Neural correlates of communication modes in medical students using fMRI

Neural correlates of communication modes in medical students using fMRI | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Neural correlates of communication modes in medical students using fMRI Raluca Corina Oprea, Frederic Andersson, Valerie Gissot, Thomas Desmidt, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4463294/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 22 Feb, 2025 Read the published version in Brain Imaging and Behavior → Version 1 posted 7 You are reading this latest preprint version Abstract This study aims to determine if the six different types of communication (Directive, Imaginative, Reflective, Persuasive, Harmonizing, Promoting), as presented in the Process Communication Model, correlate with a respective neural pathway. Participants were 30 medical students with no past medical history. They underwent functional magnetic resonance imaging (fMRI) while watching videos typical of each communication type. By comparing each of the six experimental conditions with all the other ones, common activations were detected in the core memory network. Assertive communication styles (Directive, Imaginative) generated activations in conflict detection and resolution related areas, with a predominance in the frontal lobe. Emotive communication (Harmonizing, Promoting) highlighted activations associated with the interpretation of social and emotional cues, with a temporo-occipital predominance. There were no significant activations for the Reflective and Persuasive channel, the two channels that were most coherent with the subjects’ base patterns and communication. This study indicated that out of the six communication types that were analyzed, four have a specific and congruous underlying cerebral process. This shows that neural response patterns vary across different communication styles, reflecting differences in cognitive and emotional processing. fMRI communication mode social neuroscience social interaction personality Figures Figure 1 Introduction How healthcare professionals communicate, and whether that brings about cohesion, tension, opposition or cooperation, is vital to patient care and collegiality. Medical work environments are intricate and demanding, with a strong emphasis on safety and increasingly burdened by administrative and legal considerations (Heuer, 2021 ). It is particularly challenging to consistently demonstrate excellent interpersonal skills in this context. Research conducted in French hospitals has revealed frequent instances of tense communication, interpersonal conflicts and dysfunctional relationships, which have detrimental effects on performance, supervision of trainees, quality of care, and potentially contribute to burnout (Benallah & Domin, 2020 ). Communication is recognized as a cornerstone of healthcare, applicable to all aspects of medical practice (King & Hoppe, 2013 ). To achieve this, it is necessary to understand that in today’s healthcare culture, the manner in which information is conveyed is as important as the information itself. To the extent that communication is the thread that connects all domains concerning medical care and that these domains are all interconnected, health systems seeking to improve the safety, quality and patient-centeredness of their care must identify and reduce barriers to effective communication and adopt strategies that strengthen caregivers’ professional and interpersonal communication skills. Our study chose to focus on the Process Communication Model (PCM) (Andrew et al., 2021 ) and its applicability in order to gain an insight into the physiopathological communication patterns using functional Magnetic Resonance Imaging (fMRI). To that purpose, healthy subjects studying to become healthcare professionals underwent fMRI while watching different videos typical of the six channels of communication of the PCM. Process Communication Model The PCM is a psychological framework developed by Dr. Taibi Kahler that helps individuals understand and communicate effectively based on personality types and their corresponding psychological needs (Dusollier, 2006 ). Initially used by the National Aeronautics and Space Administration (NASA) in the 1980s as a help in the astronaut selection methodology, it assisted in switching the focus from “content” analysis to “process” analysis in verbal and nonverbal communication. Its goal is to model the elements that can lead to better communication between two individuals, while providing different strategies so that each profile can regain intellectual and emotional availability after exposure to stress factors (Andrew et al., 2021 ). This theory originates in an observation made by Kahler that some patients he followed in therapy could present repetitive, invariable and predictive patterns of a high level of stress even though they were suffering from various pathologies. These patterns could be objectified through the modification of five indicators: the words used by the person, the tone of voice, the gestures, the posture and the expression of the face (Lefebvre & Beaucousin, 2023 ). At the time, Kahler posed the question of the reasons that lead to a change in behavior and motivation during an individual's life. It postulates that each person starts with the characteristics associated with the profile of the Base of his building and adopts according to the Phases of life (induced by events or lived experiences) some of the characteristics and motivations associated with the other types of personality. This conceptualization allows him to explain the duality of the human being evolving between identity stability and behavioral and motivational modifications that can appear during a lifetime. What results is a definition of six personality types, each being present in everyone, with a predominant personality type called Base and varying strengths for each of the other five. The six types are: Thinker, Persister, Harmonizer, Rebel, Imaginer, and Promoter. Each type has its specific character strengths and specific perceptions while communicating. PCM also identifies six different modes (offers) of communication, known as the Channels. These channels represent distinct ways in which individuals prefer to communicate and receive information. Each channel is associated with specific behaviors, preferences and characteristics and relates to specific psychological needs and behavior patterns: The Directive channel primarily focuses on establishing goals, providing guidance and directing others toward achieving objectives. Individuals who primarily use the directing channel tend to exhibit assertiveness, a focus on task-oriented communication, adaptability and resourcefulness. They are often skilled at setting clear expectations, giving instructions, and ensuring that tasks are completed effectively. The Imaginative channel focuses on creativity, innovation, and big-picture thinking. communicators using this channel are imaginative, calm, visionary, and skilled at generating new ideas, conceptualizing possibilities, and thinking outside the box. The Reflective channel focuses on empathy, active listening, and building rapport. Individuals using this channel are observant, conscientious, seek understanding, and engage in reflective and supportive communication. The Persuasive channel emphasizes analysis, reflection, charisma, and the ability to motivate and inspire others. Communicators using this channel are responsible, organized, skilled at presenting ideas, utilizing persuasive techniques, and rallying others around their vision or goals. The Harmonizing channel prioritizes fostering positive relationships, collaboration, and conflict resolution. Individuals using this channel seek to create a harmonious and cooperative environment, valuing empathy, compassion, compromise, and consensus-building. The Promoting channel emphasizes enthusiasm, spontaneity, and the ability to engage and energize others. Individuals using this channel are dynamic, expressive, and excel at public speaking, generating excitement, and creativity. In PCM, individuals may exhibit a primary mode of communication (depending on their Base personality type, their perception and communication channel), but they can also adapt and utilize other modes based on contextual factors and personal preferences. Understanding and accommodating different communication offers can significantly enhance effective and harmonious interactions with others. PCM exhibits certain similarities to other personality models, such as the Social Style Model, and Myers-Briggs Type Indicator (Dymond & Barnes, 1997 ). However, PCM distinguishes itself through some unique points of difference. These include PCM's structured methodology for comprehending stress and distress behaviors, including unproductive aggressive and submissive behaviors. Additionally, PCM offers specific skills to prevent and resolve conflicts, along with providing individuals with valuable insights into strategies for self-management. In the present study, we hypothesize that each communication mode is underpinned by a different neural pathway. Therefore, our aim is to provide a deeper understanding of the impact of each of the six communication modes on cerebral functioning. By elucidating the underlying cerebral processes associated with each communication mode individually, we can gain insights into the nature of communication itself. Methods Ethics approval Participants were recruited according to the principles of the Helsinki Declaration of 1975 and its successive updates. The study protocol was approved by the French National Agency (ID RCB : 2020-A00745-34) and by the Sud-Mediterranee III Ethical Committee (2020.05.07–20.04.07.89618). All participants signed informed consent forms prior to the start of the study. The protocol was registered on the ClinicalTrials.gov website (NCT04533126) and was supervised by a clinical investigation monitoring committee (Inserm CIC1415). Participants For this observational cross-sectional