{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T07:00:38Z","timestamp":1785308438780,"version":"3.55.0"},"reference-count":55,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Behav. Neurosci."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Clinical decision-making often occurs under conditions of high cognitive load, emotional stress, and time pressure. Psychological distancing, an emotion-focused coping strategy involving the mental separation of oneself from emotionally stressful situations to reduce affective impact, supports affect regulation in such contexts; however, its neural implementation during realistic multitasking and the extent to which it is shaped by clinical expertise remain poorly understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We investigated the neural correlates of psychological distancing during high-risk multitasking clinical scenarios in experienced nurses and nursing students. Participants first completed immersive virtual reality simulations of realistic clinical situations, followed by an auditory functional magnetic resonance imaging task derived from the same scenarios. Psychological distancing was assessed using a validated self-report measure, and brain\u2013behavior associations were examined separately for experienced nurses and nursing students.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Although self-reported psychological distancing did not differ between groups, clear expertise-related neural differences were observed. In experienced nurses, higher distancing was associated with reduced activation in regions of the default mode network, including the angular gyrus, middle temporal gyrus, and precuneus, which are implicated in internally oriented cognitive and emotional processing. In contrast, nursing students exhibited increased activation restricted to the cerebellum, suggesting greater dependence on effortful and compensatory neural mechanisms during emotion regulation under multitasking demands.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These findings provide evidence that clinical expertise may influence the neural implementation of psychological distancing, shifting it from effortful regulation toward reduced engagement of internally oriented processing, which may reflect a more automatized regulatory implementation. This neural process may support adaptive emotion regulation during decision-making under stress, highlighting a potential neurobehavioral mechanism through which expertise shapes performance in complex clinical environments.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnbeh.2026.1811561","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T06:04:00Z","timestamp":1785305040000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical expertise shifts psychological distancing from effortful regulation to reduced engagement on internally oriented processing during multitasking"],"prefix":"10.3389","volume":"20","author":[{"given":"Kelssy Hitomi","family":"dos Santos Kawata","sequence":"first","affiliation":[{"name":"Department of Clinical Information Engineering, Graduate School of Medicine, The University of Tokyo","place":["Tokyo, Japan"]},{"name":"Graduate School of Interdisciplinary Information Studies, The University of Tokyo","place":["Tokyo, Japan"]},{"name":"Faculty of Information Sciences and Graduate School of Information Sciences, Hiroshima City University","place":["Hiroshima, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shusaku","family":"Uruta","sequence":"additional","affiliation":[{"name":"Faculty of Information Sciences and Graduate School of Information Sciences, Hiroshima City University","place":["Hiroshima, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Airi","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Faculty of Information Sciences and Graduate School of Information Sciences, Hiroshima City University","place":["Hiroshima, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koki","family":"Ono","sequence":"additional","affiliation":[{"name":"Department of Clinical Information Engineering, Graduate School of Medicine, The University of Tokyo","place":["Tokyo, Japan"]},{"name":"Department of Preventive Medicine and Public Health, School of Medicine, Keio University","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shoichiro","family":"Amari","sequence":"additional","affiliation":[{"name":"Department of Clinical Information Engineering, Graduate School of Medicine, The University of Tokyo","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hironori","family":"Nakatani","sequence":"additional","affiliation":[{"name":"Department of Information Media Technology, School of Information and Telecommunication Engineering, Tokai University","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyosuke","family":"Nozawa","sequence":"additional","affiliation":[{"name":"Division of Health Sciences, Graduate School of Medicine, The University of Osaka","place":["Osaka, Japan"]},{"name":"Graduate School of Nursing, Kawasaki City College of