Their pain is not our pain: Brain and autonomic correlates of empathic resonance with the pain of same and different race individuals

Recent advances in social neuroscience research have unveiled the neurophysiological correlates of race and intergroup processing. However, little is known about the neural mechanisms underlying intergroup empathy. Combining event‐related fMRI with measurements of pupil dilation as an index of autonomic reactivity, we explored how race and group membership affect empathy‐related responses. White and Black subjects were presented with video clips depicting white, black, and unfamiliar violet‐skinned hands being either painfully penetrated by a syringe or being touched by a Q‐tip. Both hemodynamic activity within areas known to be involved in the processing of first and third‐person emotional experiences of pain, i.e., bilateral anterior insula, and autonomic reactivity were greater for the pain experienced by own‐race compared to that of other‐race and violet models. Interestingly, greater implicit racial bias predicted increased activity within the left anterior insula during the observation of own‐race pain relative to other‐race pain. Our findings highlight the close link between group‐based segregation and empathic processing. Moreover, they demonstrate the relative influence of culturally acquired implicit attitudes and perceived similarity/familiarity with the target in shaping emotional responses to others' physical pain. Hum Brain Mapp 34:3168–3181, 2013. © 2012 Wiley Periodicals, Inc.     

Overlapping and distinct representations of advantageous and disadvantageous inequality

Advantageous inequality (AI) aversion, or paying at a personal cost to achieve equal reward distribution, represents a unique feature of human behavior. Here, we show that individuals have strong preferences for fairness in both disadvantageous (DI) and advantageous inequality (AI) situations, such that they alter others' payoff at a personal financial cost. At the neural level, we found that both types of inequality activated the putamen, orbitofrontal cortex, and insula, regions implicated in motivation. Individual difference analyses found that those who spent more money to increase others' payoff had stronger activity in putamen when they encountered AI and less functional connectivity between putamen and both orbitofrontal cortex and anterior insula. Conversely, those who spent more money to reduce others' payoff had stronger activity in amygdala in response to DI and less functional connectivity between amygdala and ventral anterior cingulate cortex. These dissociations suggest that both types of inequality are processed by similar brain areas, yet modulated by different neural pathways. Hum Brain Mapp 35:3290–3301, 2014. © 2013 Wiley Periodicals, Inc .     

Mindfulness meditation regulates anterior insula activity during empathy for social pain

Mindfulness has been shown to reduce stress, promote health, and well‐being, as well as to increase compassionate behavior toward others. It reduces distress to one's own painful experiences, going along with altered neural responses, by enhancing self‐regulatory processes and decreasing emotional reactivity. In order to investigate if mindfulness similarly reduces distress and neural activations associated with empathy for others' socially painful experiences, which might in the following more strongly motivate prosocial behavior, the present study compared trait, and state effects of long‐term mindfulness meditation (LTM) practice. To do so we acquired behavioral data and neural activity measures using functional magnetic resonance imaging (fMRI) during an empathy for social pain task while manipulating the meditation state between two groups of LTM practitioners that were matched with a control group. The results show increased activations of the anterior insula (AI) and anterior cingulate cortex (ACC) as well as the medial prefrontal cortex and temporal pole when sharing others' social suffering, both in LTM practitioners and controls. However, in LTM practitioners, who practiced mindfulness meditation just prior to observing others' social pain, left AI activation was lower and the strength of AI activation following the mindfulness meditation was negatively associated with trait compassion in LTM practitioners. The findings suggest that current mindfulness meditation could provide an adaptive mechanism in coping with distress due to the empathic sharing of others' suffering, thereby possibly enabling compassionate behavior. Hum Brain Mapp 38:4034–4046, 2017. © 2017 Wiley Periodicals, Inc.     

Shared and nonshared neural networks of cognitive and affective theory‐of‐mind: A neuroimaging study using cartoon picture stories