fMRI study, we recruited 30 healthy participants, in 2 groups of 15 men and 15 women. No randomization or blinding were necessary. Inclusion criteria were healthy, voluntary subjects, both sexes, aged between 20 and 30 years, medical students from 2nd year at the medical school at the University of Tours, France, having signed a written informed consent form and insured with a social security scheme. Non-inclusion criteria were: any psychiatric disorders as evaluated by the MINI 7.0 (Mini-International Neuropsychiatric Interview), present or past neurological disorders with a daily functional impact. A clinical evaluation (demographic data, medical and surgical history, treatments, psychometric scales) and neuroimaging (MRI) was carried out. The psychometric evaluation consisted in the following scales: PCM Personality Pattern Inventory and Positivity scale (Caprara et al., 2012 ) (annex 1 and 2). Stimuli and Experimental procedure Twelve videos (mean duration 10.27s) were used. For each of the 6 PCM communication channels, two videos (one with a male actor, one with a female actress) presented an individual pronouncing this sentence: “If you like this communication style, click on the button". The paradigm was explained to the participants before scanning. The participants, lying in a supine position in the scanner, viewed the stimuli, rear-projected on a screen at the rear of the magnet, through a mirror. The participants underwent two consecutive fMRI runs (each lasting 5 minutes). Each experimental run consisted of 12 activation blocks (videos), interspersed with period with a fixation cross (mean duration 10.15s). During each run, two videos of each of the PCM communication channels were used. For each video, the subjects had to push a button of a response box if they like the communication style. All stimuli were presented using E-PRIME (v2.0; Psychology Software Tools). Imaging protocol Imaging data were acquired on a 3T Siemens Magnetom Verio scanner (Siemens AG, Erlangen, Germany) using a 12 channels brain coil. High-resolution T1-weighted 3D anatomical scans (192 contiguous sagittal slices; 1 mm slice thickness; TR = 2.3s; TE = 2.98ms; TI = 0.9ms; flip angle = 9°; in-plane resolution = 1 × 1mm) were acquired for each subject. Functional images (2 runs, 150 volumes each), were acquired using a T2*-weighted gradient-echo EPI sequence (35 transversal slices in ascending order; slice thickness 3mm (10% gap); TR = 2.0s, TE = 30ms, flip angle = 90°, in-plane resolution = 3×3mm). Imaging data preprocessing and analysis The fMRI data was pre-processed using SPM12 (Wellcome Center for Human Neuroimaging, London, UK). For each functional run, data was pre-processed to remove sources of noise and artefacts. Functional data was corrected for differences in acquisition time between slices for each whole-brain volume, realigned within and across runs to correct for head movement. Finally, data were then spatially normalized using the MNI Atlas and smoothed using a FWHM 6x6x6 filter. The design matrix included six regressors of interest: Directive, Imaginative, Reflective, Persuasive, Harmonizing and Promoting. We also included the realignment parameters as nuisance covariates to account for residual motion artefacts. Betas estimates were computed for each of the regressors and betas images were then used to create six contrasts (corresponding to each regressor vs all others regressor): Directive vs all, Imaginative vs all, Reflective vs all, Persuasive vs all, Harmonizing vs all and Promoting vs all. Focal activations were considered as significant at an uncorrected voxel level of p < .001 with a clusterwise correction for multiple comparisons (p < .05 FWE). Results Sample characteristics Participants did not significantly differ in terms of age, sex, handedness or marital status. Their median age at the time of the fMRI procedure was 21.83 (standard deviation 1.91). The median Positivity Scale score was 32.5 (standard deviation 4.76). Outcomes Table 1 Peaks of clusters showing significant activations for the Directive vs All contrast. Side Main regions of cluster MNI coordinates (mm) Cluster-level Voxel-level x y z pFWE ke T L Precentral gyrus; supplementary motor area; insula; postcentral gyrus -30 20 10 0.000 5089 6.64 2 10 60 6.33 -36 6 30 6.22 R Precentral gyrus; inferior frontal gyrus (pars opercularis & triangularis); insula 48 14 24 0.000 2415 6.02 48 10 34 5.51 18 14 -6 5.41 L Superior/ middle temporal gyrus -62 -12 0 0.000 670 5.79 -56 -24 2 5 -48 -30 -4 4.75 L Caudate; thalamus -2 4 -4 0.000 309 5.5 -6 -2 4 4.63 2 8 6 3.92 R Superior/ middle temporal gyrus 50 -34 4 0.000 967 5.27 50 -32 4 5.27 48 -40 8 5.26 L Middle frontal gyrus -28 44 16 0.042 121 4.59 L Anterior cingulum -10 32 18 0.028 133 4.34 -12 26 26 4.15 MNI: Montreal Neurologic Institute; FWE: family-wise error; ke: cluster size; L: left; R: right As shown in Table 1 , the Directive vs All contrasts resulted in several very sizeable clusters including regions such as the prefrontal cortex, temporal lobes, insula, inferior frontal gyrus, precentral gyrus, anterior cingulate cortex, pars opercularis and triangularis. Table 2 Peaks of clusters showing significant activations for the Imaginative vs All contrasts. Side Main regions of cluster MNI coordinates (mm) Cluster-level Voxel-level x y z pFWE ke T L Inferior parietal gyrus; supramarginal gyrus; angular gyrus -52 -52 50 0.000 524 5.94 -60 -52 32 4.67 -50 -50 30 4.47 L Middle/ inferior frontal gyrus, + pars opercularis & triangularis -40 26 20 0.000 295 5.07 -50 20 36 4.67 -48 16 46 4.67 L Middle occipital gyrus -34 -82 28 0.003 199 4.98 -28 -80 22 4.96 L Precuneus -4 -64 46 0.000 342 4.92 -16 -64 40 3.66 MNI: Montreal Neurologic Institute; FWE: family-wise error; ke: cluster size; L: left; R: right Table 2 shows the activations for the Imaginative vs All contrasts, with the following main regions being involved: medial prefrontal cortex, angular gyrus, inferior parietal lobe, precuneus, pars opercularis and triangularis. Table 3 Peaks of clusters showing significant activations for the Promoting vs All contrasts. Side Main regions of cluster MNI coordinates (mm) Cluster-level Voxel-level x y z pFWE ke T R Middle temporal gyrus 48 14 -34 0.000 745 7.54 54 8 -22 5.59 52 -8 -20 4.95 R Middle/ inferior temporal gyrus; inferior occipital gyrus 50 -70 2 0.000 768 7.38 46 -84 -4 4.47 L Middle temporal gyrus -64 -42 8 0.000 1799 6.82 -54 12 -18 5.93 -56 4 -16 5.69 L Middle occipital gyrus; middle temporal gyrus -42 -74 6 0.000 509 5.16 -50 -76 4 5.11 -54 -72 12 4.37 R Superior/middle temporal gyrus 50 -38 0 0.000 260 5.06 44 -28 0 4.96 46 -44 8 4.69 MNI: Montreal Neurologic Institute; FWE: family-wise error; ke: cluster size; L: left; R: right Table 3 illustrates the cerebral activations in the Promoting vs All contrasts, wherein the predominant regions are regrouped bilaterally in the middle temporal gyrus and middle occipital gyrus. The main activations in the Harmonizing vs All contrasts are being highlighted in Table 4 (below), with the primary regions being: insula, middle temporal gyrus, postcentral gyrus, middle occipital gyrus and Rolandic operculum. Table 4 Peaks of clusters showing significant activations for the Harmonizing vs All contrasts. Side Main regions of cluster MNI coordinates (mm) Cluster-level Voxel-level x y z pFWE ke T R Middle/inferior temporal gyrus; inferior occipital gyrus 44 -66 0 0.000 1612 10.16 L Middle/inferior occipital gyrus; middle temporal gyrus -52 -68 6 0.001 1448 9.42 -42 -74 2 7.97 R Superior/middle occipital gyrus; cuneus 18 -82 40 0.000 945 6.64 22 -88 28 6.35 28 -90 8 5 R Temporal superior gyrus 62 -30 20 0.000 524 5.55 50 -28 10 4.33 38 -34 12 4.29 R Postcentral gyrus; middle cingulum 22 -40 48 0.000 408 5.46 28 -34 54 5 30 -34 44 4.92 L Superior temporal gyrus; Rolandic operculum -42 -36 24 0.006 170 5.44 -44 -22 26 4.2 L Superior/middle occipital gyrus; cuneus; calcarine -6 -98 10 0.000 304 5.36 -24 -90 8 4.67 -14 -94 6 3.98 R Insula; putamen 28 -6 16 0.024 132 4.97 34 0 16 4.7 20 -10 28 4.09 MNI: Montreal Neurologic Institute; FWE: family-wise error; ke: cluster size; L: left; R: right The Reflective vs All and Persuasive vs All contrasts produced no significant activation. Furthermore, as an exploratory analysis, beta values for each condition were extracted in each cluster in order to compute a correlation with the Positivity Scale and the PCM Personality Pattern inventory results. No significant association was found for the Positivity Scale (all p > 0.05). No significant comparative results were found for the PCM Personality Pattern inventory due to the sample size. All activations for the Directive vs All , Imaginative vs All , Promoting vs All and Harmonizing vs All contrasts are shown below, in Fig. 1 . Discussion To our knowledge, this study is the first to investigate the connection between communication as described in PCM and the underlying neural activation patterns. Our hypothesis supported the fact that neural response patterns vary across different communication styles, reflecting differences in cognitive and emotional processing. This discussion will focus on the functional implications of the different activations. In order to examine the neural response patterns common to each communication mode, an analysis (comprising the contrasts of each experimental condition vs all of the other experimental conditions) was performed. Consistent with our prediction, this analysis confirmed that all conditions activate the core memory network (posterior midline structures, parietal lobe and temporal lobe (Beaty et al., 2018 )) and areas related to mentalizing (bilateral temporo-parietal junction and medial prefrontal cortex (Monticelli et al., 2021 )) and executive control (right prefrontal cortex (Friedman & Robbins, 2022 )). The Directive vs All contrast confirmed our prediction that a directive, action-oriented approach generates greater activation in conflict detection and resolution related areas (left prefrontal cortex and posterior medial frontal cortex), in the mirror