Osteopathy and Mental Health: An Embodied, Predictive, and Interoceptive Framework.

Lucas Bohlen,Robert Shaw,Jorge E Esteves,Francesco Cerritelli

doi:10.3389/fpsyg.2021.767005

Abstract

Globally, mental and musculoskeletal disorders present with high prevalence, disease burden, and comorbidity. In order to improve the quality of care for patients with persistent physical and comorbid mental health conditions, person-centered care approaches addressing psychosocial factors are currently advocated. Central to successful person-centered care is a multidisciplinary collaboration between mental health and musculoskeletal specialists underpinned by a robust therapeutic alliance. Such a collaborative approach might be found in osteopathy, which is typically utilized to treat patients with musculoskeletal disorders but may arguably also benefit mental health outcomes. However, research and practice exploring the reputed effect of osteopathy on patients with mental health problems lack a robust framework. In this hypothesis and theory article, we build upon research from embodied cognition, predictive coding, interoception, and osteopathy to propose an embodied, predictive and interoceptive framework that underpins osteopathic person-centered care for individuals with persistent physical and comorbid mental health problems. Based on the premise that, for example, chronic pain and comorbid depression are underlined by overly precise predictions or imprecise sensory information, we hypothesize that osteopathic treatment may generate strong interoceptive prediction errors that update the generative model underpinning the experience of pain and depression. Thus, physical and mental symptoms may be reduced through active and perceptual inference. We discuss how these theoretical perspectives can inform future research into osteopathy and mental health to reduce the burden of comorbid psychological factors in patients with persistent physical symptoms and support person-centered multidisciplinary care in mental health.

Highlights

It is estimated that over one billion people are affected by mental and addictive disorders worldwide (Rehm and Shield, 2019)
We have proposed that osteopathic treatment may facilitate perceptual inference processes by increasing the weight of interoceptive prediction errors to update the belief issuing maladaptive predictions and reduce physical and mental health symptoms sustained through active inference processes
Perceptual inference processes are engaged to update the prior based on the likelihood revising the generative model holding the belief and issuing the prediction. These processes, arguably, underpin osteopathic treatment and putatively reduce physical and mental states associated with pain and depression by updating persistent and noisy interoceptive prediction errors with surprising and precise interoceptive prediction errors

Summary

INTRODUCTION

It is estimated that over one billion people are affected by mental and addictive disorders worldwide (Rehm and Shield, 2019). The theory of constructed emotion argues that an emotion concept is an embodied, whole-brain representation that is created by an internal model (informed by past experiences) to predict sensory information, infer causes, guide action, and recognize consequences for allostasis through interoception; this prediction (after prediction error minimization) becomes a perception or an experience that categorizes the sensory event and results in an instance of emotion (Feldman Barrett, 2017). Future research is necessary to investigate if osteopathic treatment for patients with chronic pain and comorbid depression influences physical and mental symptoms and interoceptive, autonomic, and allostatic measures

DISCUSSION AND FUTURE

CONCLUSION

DATA AVAILABILITY STATEMENT