2026 ECNP Congress

EP02-2014

The multimodal investigation of the assessment of clinician’s subjective experience: the MULTIACSE project

Elena Bondi — G. Videtta, C. Colli, G. Enrico, L. Sperti, M. Pallagrosi, L. Fonzi, Y. Barone, G. Schiena, E. Maggioni, A. Picardi, P. Brambilla · University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy

2026 ECNP Congress

Introduction

The clinician–patient relationship is central to psychiatric practice, yet its underlying neurophysiological mechanisms remain largely unexplored [1]. The Assessment of Clinician’s Subjective Experience (ACSE) is a validated instrument that captures clinicians’ subjective experience during the first clinical interview across five dimensions, which correlate with patients’ symptom severity [2]. Despite its established clinical utility [3], the neurobiological substrates of the ACSE dimensions remain uninvestigated. Our recent pilot study established the first protocol for recording the clinicians’ electroencephalography (EEG) during first clinical interviews, identifying preliminary neural correlates of ACSE dimensions and demonstrating the possibility of studying clinicians’ emotional states in real time [4]. However, that work was limited by small sample size, single-modality recording, and clinician-only data acquisition. Building on these findings and on robust evidence for the complementarity of electrophysiological and hemodynamic brain signals [5], the present study extends this line of research through a multimodal and hyperscanning approach.

Aims

The MULTIACSE study aims to provide a comprehensive neurophysiological characterization of the clinician–patient relationship by combining EEG with functional near-infrared spectroscopy (fNIRS) in clinicians and EEG hyperscanning in clinicians and patients. This could establish the first multimodal neural framework for understanding the neurobiological underpinnings of clinicians’ subjective experience and clinician-patient interpersonal neural coupling, with implications for improving psychiatric training, professional mental health, and personalized clinical management.

Trial Design: Non-pharmacological, interventional, and monocentric study.

Methods

Study setting: the study will be conducted at the Psychiatric Unit of Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico and University of Milan, in a multidisciplinary framework. Data will be collected from 20 clinician–patient dyads. Interventions: after informed consent (T-1), clinicians will conduct a standard first clinical interview during simultaneous EEG-fNIRS recordings (T0); a subsample of 5 dyads will additionally undergo EEG hyperscanning. Immediately after (T1), clinicians will complete the ACSE while still wearing the equipment. Subsequently (T2), clinicians will privately listen to the audio-recorded interview and annotate moments corresponding to each ACSE dimension, enabling dimension-specific multimodal analysis. EEG and fNIRS data will be preprocessed using standardized pipelines, and spectral neuronal, hemodynamic, and connectivity features will be extracted. Unimodal and multimodal analyses will identify neural correlates of ACSE dimensions, while inter-brain synchronization metrics will be related to ACSE scores in hyperscanning data.

Expected Results: By integrating complementary electrophysiological and hemodynamic signals, we expect to identify neurophysiological signatures associated with the ACSE dimensions, potentially confirming, at least in part, preliminary findings from our previous pilot study [4]. For the hyperscanning component, we hypothesize that inter-brain synchronization patterns will correlate with ACSE scores, offering the first neurophysiological evidence of interpersonal neural coupling in the therapeutic relationship.

Discussion

MULTIACSE aims to lay the groundwork for a neuroscientifically-informed understanding of the clinician–patient relationship in psychiatry. The multimodal framework will deepen the understanding of the embodied dynamics that underlie the therapeutic relationship, offering new perspectives on how clinicians’ subjective states shape therapeutic interactions.

References

  1. Nordgaard, J., et al., 2013. The psychiatric interview: validity, structure, and subjectivity. Eur. Arch. Psychiatry Clin. Neurosci. 263, 353–364.
  2. Pallagrosi, M., et al., 2016. Association between clinician’s subjective experience during patient evaluation and psychiatric diagnosis. Psychopathology 49 (2), 83–94.
  3. Picardi, A., et al., 2017. Psychopathological dimensions and the clinician’s subjective experience. Psychiatry Res. 258, 407–414.
  4. Videtta, G., 2026. The role of the clinician’s subjective experience in the interaction with the patient: a pilot study on neurobiological correlates. PhD thesis, University of Milan. https://hdl.handle.net/2434/1205019.
  5. Bondi, E., et al., 2025. Neurovascular coupling of inhibitory control in late-onset depression: a simultaneous EEG-fMRI study. NeuroImage 121320.