neuron system, bilaterally in the superior and middle temporal gyri, as well as in emotion processing related areas (insula, anterior cingulate cortex). The prefrontal cortex (PFC) plays a central role in processing assertive communication. Its medial regions handle social perceptions and cooperation, while ventral regions assess social reward, punishment, and motivation (Amodio & Frith, 2006 ; Fehr & Camerer, 2007 ; Kohls et al., 2012 ; Mitchell et al., 2006 ). The dorsolateral PFC specifically processes the assertive tone and content (Arnsten, 2009 ). The superior temporal gyrus in the temporal lobes is pivotal in decoding assertive speech, including voice nuances and prosody (Crinion et al., 2003 ). The insula , deeply embedded in the cerebral cortex, evaluates emotional aspects of assertive communication, aiding in understanding the speaker's emotional state and attitude (Dolan, 2002 ; Gu et al., 2013 ). The mirror neuron system (MNS), involving areas like the inferior frontal gyrus and precentral gyrus, activates during action observation, enabling simulation and empathy for assertive behavior (Rajmohan & Mohandas, 2007 ; Rizzolatti & Craighero, 2004 ). Lastly, the anterior cingulate cortex (ACC) is involved in monitoring and regulating cognitive and emotional processes (Stevens et al., 2011 ). Resting-state fMRI studies indicate that it is most functionally connected with areas implicated in affective processing (particularly amygdala and hippocampus) (Rosenberg et al., 2020 ). When perceiving assertiveness, the ACC helps in assessing the emotional significance of the communication style and its impact on oneself. It may also be involved in evaluating the level of control exerted by the assertive speaker, because of its role in the so-called ‘fear network’ (El-Hage et al., 2012 ). The Imaginative vs All contrast showcased the following activations in key regions typically associated with reflective thinking: the Default Mode Network (DMN), which includes the medial prefrontal cortex (mPFC) and the angular gyrus, among other regions. It is implicated in introspection (Gusnard et al., 2001 ), self-referential thinking, autobiographical memory, and mind wandering. The DMN is often activated during imaginative and reflective processes, as individuals generate and explore mental simulations and engage in internal mentation relevant to communication (Raichle et al., 2001 ). The inferior parietal lobe (IPL), which is involved in a diverse set of neural operations, including spatial attention, multimodal sensory integration, as well as oculomotor control and attentional mechanisms (Saalasti et al., 2019 ). We particularly observed activations in the supramarginal and angular gyri, which constitute a multimodal associative area that receives auditory, visual and somatosensory inputs and thus process the phonological and semantic aspects of language (Stoeckel et al., 2009 ). The precuneus , which plays a crucial role in various cognitive processes, including self-reflection, mental imagery, episodic memory retrieval and visuospatial processing. Its activation in the context of an imaginative communication style is correlated to several of these aspects. The precuneus facilitates the integration of self-relevant information into the imaginative process, allowing individuals to incorporate their own thoughts, emotions and experiences into their communicative expression (Chen et al., 2015 ). It also contributes to the retrieval of episodic memories, allowing access to relevant content to enrich imaginative communication (Trimble & Cavanna, 2008 ). The precuneus is also a key node within the DMN, associated with introspection, self-generated thoughts and imaginative thinking (Fransson & Marrelec, 2008 ). An interesting aspect we noted for both these assertive communication styles was the activation of the pars opercularis, triangularis and adjacent cortical regions belonging to Broca’s area (IFG). Traditionally associated with speech production, syntactic processing, and the coordination of motor movements required for speech, its involvement in the context of imaginative communication may be related to the linguistic aspects of expressing assertive or imaginative thoughts and narratives. Additionally, the pars opercularis and the broader Broca’s area are interconnected with other brain regions involved in imagination, such as the prefrontal cortex and temporal lobes (Fedorenko et al., 2012 ). These connections may facilitate the integration of directive and imaginative thoughts and ideas with language processing and expression. The Promoting vs All contrast highlighted neural activations mostly regrouped bilaterally in the middle temporal gyrus (MTG) and middle occipital gyrus (MOG). Within the middle temporal gyrus , we separately focused our analysis on the posterior middle temporal gyrus (pMTG) and the anterior middle temporal gyrus (aMTG). The pMTG is implicated in the processing of visual motion and speech perception, as well as controlled retrieval of conceptual knowledge (Davey et al., 2015 ). Structural and functional connectivity analyses demonstrated that this site is at the nexus of networks recruited in automatic semantic processing (the default mode network) and executively demanding tasks (the multiple-demand network). The aMTG is associated with the automatic retrieval of specific semantic information, as well as semantic processing, including the interpretation of social and emotional cues. As far as the middle occipital gyrus (MOG) is concerned, it is primarily involved in visual processing, including object recognition, motion perception and spatial awareness. Although its main focus area is not emotive communication, it contributes to the processing of visual cues, such as facial expressions and body language, which are essential facets of emotional communication. An interesting aspect, consistent throughout literature (Fan et al., 2013 ; Guo et al., 2012 ; Liu et al., 2014 ; Zhong et al., 2016 ), is that a unique decreased abnormal activation in functional connectivity was found in L-MOG in patients diagnosed with a major depressive disorder (MDD). A common cognitive feature of MDD is mood congruent processing bias and interpretation of visual cues. In this context, MOG is therefore involved in the perception of facial emotion and its lower activations implicate disrupted visual processing of emotions (Guo et al., 2012 ). As previously mentioned, the Reflective vs All and Persuasive vs All contrasts produced no significant activation. This result, although initially discouraging, is not actually surprising, as we hypothesized more intense activations would appear if the subjects’ initial communication mode was vastly different from the one expressed in the videos. Indeed, the characteristics of the Reflective and Persuasive communication patterns are the ones most frequently used by our subjects in daily life and interactions, according to their questionnaire answers (factual thinking, information exchange). Therefore, we concluded that depending on the subjects’ cognitive style, a variable reception of other communication modes could be predicted, with more activations in diverse areas needed for adapting to a communication style incoherent with one’s own. Insignificant activations in small clusters could be observed in the right precuneus and posterior cingulate cortex, areas engaged by a range of tasks including autobiographical memory and imagining the future (Auger & Maguire, 2013 ; Leech et al., 2012 ), as well as self-reflection and self-imagery (Kircher & Thienel, 2005 ). The Harmonizing vs All contrast results were consistent with our prediction that an empathetic, reassuring communication style generates activations in emotional and semantic processing related areas (insula, MTG, MOG, Rolandic operculum), as well as DMN (postcentral gyrus). As previously detailed, MTG and MOG are involved in certain aspects of emotional processing and communication, particularly the interpretation of emotional cues and visual perception (Dolan, 2002 ). The insula is critical for emotional awareness and empathy, in accord with the James-Lange theory (Gasquoine, 2014 ). It helps in perceiving and representing the internal states of oneself and others, including emotional experiences. The anterior insula constitutes the neural basis of subjective feeling states, which might also provide a basis for the “self” (Craig, 2002 ; Critchley et al., 2004 ). Taken together, the anterior insula marks salient information by referring to subjective feeling states and therefore initiates cognitive processes for further processing of the salient information (Menon & Uddin, 2010 ; Uddin, 2015 ). Beyond being the center of interoception, the insula stands as a hub to regulate the introduction of subjective feelings into cognitive and motivational processes (Namkung et al., 2017 ). The Rolandic operculum , besides playing a role in emotion processing, functions as the sensory system for gustatory and visceral sensation, together with the cingulate-operculum network (Eickhoff et al., 2006 ). The gut-brain axis theory further confirms this phenomenon and draws a parallel between the emotional coding at the cerebral level and its transmission to the gastrointestinal tract. Blefari et al. also demonstrated its role in integrating exteroceptive-interoceptive signals that are necessary for interoceptive awareness as well as bodily self-consciousness (Blefari et al., 2017 ). While the postcentral gyrus is not primarily associated with language production or comprehension, it contributes to the somatosensory aspects of communication, allowing individuals to perceive and respond to nonverbal cues, particularly by processing proprioceptive input (Adolphs et al., 2000 ). It is interconnected with the mirror neuron system, a network of brain regions involved in imitating, observing and understanding the actions of others. Interestingly, recent studies conducted in individuals suffering from mental disorders associated with abnormal emotion regulation have found structural