A systematic review of hyperscanning in clinical encounters
Open accessAbstract
Therapeutic alliance is defined as the collaborative relationship between patient and therapist. Strong therapeutic alliances have been associated with positive clinical outcomes, but much remains unknown about alliance and its physiological basis. Interpersonal neural synchrony (INS) - the synchronization of neural signals between interacting individuals - is emerging as a novel lens for studying interactions with relatively objective and time-sensitive neuroimaging techniques. We searched four databases to identify studies of INS in clinical encounters. Our search yielded 161 articles, 46 met criteria for full-text review and 11 were included. The included articles reported INS across a total of 160 dyads, all published since 2018. Despite diverse methodologies, INS was observed in all studies and was often related to therapeutic outcomes. However, results were mixed regarding associations between INS and therapeutic alliance. These results highlight that, while promising, additional research is needed to elucidate the relationship between INS, therapeutic alliance and clinical outcomes. Future studies should aim to standardize methodologies, explore temporal dynamics (e.g., through longitudinal assessments), and include larger sample sizes.
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Authentic rapport relies on bidirectional cues.
“Similarly, any multimodal extension would also need to capture and interpret the resident’s own nonverbal communication, as authentic rapport relies on bidirectional cues [49].”
From Enhancing Psychiatry Training Using an Agentic AI Simulated Consultation Tool: Prospective Cohort Study (2026) · cites this paper as [49]
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- Authors
- Adel, L., Moses, L., Irvine, E., Greenway, K. T., Dumas, G., & Lifshitz, M.
- Affiliations
- Jewish General Hospital (CA)
- Centre Hospitalier Universitaire Sainte-Justine (CA)
- Canadian Institute for Advanced Research (CA)
- Corresponding author
- Adel, Lena
- Lifshitz, Michael
- Venue
- Neuroscience & Biobehavioral Reviews
- Publisher
- Elsevier BV
- Published
- 2025-09
- Volume
- 176
- Pages
- 106248
- ISSN
- 0149-7634 (ISSN-L)
- OpenAlex
- W4411079423
- Cited by
- 13
- References
- 77
- Citations by year
- 2026: 10 · 2025: 3
- FWCI
- 2.53
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Neuroscience & Biobehavioral Reviews (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Fonds de recherche du Québec
- Usona Institute (CF00137433)
- Natural Sciences and Engineering Research Council of Canada (DGECR-2023-00089)
- Fondation de l'Hôpital général juif
- Canadian Institutes of Health Research
- Canadian Institute for Advanced Research
- Studienstiftung des deutschen Volkes eV
- Topics
- Social Sciences › Psychology › Social Psychology › Action Observation and Synchronization
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- hyperscanning, interpersonal neural synchrony, therapeutic relationship, patient encounters, patient-therapist interaction, neuronal synchronization, clinical outcomes
- MeSH terms
- Therapeutic Alliance, Humans
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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