Helena Cassol

Phenomenology of future-oriented mind-wandering episodes

Recent research suggests that prospective and non-prospective forms of mind-wandering possess distinct properties, yet little is known about what exactly differentiates between future-oriented and non-future-oriented mind-wandering episodes. In the present study, we used multilevel exploratory factor analyses (MEFA) to examine the factorial structure of various phenomenological dimensions of mind-wandering, and we then investigated whether future-oriented mind-wandering episodes differ from other classes of mind-wandering along the identified factors. We found that the phenomenological dimensions of mind-wandering are structured in four factors: representational format (inner speech vs. visual imagery), personal relevance, realism/concreteness, and structuration. Prospective mind-wandering differed from non-prospective mind-wandering along each of these factors. Specifically, future-oriented mind-wandering episodes involved inner speech to a greater extent, were more personally relevant, more realistic/concrete, and more often part of structured sequences of thoughts. These results show that future-oriented mind-wandering possesses a unique phenomenological signature and provide new insights into how this particular form of mind-wandering may adaptively contribute to autobiographical planning.

Brains creating stories of selves: the neural basis of autobiographical reasoning

Personal identity critically depends on the creation of stories about the self and ones life. The present study investigates the neural substrates of autobiographical reasoning, a process central to the construction of such narratives. During functional magnetic resonance imaging scanning, participants approached a set of personally significant memories in two different ways: in some trials, they remembered the concrete content of the events (autobiographical remembering), whereas in other trials they reflected on the broader meaning and implications of their memories (autobiographical reasoning). Relative to remembering, autobiographical reasoning recruited a left-lateralized network involved in conceptual processing [including the dorsal medial prefrontal cortex (MPFC), inferior frontal gyrus, middle temporal gyrus and angular gyrus]. The ventral MPFC--an area that may function to generate personal/affective meaning--was not consistently engaged during autobiographical reasoning across participants but, interestingly, the activity of this region was modulated by individual differences in interest and willingness to engage in self-reflection. These findings support the notion that autobiographical reasoning and the construction of personal narratives go beyond mere remembering in that they require deriving meaning and value from past experiences.

Brain networks predict metabolism, diagnosis and prognosis at the bedside in disorders of consciousness

Recent advances in functional neuroimaging have demonstrated novel potential for informing diagnosis and prognosis in the unresponsive wakeful syndrome and minimally conscious states. However, these technologies come with considerable expense and difficulty, limiting the possibility of wider clinical application in patients. Here, we show that high density electroencephalography, collected from 104 patients measured at rest, can provide valuable information about brain connectivity that correlates with behaviour and functional neuroimaging. Using graph theory, we visualize and quantify spectral connectivity estimated from electroencephalography as a dense brain network. Our findings demonstrate that key quantitative metrics of these networks correlate with the continuum of behavioural recovery in patients, ranging from those diagnosed as unresponsive, through those who have emerged from minimally conscious, to the fully conscious locked-in syndrome. In particular, a network metric indexing the presence of densely interconnected central hubs of connectivity discriminated behavioural consciousness with accuracy comparable to that achieved by expert assessment with positron emission tomography. We also show that this metric correlates strongly with brain metabolism. Further, with classification analysis, we predict the behavioural diagnosis, brain metabolism and 1-year clinical outcome of individual patients. Finally, we demonstrate that assessments of brain networks show robust connectivity in patients diagnosed as unresponsive by clinical consensus, but later rediagnosed as minimally conscious with the Coma Recovery Scale-Revised. Classification analysis of their brain network identified each of these misdiagnosed patients as minimally conscious, corroborating their behavioural diagnoses. If deployed at the bedside in the clinical context, such network measurements could complement systematic behavioural assessment and help reduce the high misdiagnosis rate reported in these patients. These metrics could also identify patients in whom further assessment is warranted using neuroimaging or conventional clinical evaluation. Finally, by providing objective characterization of states of consciousness, repeated assessments of network metrics could help track individual patients longitudinally, and also assess their neural responses to therapeutic and pharmacological interventions.