and functional changes in the somatosensory cortex, including the postcentral gyrus (Kropf et al., 2019 ). Finally, this study's strength lies in its utilization of a homogeneous cohort comprising medical students, offering valuable insights into the communication patterns of healthcare practitioners. This not only fosters avenues for intra-professional communication enhancement but also holds promise for refining doctor-patient interactions, thereby advancing a more empathetic and effective medical care paradigm. Limitations One notable limitation of this study pertains to its sample size. While it would have been intriguing to compare subgroups based on communication mode and gender, the number of subjects was insufficient to draw statistically robust conclusions in this regard. This constraint underscores the need for future research with larger and more diverse participant cohorts to delve deeper into these potentially significant distinctions. Another emerging constraint arises concerning experimental paradigms that investigate distinct facets of communication, overlooking the intricate nature of social communication. Subsequent investigations ought to embrace a more ecologically valid approach by employing research designs that examine language alongside congruent or incongruent nonverbal cues. This approach will provide additional insights into the varying functions of specific brain regions and their specialized involvement in comprehending verbal and nonverbal signals as diverse modalities of communication. Additionally, future investigations should contemplate the integration of behavioral and combined neurophysiological methodologies, expanding the scope of sampling from individuals within the typical population to those within psychiatric populations. Conclusion In summary, our study affirms the validity of the Process Communication Model in healthy subjects, revealing distinct neural patterns for four of the six channels. Further analysis is needed for channels with inconclusive results, particularly within cohorts presenting neuronal or psychiatric pathologies. These insights hold promise for enhancing communication within modern healthcare, potentially leading to more effective and tailored medical care practices. Declarations Funding The study was funded by Kahler Communication France. The study funder had no role to play in the study design, data collection, data analysis, or data interpretation. Patrice Dubourg, a representative of Kahler Communication France, provided critical feedback on the final version of the manuscript. The corresponding author had full access to the data and holds the responsibility for the decision to submit for publication the manuscript on behalf of all the co-authors. Data availability statement The data underlying this article will be shared on reasonable request to the corresponding author (WEH). Disclosure statement WEH reports personal fees from Air Liquide, Boehringer-Ingelheim, Chugai, EISAI, Janssen, Jazz Pharmaceuticals, Lundbeck, Nordic Pharma, Novartis, Otsuka, and UCB. He received research grants from the Fondation de France, and from the French National Hospital Program for Clinical Research (PHRC), unrelated to the submitted work. No potential conflict of interest was reported by the other authors. References Adolphs, R., Damasio, H., Tranel, D., Cooper, G., & Damasio, A. R. (2000). A Role for Somatosensory Cortices in the Visual Recognition of Emotion as Revealed by Three-Dimensional Lesion Mapping. The Journal of Neuroscience , 20 (7), 2683–2690. https://doi.org/10.1523/JNEUROSCI.20-07-02683.2000 Amodio, D. M., & Frith, C. D. (2006). Meeting of minds: The medial frontal cortex and social cognition. 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Journal of Affective Disorders , 206 , 280–286. https://doi.org/10.1016/j.jad.2016.09.005 Additional Declarations No competing interests reported. Supplementary Files graphicalabstract.png Graphical abstract Cite Share Download PDF Status: Published Journal Publication published 22 Feb, 2025 Read the published version in Brain Imaging and Behavior → Version 1 posted Editorial decision: Revision requested 10 Oct, 2024 Reviews received at journal 04 Oct, 2024 Reviewers agreed at journal 14 Sep, 2024 Reviewers invited by journal 05 Jun, 2024 Editor assigned by journal 05 Jun, 2024 Submission checks completed at journal 27 May, 2024 First submitted to journal 22 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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16:09:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1266192,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4463294/v1/acaa2437-081a-4895-a55b-0e3c959c2b6a.pdf"},{"id":58169312,"identity":"63375343-e494-41ad-93cf-1a052671ed96","added_by":"auto","created_at":"2024-06-12 03:30:25","extension":"png","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":114987,"visible":true,"origin":"","legend":"\u003cp\u003eGraphical abstract\u003c/p\u003e","description":"","filename":"graphicalabstract.png","url":"https://assets-eu.researchsquare.com/files/rs-4463294/v1/c0b090bb4e3e9d48828cce34.png"}],"financialInterests":"No competing interests reported.","formattedTitle":"Neural correlates of communication modes in medical students using fMRI","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHow healthcare professionals communicate, and whether that brings about cohesion, tension, opposition or cooperation, is vital to patient care and collegiality. Medical work environments are intricate and demanding, with a strong emphasis on safety and increasingly burdened by administrative and legal considerations (Heuer, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). It is particularly challenging to consistently demonstrate excellent interpersonal skills in this context. Research conducted in French hospitals has revealed frequent instances of tense communication, interpersonal conflicts and dysfunctional relationships, which have detrimental effects on performance, supervision of trainees, quality of care, and potentially contribute to burnout (Benallah \u0026amp; Domin, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Communication is recognized as a cornerstone of healthcare, applicable to all aspects of medical practice (King \u0026amp; Hoppe, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). To achieve this, it is necessary to understand that in today\u0026rsquo;s healthcare culture, the manner in which information is conveyed is as important as the information itself. To the extent that communication is the thread that connects all domains concerning medical care and that these domains are all interconnected, health systems seeking to improve the safety, quality and patient-centeredness of their care must identify and reduce barriers to effective communication and adopt strategies that strengthen caregivers\u0026rsquo; professional and interpersonal communication skills.\u003c/p\u003e \u003cp\u003eOur study chose to focus on the Process Communication Model (PCM) (Andrew et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) and its applicability in order to gain an insight into the physiopathological communication patterns using functional Magnetic Resonance Imaging (fMRI). To that purpose, healthy subjects studying to become healthcare professionals underwent fMRI while watching different videos typical of the six channels of communication of the PCM.\u003c/p\u003e\n\u003ch3\u003eProcess Communication Model\u003c/h3\u003e\n\u003cp\u003eThe PCM is a psychological framework developed by Dr. Taibi Kahler that helps individuals understand and communicate effectively based on personality types and their corresponding psychological needs (Dusollier, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). Initially used by the National Aeronautics and Space Administration (NASA) in the 1980s as a help in the astronaut selection methodology, it assisted in switching the focus from \u0026ldquo;content\u0026rdquo; analysis to \u0026ldquo;process\u0026rdquo; analysis in verbal and nonverbal communication. Its goal is to model the elements that can lead to better communication between two individuals, while providing different strategies so that each profile can regain intellectual and emotional availability after exposure to stress factors (Andrew et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis theory originates in an observation made by Kahler that some patients he followed in therapy could present repetitive, invariable and predictive patterns of a high level of stress even though they were suffering from various pathologies. These patterns could be objectified through the modification of five indicators: the words used by the person, the tone of voice, the gestures, the posture and the expression of the face (Lefebvre \u0026amp; Beaucousin, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAt the time, Kahler posed the question of the reasons that lead to a change in behavior and motivation during an individual's life. It postulates that each person starts with the characteristics associated with the profile of the Base of his building and adopts according to the Phases of life (induced by events or lived experiences) some of the characteristics and motivations associated with the other types of personality. This conceptualization allows him to explain the duality of the human being evolving between identity stability and behavioral and motivational modifications that can appear during a lifetime.\u003c/p\u003e \u003cp\u003eWhat results is a definition of six personality types, each being present in everyone, with a predominant personality type called Base and varying strengths for each of the other five. The six types are: Thinker, Persister, Harmonizer, Rebel, Imaginer, and Promoter. Each type has its specific character strengths and specific perceptions while communicating.