Theory of mind (ToM) refers to the ability to represent one's own and others' cognitive and affective mental states. Recent imaging studies have aimed to disentangle the neural networks involved in cognitive as opposed to affective ToM, based on clinical observations that the two can functionally dissociate. Due to large differences in stimulus material and task complexity findings are, however, inconclusive. Here, we investigated the neural correlates of cognitive and affective ToM in psychologically healthy male participants (n = 39) using functional brain imaging, whereby the same set of stimuli was presented for all conditions (affective, cognitive and control), but associated with different questions prompting either a cognitive or affective ToM inference. Direct contrasts of cognitive versus affective ToM showed that cognitive ToM recruited the precuneus and cuneus, as well as regions in the temporal lobes bilaterally. Affective ToM, in contrast, involved a neural network comprising prefrontal cortical structures, as well as smaller regions in the posterior cingulate cortex and the basal ganglia. Notably, these results were complemented by a multivariate pattern analysis (leave one study subject out), yielding a classifier with an accuracy rate of more than 85% in distinguishing between the two ToM‐conditions. The regions contributing most to successful classification corresponded to those found in the univariate analyses. The study contributes to the differentiation of neural patterns involved in the representation of cognitive and affective mental states of others. Hum Brain Mapp, 36:29–39, 2015. © 2014 Wiley Periodicals, Inc.     

Integrating Incomplete Information With Imperfect Advice

When our own knowledge is limited, we often turn to others for information. However, social learning does not guarantee accurate learning or better decisions: Other people's knowledge can be as limited as our own, and their advice is not always helpful. This study examines how human learners put two “imperfect” heads together to make utility‐maximizing decisions. Participants played a card game where they chose to “stay” with a card of known value or “switch” to an unknown card, given an advisor's advice to stay or switch. Participants used advice strategically based on which cards the advisor could see (Experiment 1), how helpful the advisor was (Experiment 2), and what strategy the advisor used to select advice (Experiment 3). Overall, participants benefited even from imperfect advice based on incomplete information. Participants’ responses were consistent with a Bayesian model that jointly infers how the advisor selects advice and the value of the advisor's card, compared to an alternative model that weights advice based on the advisor's accuracy. By reasoning about others’ minds, human learners can make the best of even noisy, impoverished social information.     

Cognitive neuroscience of social emotions and implications for psychopathology: Examining embarrassment,guilt, envy,and schadenfreude

Social emotions are affective states elicited during social interactions and integral for promoting socially appropriate behaviors and discouraging socially inappropriate ones. Social emotion‐processing deficits significantly impair interpersonal relationships, and play distinct roles in the manifestation and maintenance of clinical symptomatology. Elucidating the neural correlates of discrete social emotions can serve as a window to better understanding and treating neuropsychiatric disorders. Moral cognition and social emotion‐processing broadly recruit a fronto–temporo–subcortical network, supporting empathy, perspective‐taking, self‐processing, and reward‐processing. The present review specifically examines the neural correlates of embarrassment, guilt, envy, and schadenfreude. Embarrassment and guilt are self‐conscious emotions, evoked during negative evaluation following norm violations and supported by a fronto–temporo–posterior network. Embarrassment is evoked by social transgressions and recruits greater anterior temporal regions, representing conceptual social knowledge. Guilt is evoked by moral transgressions and recruits greater prefrontal regions, representing perspective‐taking and behavioral change demands. Envy and schadenfreude are fortune‐of‐other emotions, evoked during social comparison and supported by a prefronto–striatal network. Envy represents displeasure in others' fortunes, and recruits increased dorsal anterior cingulate cortex, representing cognitive dissonance, and decreased reward‐related striatal regions. Schadenfreude represents pleasure in others' misfortunes, and recruits reduced empathy‐related insular regions and increased reward‐related striatal regions. Implications for psychopathology and treatment design are discussed.     

Computational and Neurobiological Substrates of Cost-Benefit Integration in Altruistic Helping Decision

