dynamic coordination of bodily practices and artefacts in sociomaterial activities. To elucidate this perspective, we introduce seven principles defining conceptual thinking within an ecological-enactive framework of cognition.

Longevity as a Responsibility: Constructing Healthy Aging by Enacting within Contexts over the Entire Lifespan.

Studying aging now requires going beyond the bio-psycho-social model and incorporating a broader multidisciplinary view capable of capturing the ultimate complexity of being human that is expressed as individuals age. Current demographic trends and the lengthening of life expectancies allow the observation of long-lived individuals in full health. These super-agers are no longer an exception. Indeed, individuals can have a good quality of life even over age 70 and living with chronic or neurodegenerative diseases. This change is driven in part by the cohort effect observed in people who are about to age today (e.g., better schooling, more advanced health conditions, and technologization) but more so by the gradual overcoming of ageist views. An aged person is no longer seen as a quitter but rather as one empowered to direct their own trajectory of potentially healthy longevity. According to this vision, this article proposes a situated lifespan perspective for the study of aging that integrates pedagogical models of developmental ecology with psychological theories of optimal experience to understand the individual motivational perspective on aging. At the same time, it does not disregard analyzing the daily and cultural contexts in which everyone situates and that guide aging trajectories. Nor does it forget that aging people are body-mind (embodied) organisms that, with contexts and through motivations, seize opportunities for action (affordances) to evolve in an optimal way during their lifespan. This theoretical reflection sheds new light on the aging process and on future trends in healthy longevity research.

Enhancing Agency in Posttraumatic Stress Disorder Therapies Through Sensorimotor Technologies.

Posttraumatic stress disorder (PTSD) is a significant public health concern, with only a third of patients recovering within a year of treatment. While PTSD often disrupts the sense of body ownership and sense of agency (SA), attention to the SA in trauma has been lacking. This perspective paper explores the loss of the SA in PTSD and its relevance in the development of symptoms. Trauma is viewed as a breakdown of the SA, related to a freeze response, with peritraumatic dissociation increasing the risk of PTSD. Drawing from embodied cognition, we propose an enactive perspective of PTSD, suggesting therapies that restore the SA through direct engagement with the body and environment. We discuss the potential of agency-based therapies and innovative technologies such as gesture sonification, which translates body movements into sounds to enhance the SA. Gesture sonification offers a screen-free, noninvasive approach that could complement existing trauma-focused therapies. We emphasize the need for interdisciplinary collaboration and clinical research to further explore these approaches in preventing and treating PTSD.

The meaningfulness of exploring one's own limits through interactions and enjoyment in outdoor high-intensity physiotherapy for people with multiple sclerosis: a qualitative study.

Background and purpose: Physical activity (PA) is often reduced in people with MS (pwMS), even when disability is low. Understanding the perspectives of pwMS on interventions aiming to improve PA is important to inform the development of such services. The aim of this study was to explore the experiences of pwMS participating in an outdoor, high-intensity and balance exercise group intervention. Methods: This qualitative study was nested within an RCT exploring a novel intervention integrating sensorimotor exercises with high-intensity intervals of running/walking. Individual, in-depth interviews with the intervention group (n = 15; 12 women, 3 men; age 38-66; EDSS score 0-3.5) were conducted postintervention (mean days = 14), analyzed using a phenomenological-inspired approach with systematic text condensation, and interpreted based on enactive theory. Results: Four categories were generated: (1) Exploration of one's own physical abilities: Challenging one's own limits was perceived by all participants to improve movement performance and/or intensity level. Such bodily changes engendered strong positive feelings. Some negative consequences of high-intensity training were described, increasing a feeling of loss. (2) New insights and beliefs: Participants experienced enhanced beliefs in their own capabilities, which they integrated in activities outside the intervention. (3) An engaging environment: The group setting was perceived as supportive, and the outdoor environment was perceived as stimulating activity. (4) Professional leadership, tailoring and co-creation of enjoyment: Physiotherapist-led, individualized interactions were regarded as necessary to safely revisit prior activities, such as running. Co-creating enjoyment facilitated high-intensity training and intervention adherence. Discussion: High-intensity training combined with detailed exercises in a physiotherapy outdoor group was perceived to create meaningful bodily changes and enhance PA and prospects for both PA and life. Importantly, however, some negative experiences were also reported from the high-intensity training. Enactive theory allowed for the illumination of new perspectives: the importance of embodiment for self-efficacy and of tailored physiotherapy and an outdoor-group environment for exploring one's own limits to physical capabilities. These aspects should inform future exercise interventions in pwMS with low disability.