\u003c/p\u003e \u003cp\u003ePCM also identifies six different modes (offers) of communication, known as the Channels. These channels represent distinct ways in which individuals prefer to communicate and receive information. Each channel is associated with specific behaviors, preferences and characteristics and relates to specific psychological needs and behavior patterns:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eThe \u003cb\u003eDirective\u003c/b\u003e channel primarily focuses on establishing goals, providing guidance and directing others toward achieving objectives. Individuals who primarily use the directing channel tend to exhibit assertiveness, a focus on task-oriented communication, adaptability and resourcefulness. They are often skilled at setting clear expectations, giving instructions, and ensuring that tasks are completed effectively.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eThe \u003cb\u003eImaginative\u003c/b\u003e channel focuses on creativity, innovation, and big-picture thinking. communicators using this channel are imaginative, calm, visionary, and skilled at generating new ideas, conceptualizing possibilities, and thinking outside the box.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eThe \u003cb\u003eReflective\u003c/b\u003e channel focuses on empathy, active listening, and building rapport. Individuals using this channel are observant, conscientious, seek understanding, and engage in reflective and supportive communication.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eThe \u003cb\u003ePersuasive\u003c/b\u003e channel emphasizes analysis, reflection, charisma, and the ability to motivate and inspire others. Communicators using this channel are responsible, organized, skilled at presenting ideas, utilizing persuasive techniques, and rallying others around their vision or goals.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eThe \u003cb\u003eHarmonizing\u003c/b\u003e channel prioritizes fostering positive relationships, collaboration, and conflict resolution. Individuals using this channel seek to create a harmonious and cooperative environment, valuing empathy, compassion, compromise, and consensus-building.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eThe \u003cb\u003ePromoting\u003c/b\u003e channel emphasizes enthusiasm, spontaneity, and the ability to engage and energize others. Individuals using this channel are dynamic, expressive, and excel at public speaking, generating excitement, and creativity.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eIn PCM, individuals may exhibit a primary mode of communication (depending on their Base personality type, their perception and communication channel), but they can also adapt and utilize other modes based on contextual factors and personal preferences. Understanding and accommodating different communication offers can significantly enhance effective and harmonious interactions with others.\u003c/p\u003e \u003cp\u003ePCM exhibits certain similarities to other personality models, such as the Social Style Model, and Myers-Briggs Type Indicator (Dymond \u0026amp; Barnes, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e1997\u003c/span\u003e). However, PCM distinguishes itself through some unique points of difference. These include PCM's structured methodology for comprehending stress and distress behaviors, including unproductive aggressive and submissive behaviors. Additionally, PCM offers specific skills to prevent and resolve conflicts, along with providing individuals with valuable insights into strategies for self-management.\u003c/p\u003e \u003cp\u003eIn the present study, we hypothesize that each communication mode is underpinned by a different neural pathway. Therefore, our aim is to provide a deeper understanding of the impact of each of the six communication modes on cerebral functioning. By elucidating the underlying cerebral processes associated with each communication mode individually, we can gain insights into the nature of communication itself.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eEthics approval\u003c/h2\u003e \u003cp\u003e Participants were recruited according to the principles of the Helsinki Declaration of 1975 and its successive updates. The study protocol was approved by the French National Agency (ID RCB : 2020-A00745-34) and by the Sud-Mediterranee III Ethical Committee (2020.05.07\u0026ndash;20.04.07.89618). All participants signed informed consent forms prior to the start of the study. The protocol was registered on the ClinicalTrials.gov website (NCT04533126) and was supervised by a clinical investigation monitoring committee (Inserm CIC1415).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eFor this observational cross-sectional fMRI study, we recruited 30 healthy participants, in 2 groups of 15 men and 15 women. No randomization or blinding were necessary. Inclusion criteria were healthy, voluntary subjects, both sexes, aged between 20 and 30 years, medical students from 2nd year at the medical school at the University of Tours, France, having signed a written informed consent form and insured with a social security scheme.\u003c/p\u003e \u003cp\u003eNon-inclusion criteria were: any psychiatric disorders as evaluated by the MINI 7.0 (Mini-International Neuropsychiatric Interview), present or past neurological disorders with a daily functional impact. A clinical evaluation (demographic data, medical and surgical history, treatments, psychometric scales) and neuroimaging (MRI) was carried out. The psychometric evaluation consisted in the following scales: PCM Personality Pattern Inventory and Positivity scale (Caprara et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2012\u003c/span\u003e) (annex 1 and 2).\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003eStimuli and Experimental procedure\u003c/h2\u003e \u003cp\u003eTwelve videos (mean duration 10.27s) were used. For each of the 6 PCM communication channels, two videos (one with a male actor, one with a female actress) presented an individual pronouncing this sentence: \u0026ldquo;If you like this communication style, click on the button\". The paradigm was explained to the participants before scanning. The participants, lying in a supine position in the scanner, viewed the stimuli, rear-projected on a screen at the rear of the magnet, through a mirror. The participants underwent two consecutive fMRI runs (each lasting 5 minutes). Each experimental run consisted of 12 activation blocks (videos), interspersed with period with a fixation cross (mean duration 10.15s). During each run, two videos of each of the PCM communication channels were used. For each video, the subjects had to push a button of a response box if they like the communication style. All stimuli were presented using E-PRIME (v2.0; Psychology Software Tools).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003eImaging protocol\u003c/h2\u003e \u003cp\u003eImaging data were acquired on a 3T Siemens Magnetom Verio scanner (Siemens AG, Erlangen, Germany) using a 12 channels brain coil. High-resolution T1-weighted 3D anatomical scans (192 contiguous sagittal slices; 1 mm slice thickness; TR\u0026thinsp;=\u0026thinsp;2.3s; TE\u0026thinsp;=\u0026thinsp;2.98ms; TI\u0026thinsp;=\u0026thinsp;0.9ms; flip angle\u0026thinsp;=\u0026thinsp;9\u0026deg;; in-plane resolution\u0026thinsp;=\u0026thinsp;1 \u0026times; 1mm) were acquired for each subject. Functional images (2 runs, 150 volumes each), were acquired using a T2*-weighted gradient-echo EPI sequence (35 transversal slices in ascending order; slice thickness 3mm (10% gap); TR\u0026thinsp;=\u0026thinsp;2.0s, TE\u0026thinsp;=\u0026thinsp;30ms, flip angle\u0026thinsp;=\u0026thinsp;90\u0026deg;, in-plane resolution\u0026thinsp;=\u0026thinsp;3\u0026times;3mm).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003eImaging data preprocessing and analysis\u003c/h2\u003e \u003cp\u003eThe fMRI data was pre-processed using SPM12 (Wellcome Center for Human Neuroimaging, London, UK). For each functional run, data was pre-processed to remove sources of noise and artefacts. Functional data was corrected for differences in acquisition time between slices for each whole-brain volume, realigned within and across runs to correct for head movement. Finally, data were then spatially normalized using the MNI Atlas and smoothed using a FWHM 6x6x6 filter. The design matrix included six regressors of interest: Directive, Imaginative, Reflective, Persuasive, Harmonizing and Promoting. We also included the realignment parameters as nuisance covariates to account for residual motion artefacts. Betas estimates were computed for each of the regressors and betas images were then used to create six contrasts (corresponding to each regressor vs all others regressor): Directive vs all, Imaginative vs all, Reflective vs all, Persuasive vs all, Harmonizing vs all and Promoting vs all. Focal activations were considered as significant at an uncorrected voxel level of p\u0026thinsp;\u0026lt;\u0026thinsp;.001 with a clusterwise correction for multiple comparisons (p\u0026thinsp;\u0026lt;\u0026thinsp;.05 FWE).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eSample characteristics\u003c/h2\u003e \u003cp\u003eParticipants did not significantly differ in terms of age, sex, handedness or marital status. Their median age at the time of the fMRI procedure was 21.83 (standard deviation 1.91). The median Positivity Scale score was 32.5 (standard deviation 4.76).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eOutcomes\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePeaks of clusters showing significant activations for the Directive vs All contrast.