Although altruistic behaviors, e.g., sacrificing one''s own interests to alleviate others'' suffering, are widely observed in human society, altruism varies greatly across individuals. Such individual differences in altruistic preference have been hypothesized to arise from both individuals'' dispositional empathic concern for others'' welfare and context-specific cost-benefit integration processes. However, how cost-benefit integration is implemented in the brain and how it is linked to empathy remain unclear. Here, we combine a novel paradigm with the model-based functional magnetic resonance imaging (fMRI) approach to examine the neurocomputational basis of altruistic behaviors. Thirty-seven adults (16 females) were tested. Modeling analyses suggest that individuals are likely to integrate their own monetary costs with nonlinearly transformed recipients'' benefits. Neuroimaging results demonstrate the involvement of an extended common currency system during decision-making by showing that selfish and other-regarding motives were processed in dorsal anterior cingulate cortex (ACC) and right inferior parietal lobe in a domain-general manner. Importantly, a functional dissociation of adjacent but different subregions within anterior insular cortex (aINS) was observed for different subprocesses underlying altruistic behaviors. While dorsal aINS (daINS) and inferior frontal gyrus (IFG) were involved in valuation of benefactors'' costs, ventral aINS and middle INS (vaINS/mINS), as empathy-related regions, reflected individual variations in valuating recipients'' benefits. Multivariate analyses further suggest that both vaINS/mINS and dorsolateral prefrontal cortex (DLPFC) reflect individual variations in general altruistic preferences which account for both dispositional empathy and context-specific other-regarding tendency. Together, these findings provide valuable insights into our understanding of psychological and neurobiological basis of altruistic behaviors.SIGNIFICANCE STATEMENT Altruistic behaviors play a crucial role in facilitating solidarity and development of human society, but the mechanisms of the cost-benefit integration underlying these behaviors are still unclear. Using model-based neuroimaging approaches, we clarify that people integrate personal costs and non-linearly transformed other''s benefits during altruistic decision-making and the implementations of the integration processes are supported by an extended common currency neural network. Importantly, multivariate analyses reveal that both empathy-related and cognitive control-related brain regions are involved in modulating individual variations of altruistic preference, which implicate complex psychological and computational processes. Our results provide a neurocomputational account of how people weigh between different attributes to make altruistic decisions and why altruistic preference varies to a great extent across individuals.     

Somatic engagement alters subsequent neurobehavioral correlates of affective mentalizing

Socio‐emotional encounters involve a resonance of others'' affective states, known as affect sharing (AS); and attribution of mental states to others, known as theory‐of‐mind (ToM). Empathy necessitates the integration of both processes, yet their interaction during emotional episodes and subsequent generation of inferences on others'' affective states has rarely been tested. To address this, we developed a novel experimental design, wherein we manipulated AS by presenting nonverbal emotionally negative movies twice—each time accompanied by one of two soundtracks that accentuated either somatic cues or externally generated sounds. Movies were followed by questions addressing affective‐ToM (emotional inferences), cognitive‐ToM (inferences on beliefs and knowledge), and non‐ToM aspects. Results revealed a neural differentiation between AS, affective‐ToM, and cognitive‐ToM. AS movies activated regions that have been implicated in emotional (e.g., amygdala) and somatosensory processing, and synchronized brain activity between participants in the latter. Affective‐ToM activated the middle insula, limbic regions, and both ventral and dorsal portions of the medial prefrontal cortex (ventral medial prefrontal cortex [VMPFC] and dorsal medial prefrontal cortex [DMPFC], respectively), whereas cognitive‐ToM activated posteromedial and lateral–prefrontal and temporal cortices. Critically, AS movies specifically altered neural activation in AS and ToM‐related regions during subsequent affective‐ToM inferences, most notably in the DMPFC. Moreover, DMPFC–VMPFC connectivity correlated with affective‐ToM accuracy, when such questions followed AS movies. Our results associate empathic processes with designated neural activations and shed light on how neuro‐behavioral indices of affective ToM are shaped by preceding somatic engagement.     

Neural correlates of recursive thinking during interpersonal strategic interactions

To navigate the complex social world, individuals need to represent others'' mental states to think strategically and predict their next move. Strategic mentalizing can be classified into different levels of theory of mind according to its order of mental state attribution of other people''s beliefs, desires, intentions, and so forth. For example, reasoning people''s beliefs about simple world facts is the first‐order attribution while going further to reason people''s beliefs about the minds of others is the second‐order attribution. The neural substrates that support such high‐order recursive reasoning in strategic interpersonal interactions are still unclear. Here, using a sequential‐move interactional game together with functional magnetic resonance imaging (fMRI), we showed that recursive reasoning engaged the frontal‐subcortical regions. At the stimulus stage, the ventral striatum was more activated in high‐order reasoning as compared with low‐order reasoning. At the decision stage, high‐order reasoning activated the medial prefrontal cortex (mPFC) and other mentalizing regions. Moreover, functional connectivity between the dorsomedial prefrontal cortex (dmPFC) and the insula/hippocampus was positively correlated with individual differences in high‐order social reasoning. This work delineates the neural correlates of high‐order recursive thinking in strategic games and highlights the key role of the interplay between mPFC and subcortical regions in advanced social decision‐making.     