Prevalence of coma-recovery scale-revised signs of consciousness in patients in minimally conscious state

ABSTRACT Different behavioural signs of consciousness can distinguish patients with an unresponsive wakefulness syndrome from patients in minimally conscious state (MCS). The Coma Recovery Scale-Revised (CRS-R) is the most sensitive scale to differentiate the different altered states of consciousness and eleven items detect the MCS. The aim of this study is to document the prevalence of these items. We analysed behavioural assessments of 282 patients diagnosed in MCS based on the CRS-R. Results showed that some items are particularly frequent among patients in MCS, namely fixation, visual pursuit, and reproducible movement to command, which were observed in more than 50% of patients. These responses were also the most probably observed items when the patients only showed one sign of consciousness. On the other hand, some items were rarely or never observed alone, e.g., object localisation (reaching), object manipulation, intelligible verbalisation, and object recognition. The results also showed that limiting the CRS-R assessment to the five most frequently observed items (i.e., fixation, visual pursuit, reproducible movement to command, automatic motor response and localisation to noxious stimulation) detected 99% of the patients in MCS. If clinicians have only limited time to assess patients with disorders of consciousness, we suggest to evaluate at least these five items of the CRS-R.

Regional brain volumetry and brain function in severely brain-injured patients: Regional Brain Volumetry and Function in DOC

The relationship between residual brain tissue in patients with disorders of consciousness (DOC) and the clinical condition is unclear. This observational study aimed to quantify gray (GM) and white matter (WM) atrophy in states of (altered) consciousness.

Fantasy proneness correlates with the intensity of near-death experience

Little is known about the personality characteristics of those who have experienced a “Near-Death Experience” (NDE). One interesting candidate is fantasy proneness. We studied this trait in individuals who developed NDEs in the presence (i.e., classical NDEs) or absence (i.e., NDEs-like) of a life-threatening situation. We surveyed a total of 228 individuals. From those, 108 qualified as NDE experiencers (i.e., Greyson NDE scale total score ≥7): 51 had their NDEs in the context of a life-threatening situation; 57 had their NDEs not related to a life-threatening situation. From those who did not meet the criteria to be considered “experiencers,” 20 had their NDE in the absence of a life-threatening situation; 50 had faced death but did not recall a NDE and finally, 50 were healthy people without a history of life threat and/or NDE. All participants completed a measure of NDE intensity (the Greyson NDE scale) and a measure of fantasy proneness (the Creative Experiences Questionnaire). People reporting NDEs-like scored higher on fantasy proneness than those reporting classical NDEs, individuals whose experiences did not meet the NDE criteria and matched controls. By contrast, individuals reporting classical NDEs did not show different engagement in fantasy as matched controls. The reported intensity of the experiences was positively correlated with engagement in fantasy. Our findings support the view that strong engagement in fantasy by individuals recalling NDEs-like might make these persons more likely to report such subjective experiences when exposed to suitable physiological and/or psychological conditions (e.g., meditation, syncope).

Robust EEG-based cross-site and cross-protocol classification of states of consciousness

Determining the state of consciousness in patients with disorders of consciousness is a challenging practical and theoretical problem. Recent findings suggest that multiple markers of brain activity extracted from the EEG may index the state of consciousness in the human brain. Furthermore, machine learning has been found to optimize their capacity to discriminate different states of consciousness in clinical practice. However, it is unknown how dependable these EEG markers are in the face of signal variability because of different EEG configurations, EEG protocols and subpopulations from different centres encountered in practice. In this study we analysed 327 recordings of patients with disorders of consciousness (148 unresponsive wakefulness syndrome and 179 minimally conscious state) and 66 healthy controls obtained in two independent research centres (Paris Pitié-Salpêtrière and Liège). We first show that a non-parametric classifier based on ensembles of decision trees provides robust out-of-sample performance on unseen data with a predictive area under the curve (AUC) of ~0.77 that was only marginally affected when using alternative EEG configurations (different numbers and positions of sensors, numbers of epochs, average AUC = 0.750 ± 0.014). In a second step, we observed that classifiers based on multiple as well as single EEG features generalize to recordings obtained from different patient cohorts, EEG protocols and different centres. However, the multivariate model always performed best with a predictive AUC of 0.73 for generalization from Paris 1 to Paris 2 datasets, and an AUC of 0.78 from Paris to Liège datasets. Using simulations, we subsequently demonstrate that multivariate pattern classification has a decisive performance advantage over univariate classification as the stability of EEG features decreases, as different EEG configurations are used for feature-extraction or as noise is added. Moreover, we show that the generalization performance from Paris to Liège remains stable even if up to 20% of the diagnostic labels are randomly flipped. Finally, consistent with recent literature, analysis of the learned decision rules of our classifier suggested that markers related to dynamic fluctuations in theta and alpha frequency bands carried independent information and were most influential. Our findings demonstrate that EEG markers of consciousness can be reliably, economically and automatically identified with machine learning in various clinical and acquisition contexts.