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSide\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMain regions of cluster\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eMNI coordinates (mm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCluster-level\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eVoxel-level\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ey\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ez\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003epFWE\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eke\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003eT\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePrecentral gyrus; supplementary motor area; insula; postcentral gyrus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e5089\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePrecentral gyrus; inferior frontal gyrus (pars opercularis \u0026amp; triangularis); insula\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e2415\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.51\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSuperior/ middle temporal gyrus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e670\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eCaudate; thalamus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e309\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSuperior/ middle temporal gyrus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e967\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMiddle frontal gyrus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAnterior cingulum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMNI: Montreal Neurologic Institute; FWE: family-wise error; ke: cluster size; L: left; R: right\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, the \u003cb\u003eDirective vs All\u003c/b\u003e contrasts resulted in several very sizeable clusters including regions such as the prefrontal cortex, temporal lobes, insula, inferior frontal gyrus, precentral gyrus, anterior cingulate cortex, pars opercularis and triangularis.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePeaks of clusters showing significant activations for the Imaginative vs All contrasts.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSide\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMain regions of cluster\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eMNI coordinates (mm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCluster-level\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eVoxel-level\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ey\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ez\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003epFWE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eke\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eT\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eInferior parietal gyrus; supramarginal gyrus; angular gyrus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e524\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMiddle/ inferior frontal gyrus, + pars opercularis \u0026amp; triangularis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e295\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMiddle occipital gyrus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePrecuneus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e342\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMNI: Montreal Neurologic Institute; FWE: family-wise error; ke: cluster size; L: left; R: right\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the activations for the \u003cb\u003eImaginative vs All\u003c/b\u003e contrasts, with the following main regions being involved: medial prefrontal cortex, angular gyrus, inferior parietal lobe, precuneus, pars opercularis and triangularis.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePeaks of clusters showing significant activations for the Promoting vs All contrasts.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSide\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMain regions of cluster\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eMNI coordinates (mm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCluster-level\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eVoxel-level\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ey\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ez\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003epFWE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eke\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eT\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMiddle temporal gyrus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e745\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7.54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMiddle/ inferior temporal gyrus; inferior occipital gyrus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e768\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMiddle temporal gyrus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e1799\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMiddle occipital gyrus; middle temporal gyrus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e509\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSuperior/middle temporal gyrus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e260\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMNI: Montreal Neurologic Institute; FWE: family-wise error; ke: cluster size; L: left; R: right\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e illustrates the cerebral activations in the \u003cb\u003ePromoting vs All\u003c/b\u003e contrasts, wherein the predominant regions are regrouped bilaterally in the middle temporal gyrus and middle occipital gyrus.\u003c/p\u003e \u003cp\u003eThe main activations in the \u003cb\u003eHarmonizing vs All\u003c/b\u003e contrasts are being highlighted in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e (below), with the primary regions being: insula, middle temporal gyrus, postcentral gyrus, middle occipital gyrus and Rolandic operculum.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePeaks of clusters showing significant activations for the Harmonizing vs All contrasts.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSide\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMain regions of cluster\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eMNI coordinates (mm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCluster-level\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eVoxel-level\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ey\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ez\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003epFWE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eke\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eT\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMiddle/inferior temporal gyrus; inferior occipital gyrus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1612\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMiddle/inferior occipital gyrus; middle temporal gyrus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1448\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9.42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7.97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSuperior/middle occipital gyrus; cuneus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e945\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eTemporal superior gyrus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e524\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePostcentral gyrus; middle cingulum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e408\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSuperior temporal gyrus; Rolandic operculum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e170\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSuperior/middle occipital gyrus; cuneus; calcarine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e304\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eInsula; putamen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eMNI: Montreal Neurologic Institute; FWE: family-wise error; ke: cluster size; L: left; R: right\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe \u003cb\u003eReflective vs All\u003c/b\u003e and \u003cb\u003ePersuasive vs All\u003c/b\u003e contrasts produced no significant activation. Furthermore, as an exploratory analysis, beta values for each condition were extracted in each cluster in order to compute a correlation with the Positivity Scale and the PCM Personality Pattern inventory results. No significant association was found for the Positivity Scale (all \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). No significant comparative results were found for the PCM Personality Pattern inventory due to the sample size.\u003c/p\u003e \u003cp\u003eAll activations for the \u003cb\u003eDirective vs All\u003c/b\u003e, \u003cb\u003eImaginative vs All\u003c/b\u003e, \u003cb\u003ePromoting vs All\u003c/b\u003e and \u003cb\u003eHarmonizing vs All\u003c/b\u003e contrasts are shown below, in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eTo our knowledge, this study is the first to investigate the connection between communication as described in PCM and the underlying neural activation patterns. Our hypothesis supported the fact that neural response patterns vary across different communication styles, reflecting differences in cognitive and emotional processing. This discussion will focus on the functional implications of the different activations.\u003c/p\u003e \u003cp\u003eIn order to examine the neural response patterns common to each communication mode, an analysis (comprising the contrasts of each experimental condition \u003cem\u003evs\u003c/em\u003e all of the other experimental conditions) was performed. Consistent with our prediction, this analysis confirmed that all conditions activate the core memory network (posterior midline structures, parietal lobe and temporal lobe (Beaty et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2018\u003c/span\u003e)) and areas related to mentalizing (bilateral temporo-parietal junction and medial prefrontal cortex (Monticelli et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2021\u003c/span\u003e)) and executive control (right prefrontal cortex (Friedman \u0026amp; Robbins, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2022\u003c/span\u003e)).