Emotional responses associated with self-face processing in individuals with autism spectrum disorders: An fMRI study

Individuals with autism spectrum disorders (ASD) show impaired emotional responses to self-face processing, but the underlying neural bases are unclear. Using functional magnetic resonance imaging, we investigated brain activity when 15 individuals with high-functioning ASD and 15 controls rated the photogenicity of self-face images and photographs of others' faces. Controls showed a strong correlation between photogenicity ratings and extent of embarrassment evoked by self-face images; this correlation was weaker among ASD individuals, indicating a decoupling between the cognitive evaluation of self-face images and emotional responses. Individuals with ASD demonstrated relatively low self-related activity in the posterior cingulate cortex (PCC), which was related to specific autistic traits. There were significant group differences in the modulation of activity by embarrassment ratings in the right insular (IC) and lateral orbitofrontal cortices. Task-related activity in the right IC was lower in the ASD group. The reduced activity in the right IC for self-face images was associated with weak coupling between cognitive evaluation and emotional responses to self-face images. The PCC is responsible for self-referential processing, and the IC plays a role in emotional experience. Dysfunction in these areas could contribute to the lack of self-conscious behaviors in response to self-reflection in ASD individuals.     

Vicariously touching products through observing others' hand actions increases purchasing intention,and the effect of visual perspective in this process: An fMRI study

The growth of online shopping increases consumers' dependence on vicarious sensory experiences, such as observing others touching products in commercials. However, empirical evidence on whether observing others' sensory experiences increases purchasing intention is still scarce. In the present study, participants observed others interacting with products in the first‐ or third‐person perspective in video clips, and their neural responses were measured with functional magnetic resonance imaging (fMRI). We investigated (1) whether and how vicariously touching certain products affected purchasing intention, and the neural correlates of this process; and (2) how visual perspective interacts with vicarious tactility. Vicarious tactile experiences were manipulated by hand actions touching or not touching the products, while the visual perspective was manipulated by showing the hand actions either in first‐ or third‐person perspective. During the fMRI scanning, participants watched the video clips and rated their purchasing intention for each product. The results showed that, observing others touching (vs. not touching) the products increased purchasing intention, with vicarious neural responses found in mirror neuron systems (MNS) and lateral occipital complex (LOC). Moreover, the stronger neural activities in MNS was associated with higher purchasing intention. The effects of visual perspectives were found in left superior parietal lobule (SPL), while the interaction of tactility and visual perspective was shown in precuneus and precuneus‐LOC connectivity. The present study provides the first evidence that vicariously touching a given product increased purchasing intention and the neural activities in bilateral MNS, LOC, left SPL and precuneus are involved in this process. Hum Brain Mapp 39:332–343, 2018. © 2017 Wiley Periodicals, Inc.     

Differential neurobiological effects of expert advice on risky choice in adolescents and adults

We investigated behavioral and neurobiological mechanisms by which risk-averse advice, provided by an expert, affected risky decisions across three developmental groups [early adolescents (12-14 years), late adolescents (15-17 years), adults (18+ years)]. Using cumulative prospect theory, we modeled choice behavior during a risky-choice task. Results indicate that advice had a significantly greater impact on risky choice in both adolescent groups than in adults. Using functional magnetic resonance imaging, we investigated the neural correlates of this behavioral effect. Developmental effects on correlations between brain activity and valuation parameters were obtained in regions that can be classified into (i) cognitive control regions, such as dorsolateral prefrontal cortex (DLPFC) and ventrolateral PFC; (ii) social cognition regions, such as posterior temporoparietal junction; and (iii) reward-related regions, such as ventromedial PFC (vmPFC) and ventral striatum. Within these regions, differential effects of advice on neural correlates of valuation were observed across development. Specifically, advice increased the correlation strength between brain activity and parameters reflective of safe choice options in adolescent DLPFC and decreased correlation strength between activity and parameters reflective of risky choice options in adult vmPFC. Taken together, results indicate that, across development, distinct brain systems involved in cognitive control and valuation mediate the risk-reducing effect of advice during decision making under risk via specific enhancements and reductions of the correlation strength between brain activity and valuation parameters.     