Interoceptive experiences and ecological care: an embodied approach within therapeutical realms.

The conventional dichotomy between human health and disease has historically been approached through reductionist models that emphasize the exclusive causal relevance of physiological and pathological processes. Consequently, self-awareness and affective dimensions, integral to a phenomenological perspective, are often relegated to secondary traits, affording little consideration for the causal role of embodied living organization. Our interest lies in exploring the potential relevance of the phenomenology of embodied self-awareness in relation to interoceptive processes within therapeutic settings. As we illustrate, when the unfolding processes of interoceptive awareness and its affective capacity take precedence, the agent assumes an active, rather than passive, role in their own experience of health or illness. Departing from an enactive, phenomenological, and ecological standpoint, we propose a distinctive perspective on interoceptive processes, relying on an affective conceptualization of a spectrum of experiences of bodily being-in-the-world. Our primary argument posits that considering interoceptive processes from an embodied and ecological viewpoint of the self, interacting with the material and social environment, enables an approach to the gradient of affective experiences of embodied self-awareness-where pleasure or suffering is perceived and felt-in a naturalized, non-reductive, and relational manner. We discern two ways in which interoceptive processes interrelate with the experience of embodied self-awareness: sensitivity (self-affective) and affective-laden perception. Drawing on this distinction, we provide a nuanced description of these experiences within communities of cis-women, exemplified through the contexts of menstruation and endometriosis. This exploration seeks to enhance our understanding of the phenomenology of embodied, ecological, and affective self-experience from within diverse and situated bodies. The goal is to contribute to their autonomy and ability to adapt and self-regulate within therapeutic contexts.

The ethics of sense-making.

In this paper, we contribute to the arising field of "enactive ethics," that is, the application of enactive cognitive science to the field of ethics. To this end, we will make a case that an "ethics of sense-making" should exist. With "sense-making," we mean the permanent everyday embodied activity of interpreting the surroundings we are in, as well as our role in them. In other words, we mean the activity of understanding our environments in such a way that certain things, but not others, stand out as meaningful and relevant to us. We argue that sense-making can be performed in ethically better or worse ways. For example, one might make sense of a potentially provocative comment either as an insult or as an invitation for a respectful discussion. How one makes sense in this case will affect oneself, the other, and their present and future relations. We propose that it is often helpful to hold humans responsible for their ways of sense-making. This opens up the possibility to transform their sense-making and the worlds they inhabit. This also has significance for their eudaimonic well-being. Our ethics of sense-making focusses on the ubiquitous activities of sense-making, which, when changed, will lead to great ethical improvements of people's actions, choices, and character traits.

Affordance-based practice: An ecological-enactive approach to chronic musculoskeletal pain management.

BACKGROUND: The biomedical understanding of chronic musculoskeletal pain endorses a linear relationship between noxious stimuli and pain, and is often dualist or reductionist. Although the biopsychosocial approach is an important advancement, it has a limited theoretical foundation. As such, it tends to be misinterpreted in manners that lead to artificial boundaries between the biological, psychological, and social, with fragmented and polarized clinical applications. OBJECTIVE: We present an ecological-enactive approach to complement the biopsychosocial model. In this approach, the disabling aspect of chronic pain is characterized as an embodied, embedded, and enactive process of experiencing a closed-off field of affordances (i.e., shutting down of action possibilities). Pain is considered as a multi-dimensional, multicausal, and dynamic process, not locatable in any of the biopsychosocial component domains. Based on a person-centered reasoning approach and a dispositional view of causation, we present tools to reason about complex clinical problems in face of uncertainty and the absence of 'root causes' for pain. Interventions to open up the field of affordances include building ability and confidence, encouraging movement variability, carefully controlling contextual factors, and changing perceptions through action according to each patient's self-identified goals. A clinical case illustrates how reasoning based on an ecological-enactive approach leads to an expanded, multi-pronged, affordance-based intervention. CONCLUSIONS: The ecological-enactive perspective can provide an overarching conceptual and practical framework for clinical practice, guiding and constraining clinicians to choose, combine, and integrate tools that are consistent with each other and with a true biopsychosocial approach.