\u003c/p\u003e \u003cp\u003eThe \u003cb\u003eDirective\u003c/b\u003e \u003cb\u003evs\u003c/b\u003e \u003cb\u003eAll\u003c/b\u003e contrast confirmed our prediction that a directive, action-oriented approach generates greater activation in conflict detection and resolution related areas (left prefrontal cortex and posterior medial frontal cortex), in the mirror neuron system, bilaterally in the superior and middle temporal gyri, as well as in emotion processing related areas (insula, anterior cingulate cortex). The \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eprefrontal cortex\u003c/span\u003e (PFC) plays a central role in processing assertive communication. Its medial regions handle social perceptions and cooperation, while ventral regions assess social reward, punishment, and motivation (Amodio \u0026amp; Frith, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2006\u003c/span\u003e; Fehr \u0026amp; Camerer, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; Kohls et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Mitchell et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). The dorsolateral PFC specifically processes the assertive tone and content (Arnsten, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). The \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003esuperior temporal gyrus\u003c/span\u003e in the temporal lobes is pivotal in decoding assertive speech, including voice nuances and prosody (Crinion et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2003\u003c/span\u003e). The \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003einsula\u003c/span\u003e, deeply embedded in the cerebral cortex, evaluates emotional aspects of assertive communication, aiding in understanding the speaker's emotional state and attitude (Dolan, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2002\u003c/span\u003e; Gu et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). The \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003emirror neuron system\u003c/span\u003e (MNS), involving areas like the inferior frontal gyrus and precentral gyrus, activates during action observation, enabling simulation and empathy for assertive behavior (Rajmohan \u0026amp; Mohandas, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; Rizzolatti \u0026amp; Craighero, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). Lastly, the \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eanterior cingulate cortex\u003c/span\u003e (ACC) is involved in monitoring and regulating cognitive and emotional processes (Stevens et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Resting-state fMRI studies indicate that it is most functionally connected with areas implicated in affective processing (particularly amygdala and hippocampus) (Rosenberg et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). When perceiving assertiveness, the ACC helps in assessing the emotional significance of the communication style and its impact on oneself. It may also be involved in evaluating the level of control exerted by the assertive speaker, because of its role in the so-called \u0026lsquo;fear network\u0026rsquo; (El-Hage et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2012\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe \u003cb\u003eImaginative\u003c/b\u003e \u003cb\u003evs\u003c/b\u003e \u003cb\u003eAll\u003c/b\u003e contrast showcased the following activations in key regions typically associated with reflective thinking: the \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eDefault Mode Network\u003c/span\u003e (DMN), which includes the medial prefrontal cortex (mPFC) and the angular gyrus, among other regions. It is implicated in introspection (Gusnard et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2001\u003c/span\u003e), self-referential thinking, autobiographical memory, and mind wandering. The DMN is often activated during imaginative and reflective processes, as individuals generate and explore mental simulations and engage in internal mentation relevant to communication (Raichle et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2001\u003c/span\u003e). The \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003einferior parietal lobe\u003c/span\u003e (IPL), which is involved in a diverse set of neural operations, including spatial attention, multimodal sensory integration, as well as oculomotor control and attentional mechanisms (Saalasti et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). We particularly observed activations in the supramarginal and angular gyri, which constitute a multimodal associative area that receives auditory, visual and somatosensory inputs and thus process the phonological and semantic aspects of language (Stoeckel et al., \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). The \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eprecuneus\u003c/span\u003e, which plays a crucial role in various cognitive processes, including self-reflection, mental imagery, episodic memory retrieval and visuospatial processing. Its activation in the context of an imaginative communication style is correlated to several of these aspects. The precuneus facilitates the integration of self-relevant information into the imaginative process, allowing individuals to incorporate their own thoughts, emotions and experiences into their communicative expression (Chen et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). It also contributes to the retrieval of episodic memories, allowing access to relevant content to enrich imaginative communication (Trimble \u0026amp; Cavanna, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). The precuneus is also a key node within the DMN, associated with introspection, self-generated thoughts and imaginative thinking (Fransson \u0026amp; Marrelec, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2008\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAn interesting aspect we noted for both these assertive communication styles was the activation of the pars opercularis, triangularis and adjacent cortical regions belonging to Broca\u0026rsquo;s area (IFG). Traditionally associated with speech production, syntactic processing, and the coordination of motor movements required for speech, its involvement in the context of imaginative communication may be related to the linguistic aspects of expressing assertive or imaginative thoughts and narratives. Additionally, the pars opercularis and the broader Broca\u0026rsquo;s area are interconnected with other brain regions involved in imagination, such as the prefrontal cortex and temporal lobes (Fedorenko et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). These connections may facilitate the integration of directive and imaginative thoughts and ideas with language processing and expression.\u003c/p\u003e \u003cp\u003eThe \u003cb\u003ePromoting\u003c/b\u003e \u003cb\u003evs\u003c/b\u003e \u003cb\u003eAll\u003c/b\u003e contrast highlighted neural activations mostly regrouped bilaterally in the middle temporal gyrus (MTG) and middle occipital gyrus (MOG). Within the \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003emiddle temporal gyrus\u003c/span\u003e, we separately focused our analysis on the posterior middle temporal gyrus (pMTG) and the anterior middle temporal gyrus (aMTG). The pMTG is implicated in the processing of visual motion and speech perception, as well as controlled retrieval of conceptual knowledge (Davey et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Structural and functional connectivity analyses demonstrated that this site is at the nexus of networks recruited in automatic semantic processing (the default mode network) and executively demanding tasks (the multiple-demand network). The aMTG is associated with the automatic retrieval of specific semantic information, as well as semantic processing, including the interpretation of social and emotional cues. As far as the \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003emiddle occipital gyrus\u003c/span\u003e (MOG) is concerned, it is primarily involved in visual processing, including object recognition, motion perception and spatial awareness. Although its main focus area is not emotive communication, it contributes to the processing of visual cues, such as facial expressions and body language, which are essential facets of emotional communication. An interesting aspect, consistent throughout literature (Fan et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Guo et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Liu et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Zhong et al., \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), is that a unique decreased abnormal activation in functional connectivity was found in L-MOG in patients diagnosed with a major depressive disorder (MDD). A common cognitive feature of MDD is mood congruent processing bias and interpretation of visual cues. In this context, MOG is therefore involved in the perception of facial emotion and its lower activations implicate disrupted visual processing of emotions (Guo et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2012\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAs previously mentioned, the \u003cb\u003eReflective\u003c/b\u003e\u003cb\u003evs\u003c/b\u003e\u003cb\u003eAll\u003c/b\u003e and \u003cb\u003ePersuasive\u003c/b\u003e\u003cb\u003evs\u003c/b\u003e\u003cb\u003eAll\u003c/b\u003e contrasts produced no significant activation. This result, although initially discouraging, is not actually surprising, as we hypothesized more intense activations would appear if the subjects\u0026rsquo; initial communication mode was vastly different from the one expressed in the videos. Indeed, the characteristics of the Reflective and Persuasive communication patterns are the ones most frequently used by our subjects in daily life and interactions, according to their questionnaire answers (factual thinking, information exchange). Therefore, we concluded that depending on the subjects\u0026rsquo; cognitive style, a variable reception of other communication modes could be predicted, with more activations in diverse