Reduced functional connectivity during controlled semantic integration in schizophrenia: A multivariate approach

Impairment in controlled semantic association is a central feature of schizophrenia, and the goal of the current functional magnetic resonance imaging study was to identify the neural correlates of this impairment. Thirty people with schizophrenia and 30 healthy age‐ and gender‐matched control subjects performed a task requiring participants to match word pairs that varied in semantic distance (distant vs. close). A whole‐brain multivariate connectivity analysis revealed three functional brain networks of primary interest engaged by the task: two configurations of a multiple demands network, in which brain activity did not differ between groups, and a semantic integration network, in which coordinated activity was reduced in schizophrenia patients relative to healthy controls, for distantly relative to closely related word pairs. The hypoactivity during controlled semantic integration in schizophrenia reported here, combined with hyperactivity in automatic semantic association reported in the literature, suggests an imbalance between controlled integration and automatic association. This provides a biological basis for Bleuler's concept of schizophrenia as a “split mind” arising from an impaired ability to form coherent associations between semantic concepts. Hum Brain Mapp 36:2948–2964, 2015. © 2015 Wiley Periodicals, Inc .     

Abnormal body perception and neural activity in the insula in depression: An fMRI study of the depressed “material me”

Abstract

Objectives. In addition to affective-cognitive symptoms, patients with major depressive disorder (MDD) suffer from somato-vegetative symptoms, suggesting abnormal interoceptive awareness of their “material me”. While recent imaging studies have extensively investigated affective-cognitive symptoms in MDD, the neural correlates of somato-vegetative symptoms and abnormal interoception remain unclear. Since the “material me” has been especially associated with the anterior insula in healthy subjects, we hypothesized abnormalities in this region during interoceptive awareness in MDD. Methods. We therefore investigated behavioural and neural correlates of interoception in healthy and depressed subjects using the Body Perception Questionnaire (BPQ) and a well established heartbeat perception task in fMRI. Results. MDD patients showed significantly higher scores in the BPQ and reduced neural activity during rest periods, particularly in the bilateral anterior insula. In contrast to healthy subjects, BPQ scores no longer correlated with activity during rest periods in the anterior insula. Both BPQ scores and left anterior insula signal changes correlated with depression severity. Conclusions. We demonstrate for the first time abnormal body perception and altered activity in the insula during rest in MDD. Our results suggest that these behavioural and neural abnormalities are closely related to these patients’ somato-vegetative abnormalities and their abnormal “material me”.     

Do implicit and explicit belief processing share neural substrates?

Humans rely on their ability to infer another person's mental state to understand and predict others' behavior (“theory of mind,” ToM). Multiple lines of research suggest that not only are humans able to consciously process another person's belief state, but also are able to do so implicitly. Here we explored how general implicit belief states are represented in the brain, compared to those substrates involved in explicit ToM processes. Previous work on this topic has yielded conflicting results, and thus, the extent to which the implicit and explicit ToM systems draw on common neural bases is unclear. Participants were presented with “Sally‐Anne” type movies in which a protagonist was falsely led to believe a ball was in one location, only for a puppet to later move it to another location in their absence (false‐belief condition). In other movies, the protagonist had their back turned the entire time the puppet moved the ball between the two locations, meaning that they had no opportunity to develop any pre‐existing beliefs about the scenario (no‐belief condition). Using a group of independently localized explicit ToM brain regions, we found greater activity for false‐belief trials, relative to no‐belief trials, in the right temporoparietal junction, right superior temporal sulcus, precuneus, and left middle prefrontal gyrus. These findings extend upon previous work on the neural bases of implicit ToM by showing substantial overlap between this system and the explicit ToM system, suggesting that both abilities might recruit a common set of mentalizing processes/functional brain regions. Hum Brain Mapp 38:4760–4772, 2017. © 2017 Wiley Periodicals, Inc.     

Brain network integration dynamics are associated with loss and recovery of consciousness induced by sevoflurane

The dynamic interplay of integration and segregation in the brain is at the core of leading theoretical accounts of consciousness. The human brain dynamically alternates between a sub‐state where integration predominates, and a predominantly segregated sub‐state, with different roles in supporting cognition and behaviour. Here, we combine graph theory and dynamic functional connectivity to compare resting‐state functional MRI data from healthy volunteers before, during, and after loss of responsiveness induced with different concentrations of the inhalational anaesthetic, sevoflurane. We show that dynamic states characterised by high brain integration are especially vulnerable to general anaesthesia, exhibiting attenuated complexity and diminished small‐world character. Crucially, these effects are reversed upon recovery, demonstrating their association with consciousness. Higher doses of sevoflurane (3% vol and burst‐suppression) also compromise the temporal balance of integration and segregation in the human brain. Additionally, we demonstrate that reduced anticorrelations between the brain''s default mode and executive control networks dynamically reconfigure depending on the brain''s state of integration or segregation. Taken together, our results demonstrate that the integrated sub‐state of brain connectivity is especially vulnerable to anaesthesia, in terms of both its complexity and information capacity, whose breakdown represents a generalisable biomarker of loss of consciousness and its recovery.     