Perspectives on the insidious nature of pain metaphor: we literally need to change our metaphors.

Metaphorical language is used to convey one thing as representative or symbolic of something else. Metaphor is used in figurative language but is much more than a means of delivering "poetic imagination". A metaphor is a conceptual tool for categorising, organizing, thinking about, and ultimately shaping reality. Thus, metaphor underpins the way humans think. Our viewpoint is that metaphorical thought and communication contribute to "painogenicity", the tendency of socio-ecological environments (settings) to promote the persistence of pain. In this perspectives article, we explore the insidious nature of metaphor used in pain language and conceptual models of pain. We explain how metaphor shapes mental organisation to govern the way humans perceive, navigate and gain insight into the nature of the world, i.e., creating experience. We explain how people use metaphors to "project" their private sensations, feelings, and thoughts onto objects and events in the external world. This helps people to understand their pain and promotes sharing of pain experience with others, including health care professionals. We explore the insidious nature of "warmongering" and damage-based metaphors in daily parlance and demonstrate how this is detrimental to health and wellbeing. We explore how metaphors shape the development and communication of complex, abstract ideas, theories, and models and how scientific understanding of pain is metaphorical in nature. We argue that overly simplistic neuro-mechanistic metaphors of pain contribute to fallacies and misnomers and an unhealthy focus on biomedical research, in the hope of developing medical interventions that "prevent pain transmission [sic]". We advocate reconfiguring pain language towards constructive metaphors that foster a salutogenic view of pain, focusing on health and well-being. We advocate reconfiguring metaphors to align with contemporary pain science, to encourage acceptance of non-medicalised strategies to aid health and well-being. We explore the role of enactive metaphors to facilitate reconfiguration. We conclude that being cognisant of the pervasive nature of metaphors will assist progress toward a more coherent conceptual understanding of pain and the use of healthier pain language. We hope our article catalyses debate and reflection.

Exploring the potential of a standardized test in physiotherapy: making emotion, embodiment, and therapeutic alliance count for women with chronic pelvic pain.

Introduction: There has been an increased use of standardized measurements in health care meant to provide objective information to enhance the quality and effectivity of care. Patient performance tests are based on standardized predefined criteria with a limited focus. When facing multifaceted health conditions, information expanding the predefined criteria in a standardized test may be required to understand the patient's complex symptoms. Relying on test information based on measurements according to functional biology, one risks missing information communicated by the sensitive and expressive body of the individual patient. The aim of this article is to investigate how body, self and illness perception is constituted as a co-construction between a physiotherapist and a patient with complex symptoms, expanding the use of a standard physiotherapy test. Methods: This qualitative study is based on video-recordings and in-depth interviews of seven women with the complex health condition chronic pelvic pain. The video recordings consist of the patients performing the Standard Mensendieck test pre- and post-treatment with Norwegian psychomotor physiotherapy. The interviews are based on the patients` and the physiotherapists` conversations while watching and elaborating on these video recordings. Empirical data is analyzed within the theoretical perspectives of phenomenology and enactive theory, especially focusing on the concepts of embodiment and intersubjectivity. Results: Taking an embodied approach, considering the body as expressive, communicative, and vulnerable to the environment and context, the results show that through bodily expressions the patients experienced the test situation as demanding, thus providing information beyond what the test was intended to measure. Additionally, when administering a standardized test, the interaction between the therapist and the patient had an impact on the results. Sensitive attention towards the patients bodily expressive emotions as a vital part of the interaction, reinforced therapeutic alliance by ensuring the integrity and autonomy of the patient. Discussion: Mutual communication, gave new insights regarding the patients' complex symptoms and reinforced their belief in themselves and their recovery processes. Applying the patient's expertise on herself and her life together with the professional expertise may make health care an interdependent practice where sensemaking is a co-construction of meaning between the patient and the health personnel.