areas needed for adapting to a communication style incoherent with one\u0026rsquo;s own. Insignificant activations in small clusters could be observed in the right precuneus and posterior cingulate cortex, areas engaged by a range of tasks including autobiographical memory and imagining the future (Auger \u0026amp; Maguire, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Leech et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2012\u003c/span\u003e), as well as self-reflection and self-imagery (Kircher \u0026amp; Thienel, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2005\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe \u003cb\u003eHarmonizing\u003c/b\u003e \u003cb\u003evs\u003c/b\u003e \u003cb\u003eAll\u003c/b\u003e contrast results were consistent with our prediction that an empathetic, reassuring communication style generates activations in emotional and semantic processing related areas (insula, MTG, MOG, Rolandic operculum), as well as DMN (postcentral gyrus). As previously detailed, \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eMTG\u003c/span\u003e and \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eMOG\u003c/span\u003e are involved in certain aspects of emotional processing and communication, particularly the interpretation of emotional cues and visual perception (Dolan, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2002\u003c/span\u003e). The \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003einsula\u003c/span\u003e is critical for emotional awareness and empathy, in accord with the James-Lange theory (Gasquoine, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). It helps in perceiving and representing the internal states of oneself and others, including emotional experiences. The anterior insula constitutes the neural basis of subjective feeling states, which might also provide a basis for the \u0026ldquo;self\u0026rdquo; (Craig, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2002\u003c/span\u003e; Critchley et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). Taken together, the anterior insula marks salient information by referring to subjective feeling states and therefore initiates cognitive processes for further processing of the salient information (Menon \u0026amp; Uddin, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Uddin, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Beyond being the center of interoception, the insula stands as a hub to regulate the introduction of subjective feelings into cognitive and motivational processes (Namkung et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). The \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eRolandic operculum\u003c/span\u003e, besides playing a role in emotion processing, functions as the sensory system for gustatory and visceral sensation, together with the cingulate-operculum network (Eickhoff et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). The gut-brain axis theory further confirms this phenomenon and draws a parallel between the emotional coding at the cerebral level and its transmission to the gastrointestinal tract. Blefari et al. also demonstrated its role in integrating exteroceptive-interoceptive signals that are necessary for interoceptive awareness as well as bodily self-consciousness (Blefari et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). While the \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003epostcentral gyrus\u003c/span\u003e is not primarily associated with language production or comprehension, it contributes to the somatosensory aspects of communication, allowing individuals to perceive and respond to nonverbal cues, particularly by processing proprioceptive input (Adolphs et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2000\u003c/span\u003e). It is interconnected with the mirror neuron system, a network of brain regions involved in imitating, observing and understanding the actions of others. Interestingly, recent studies conducted in individuals suffering from mental disorders associated with abnormal emotion regulation have found structural and functional changes in the somatosensory cortex, including the postcentral gyrus (Kropf et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFinally, this study's strength lies in its utilization of a homogeneous cohort comprising medical students, offering valuable insights into the communication patterns of healthcare practitioners. This not only fosters avenues for intra-professional communication enhancement but also holds promise for refining doctor-patient interactions, thereby advancing a more empathetic and effective medical care paradigm.\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eOne notable limitation of this study pertains to its sample size. While it would have been intriguing to compare subgroups based on communication mode and gender, the number of subjects was insufficient to draw statistically robust conclusions in this regard. This constraint underscores the need for future research with larger and more diverse participant cohorts to delve deeper into these potentially significant distinctions.\u003c/p\u003e \u003cp\u003eAnother emerging constraint arises concerning experimental paradigms that investigate distinct facets of communication, overlooking the intricate nature of social communication. Subsequent investigations ought to embrace a more ecologically valid approach by employing research designs that examine language alongside congruent or incongruent nonverbal cues. This approach will provide additional insights into the varying functions of specific brain regions and their specialized involvement in comprehending verbal and nonverbal signals as diverse modalities of communication.\u003c/p\u003e \u003cp\u003eAdditionally, future investigations should contemplate the integration of behavioral and combined neurophysiological methodologies, expanding the scope of sampling from individuals within the typical population to those within psychiatric populations.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn summary, our study affirms the validity of the Process Communication Model in healthy subjects, revealing distinct neural patterns for four of the six channels. Further analysis is needed for channels with inconclusive results, particularly within cohorts presenting neuronal or psychiatric pathologies. These insights hold promise for enhancing communication within modern healthcare, potentially leading to more effective and tailored medical care practices.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was funded by Kahler Communication France. The study funder had no role to play in the study design, data collection, data analysis, or data interpretation. Patrice Dubourg, a representative of Kahler Communication France, provided critical feedback on the final version of the manuscript. The corresponding author had full access to the data and holds the responsibility for the decision to submit for publication the manuscript on behalf of all the co-authors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data underlying this article will be shared on reasonable request to the corresponding author (WEH).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosure statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWEH reports personal fees from Air Liquide, Boehringer-Ingelheim, Chugai, EISAI, Janssen, Jazz Pharmaceuticals, Lundbeck, Nordic Pharma, Novartis, Otsuka, and UCB. He received research grants from the Fondation de France, and from the French National Hospital Program for Clinical Research (PHRC), unrelated to the submitted work. 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Functional alterations of fronto-limbic circuit and default mode network systems in first-episode, drug-na\u0026iuml;ve patients with major depressive disorder: A meta-analysis of resting-state fMRI data. \u003cem\u003eJournal of Affective Disorders\u003c/em\u003e, \u003cem\u003e206\u003c/em\u003e, 280\u0026ndash;286. https://doi.org/10.1016/j.jad.2016.09.005\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"brain-imaging-and-behavior","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bior","sideBox":"Learn more about [Brain Imaging and Behavior](https://www.springer.com/journal/11682)","snPcode":"11682","submissionUrl":"https://submission.nature.com/new-submission/11682/3","title":"Brain Imaging and Behavior","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"fMRI, communication mode, social neuroscience, social interaction, personality","lastPublishedDoi":"10.21203/rs.3.rs-4463294/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4463294/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis study aims to determine if the six different types of communication (Directive, Imaginative, Reflective, Persuasive, Harmonizing, Promoting), as presented in the Process Communication Model, correlate with a respective neural pathway.\u003c/p\u003e \u003cp\u003eParticipants were 30 medical students with no past medical history. They underwent functional magnetic resonance imaging (fMRI) while watching videos typical of each communication type. By comparing each of the six experimental conditions with all the other ones, common activations were detected in the core memory network.\u003c/p\u003e \u003cp\u003eAssertive communication styles (Directive, Imaginative) generated activations in conflict detection and resolution related areas, with a predominance in the frontal lobe. Emotive communication (Harmonizing, Promoting) highlighted activations associated with the interpretation of social and emotional cues, with a temporo-occipital predominance. There were no significant activations for the Reflective and Persuasive channel, the two channels that were most coherent with the subjects\u0026rsquo; base patterns and communication.\u003c/p\u003e \u003cp\u003eThis study indicated that out of the six communication types that were analyzed, four have a specific and congruous underlying cerebral process. 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