Qualitative analysis of a nurse's responses to stroke caregivers on a web-based supportive intervention

Abstract

Background:

Approximately 800?000 people experience a stroke every year; most are cared for by unpaid family members in home settings. Web-based interventions provide 24/7 access to education/support services and have been explored in the literature with family caregivers dealing with chronic conditions. Current research into nurses' web-based interactions with caregivers in these interventions is lacking.

Objective:

The aim of this qualitative secondary data analysis was to examine a nurse specialist's responses and advice that she gave in a web-based supportive intervention for stroke family caregivers used in a randomized controlled trial for 1 year.

Methods:

Using a qualitative research design, caregivers were recruited from rehabilitation facilities in Ohio and Michigan (n?=?36). They accessed the intervention's email forum and discussion group facilitated by the nurse. These email message data were examined using rigorous content analysis.

Results:

The caregivers were primarily white women caring for a spouse, with an average age of 54 years. From the 2148 email messages between the nurse and caregivers, five themes emerged and were drawn to Friedemann's Framework. These themes included: getting to know the situation (Friedemann's coherence and individuation), validating emotions (individuation), promoting self-care (individuation), assisting in role adaptation (system maintenance and individuation), and providing healthcare information (system maintenance and individuation).

Conclusions:

These caregivers of stroke survivors were asking for advice, seeking support, and looking for information from an advanced practice nurse. Nurses, and others, in supportive roles can use these findings to promote informed care and directed interventions for caregivers dealing with stroke and its outcomes.     

When your errors make me lose or win: Event-related potentials to observed errors of cooperators and competitors

Monitoring one's own errors is a fundamental ability in terms of guiding and improving behavior, with specific neural substrates in the anterior cingulate cortex (ACC). Similarly, we can monitor others' actions and learn by observing their errors. The mirror neuron system may subserve the formation of shared representations for self-generated and observed actions, and recent research suggests that monitoring mechanisms also react to errors made by others. However, it remains unknown how these responses are modified when interpersonal context implies different goals for the actor and the observer. To investigate whether differences in social context can influence brain response to observed action errors, we manipulated competition vs. cooperation between two participants taking turns in a go/no-go task. Event-related potentials simultaneously recorded from both participants showed a typical negativity over frontocentral regions to self-generated errors, irrespective of interpersonal context, but early differential responses to other-generated errors only during cooperation, with sources in precuneus and medial premotor areas. Competition produced a distinct error-related negativity in ACC at later latencies. We conclude that error monitoring for others' actions depends on their congruence with personal goals, and recruits brain systems involved in self-referential processing specifically during cooperation.     

Success Enhancing Supervision

Summary

In this paper, the authors posit that therapists (beginning and experienced) have a propensity for being self-deprecating and critical. Following Bandura's (1977, 1986) theory of perceived self-efficacy, when this becomes reinforced by a supervisor, therapists lose their sense of self-efficacy as a therapist, and their competence suffers accordingly. In an effort to foster improved perceived self-efficacy, the authors apply solution-focused and constructive methods of therapy to the context of clinical supervision. Several case illustrations are presented compromising goal construction and the development of the supervisory relationship, co-constructing competence and confidence, circumventing impasses, the role of teaching and education in supervision, and the potential paradox of evaluation.     

Competency in integrative psychotherapy: Perspectives on training and supervision

Increasingly, many psychotherapists identify with an integrative approach to psychotherapy. In recent years, more attention has been directed toward the operationalization and evaluation of competence in professional psychology and health care service delivery. Aspects of integrative psychotherapy competency may differ from competency in other psychotherapy orientations, although convergence is more often the case. Despite the potential differences, there exist very few formal training programs or guidelines to systematically guide clinicians in developing a competent integrative practice. This paper attempts to distill the essential elements of competent integrative psychotherapy practice and focuses on how these might be developed in training and supervision. We address most of these complex issues from a specific integrative perspective: principle-based assimilative integration. (PsycINFO Database Record (c) 2010 APA, all rights reserved).