Intertwining the social and the cognitive loops: socially enactive cognition for human-compatible interactive systems.

It is increasingly important for technical systems to be able to interact flexibly, robustly and fluently with humans in real-world scenarios. However, while current AI systems excel at narrow task competencies, they lack crucial interaction abilities for the adaptive and co-constructed social interactions that humans engage in. We argue that a possible avenue to tackle the corresponding computational modelling challenges is to embrace interactive theories of social understanding in humans. We propose the notion of socially enactive cognitive systems that do not rely solely on abstract and (quasi-)complete internal models for separate social perception, reasoning and action. By contrast, socially enactive cognitive agents are supposed to enable a close interlinking of the enactive socio-cognitive processing loops within each agent, and the social-communicative loop between them. We discuss theoretical foundations of this view, identify principles and requirements for according computational approaches, and highlight three examples of our own research that showcase the interaction abilities achievable in this way. This article is part of a discussion meeting issue 'Face2face: advancing the science of social interaction'.

Intentional Understanding Through Action Coordination in Early Triadic Interactions.

The ability to understand the behaviour of other people in intentional terms has been traditionally explained by resorting to inferential mechanisms that would allow individuals to access the internal mental states of others. In recent years, the second-person perspective has established itself as a theoretical alternative to traditional models. It argues that intentional understanding is an embodied, natural, and immediate process that occurs in situations such as face-to-face early dyadic interactions between adults and infants. In this article, we argue that the way in which the second-person perspective regards body and object is problematic. Based on psychological evidence that demonstrates the constitutive role of the body and objects for cognitive development, we propose the foundations of an ecological-enactive, semiotic and pragmatic model of intentional understanding. We argue that intentional understanding should be conceived as the skilful coordination of behaviours that subjects come to enact in interactive settings, following the dynamics of bodily and material practices that have acquired normative force over time.

Collective Memory: Metaphor or Real?

Collective memory researchers predominantly in the cultural and social sciences have commonly understood the concept of collective memory as a mere metaphor, as something not existing in itself as memory but useful only as a tool for referring to the way groups construct shared representations of their past. Few have however addressed the question of whether it is a metaphor or literal in its own right. This paper looks at the plausibility of the claim that collective memory is a mere metaphor by probing its presuppositions, where the representationalist theory of mind emerges as the ground for such a claim. Then appealing to the externalist model of the mind championed in recent studies of mind in disciplines as varied as philosophy, cognitive science, evolutionary biology, and collective intentionality studies, we try to expose the presuppositions of that claim, opening up possibilities for conceiving collective memory as not merely metaphorical but literal and naturally existing as memory.

Seeing and inviting participation in autistic interactions.

What does it take to see how autistic people participate in social interactions? And what does it take to support and invite more participation? Western medicine and cognitive science tend to think of autism mainly in terms of social and communicative deficits. But research shows that autistic people can interact with a skill and sophistication that are hard to see when starting from a deficit idea. Research also shows that not only autistic people, but also their non-autistic interaction partners, can have difficulties interacting with each other. To do justice to these findings, we need a different approach to autistic interactions-one that helps everyone see, invite, and support better participation. I introduce such an approach, based on the enactive theory of participatory sense-making and supported by insights from indigenous epistemologies. This approach helps counteract the homogenizing tendencies of the "global mental health" movement, which attempts to erase rather than recognize difference, and often precludes respectful engagements. Based in the lived experiences of people in their socio-cultural-material and interactive contexts, I put forward an engaged-even engaging-epistemology for understanding how we interact across difference. From this perspective, we see participatory sense-making at work across the scientific, diagnostic, therapeutic, and everyday interactions of autistic and non-autistic people, and how everyone can invite and support more of it.