Temporality of Features in Near-Death Experience Narratives

Background: After an occurrence of a Near-Death Experience (NDE), Near-Death Experiencers (NDErs) usually report extremely rich and detailed narratives. Phenomenologically, a NDE can be described as a set of distinguishable features. Some authors have proposed regular patterns of NDEs, however, the actual temporality sequence of NDE core features remains a little explored area. Objectives: The aim of the present study was to investigate the frequency distribution of these features (globally and according to the position of features in narratives) as well as the most frequently reported temporality sequences of features. Methods: We collected 154 French freely expressed written NDE narratives (i.e., Greyson NDE scale total score ≥ 7/32). A text analysis was conducted on all narratives in order to infer temporal ordering and frequency distribution of NDE features. Results: Our analyses highlighted the following most frequently reported sequence of consecutive NDE features: Out-of-Body Experience, Experiencing a tunnel, Seeing a bright light, Feeling of peace. Yet, this sequence was encountered in a very limited number of NDErs. Conclusion: These findings may suggest that NDEs temporality sequences can vary across NDErs. Exploring associations and relationships among features encountered during NDEs may complete the rigorous definition and scientific comprehension of the phenomenon.

Qualitative thematic analysis of the phenomenology of near-death experiences

Near-death experiences (NDEs) refer to profound psychological events that can have an important impact on the experiencers’ (NDErs) lives. Previous studies have shown that NDEs memories are phenomenologically rich. In the present study, we therefore aimed to extract the common themes (referred to as “features” in the NDE literature) reported by NDErs by analyzing all the concepts stored in the narratives of their experiences. A qualitative thematic analysis has been carried out on 34 cardiac arrest survivors’ NDE narratives. Our results shed the light on the structure of the narratives by identifying 10 “time-bounded” themes which refer to isolated events encountered during the NDE and 1 “transversal” theme which characterizes the whole narrative and generally appears as a retrospective comment of self-reflection on the experience. The division of narratives into themes provides us with detailed information about the vocabulary used by NDErs to describe their experience. This established thematic method enables a rigorous description of the phenomenon, ensuring the inclusion of all self-reported manifestations of themes in narratives.

Near-Death Experiences: Actual Considerations

The notion that death represents a passing to an afterlife, where we are reunited with loved ones and live eternally in a utopian paradise, is common in the anecdotal reports of people who have encountered a “near-death experience” (NDE). These experiences are usually portrayed as being extremely pleasant including features such as a feeling of peacefulness, the vision of a dark tunnel leading to a brilliant light, the sensation of leaving the body, or the experience of a life review. NDEs are increasingly being reported as a clearly identifiable physiological and psychological reality of clinical and scientific significance. The definition and causes of the phenomenon as well as the identification of NDE experiencers are still matters of debate. The phenomenon has been thoroughly portrayed by the media, but the science of NDEs is rather recent and still lacking of rigorous experimental data and reproducible controlled experiments. It seems that the most appropriate theories to explain the phenomenon tend to integrate both psychological and neurobiological mechanisms. The paradoxical dissociation between the richness and intensity of the memory, probably occurring during a moment of brain dysfunction, offers a unique opportunity to better understand the neural correlates of consciousness. In this chapter, we will attempt to describe NDEs and the methods to identify them. We will also briefly discuss the NDE experiencers’ characteristics. We will then address the main current explicative models and the science of NDEs.