Nursing","place":["Kawasaki, Kanagawa, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihoko","family":"Sasaka","sequence":"additional","affiliation":[{"name":"Faculty of Nursing, Tokyo Ariake University of Medical and Health Sciences","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimikazu","family":"Kashiwagi","sequence":"additional","affiliation":[{"name":"National College of Nursing","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Oyama","sequence":"additional","affiliation":[{"name":"Department of Clinical Information Engineering, Graduate School of Medicine, The University of Tokyo","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"4777","DOI":"10.1002\/hbm.25570","article-title":"Overlapping and specific neural correlates for empathizing, affective mentalizing, and cognitive mentalizing: a coordinate-based meta-analytic study","volume":"42","author":"Arioli","year":"2021","journal-title":"Hum. Brain Mapp."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1016\/j.surg.2009.10.007","article-title":"The impact of stress on surgical performance: a systematic review of the literature","volume":"147","author":"Arora","year":"2010","journal-title":"Surgery"},{"key":"ref3","year":""},{"key":"ref4","doi-asserted-by":"publisher","first-page":"101250","DOI":"10.1016\/j.dr.2026.101250","article-title":"The default mode network throughout the lifespan: a state-of-the-art scoping review on its development and association to individual cognitive functioning","volume":"79","author":"Baptista","year":"2026","journal-title":"Dev. Rev."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1038\/s44184-024-00061-2","article-title":"Prevalence of burnout among healthcare professionals: a survey at fort portal regional referral hospital","volume":"3","author":"Batanda","year":"2024","journal-title":"NPJ Ment. Health Res."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"2767","DOI":"10.1093\/cercor\/bhp055","article-title":"Where is the semantic system? A critical review and meta-analysis of 120 functional neuroimaging studies","volume":"19","author":"Binder","year":"2009","journal-title":"Cereb. Cortex"},{"key":"ref7","year":"2019"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"807","DOI":"10.1016\/j.neuron.2013.10.044","article-title":"The cerebellum and cognitive function: 25 years of insight from anatomy and neuroimaging","volume":"80","author":"Buckner","year":"2013","journal-title":"Neuron"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1196\/annals.1440.011","article-title":"The brain's default network: anatomy, function, and relevance to disease","volume":"1124","author":"Buckner","year":"2008","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1038\/s41583-019-0212-7","article-title":"The brain\u2019s default network: updated anatomy, physiology and evolving insights","volume":"20","author":"Buckner","year":"2019","journal-title":"Nat. Rev. Neurosci."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"2981","DOI":"10.1093\/cercor\/bht154","article-title":"Cognitive reappraisal of emotion: a meta-analysis of human neuroimaging studies","volume":"24","author":"Buhle","year":"2014","journal-title":"Cereb. Cortex"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"564","DOI":"10.1093\/brain\/awl004","article-title":"The precuneus: a review of its functional anatomy and behavioural correlates","volume":"129","author":"Cavanna","year":"2006","journal-title":"Brain"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1016\/j.cogbrainres.2005.08.013","article-title":"Neuroimaging studies of practice-related change: fMRI and meta-analytic evidence of a domain-general control network for learning","volume":"25","author":"Chein","year":"2005","journal-title":"Cogn. Brain Res."},{"key":"ref14","volume-title":"Statistical Power Analysis for the Behavioral Sciences","author":"Cohen","year":"1988"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1007\/s10459-009-9182-2","article-title":"Clinical cognition and diagnostic error: applications of a dual process model of reasoning","volume":"14","author":"Croskerry","year":"2009","journal-title":"Adv. Health Sci. Educ."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1377","DOI":"10.1177\/0956797615578863","article-title":"Getting over it: long-lasting effects of emotion regulation on amygdala response","volume":"26","author":"Denny","year":"2015","journal-title":"Psychol. Sci."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"5677","DOI":"10.1038\/s41598-017-05888-8","article-title":"Distinct top-down and bottom-up brain connectivity during visual perception and imagery","volume":"7","author":"Dijkstra","year":"2017","journal-title":"Sci. Rep."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1526684","DOI":"10.3389\/fnbeh.2025.1526684","article-title":"The Visuomotor synchronization immersive virtual reality of a depression avatar in a stigma context experience mobilizes the Fronto-parietal cortex and anterior insula","volume":"19","author":"dos Santos Kawata","year":"2025","journal-title":"Front. Behav. Neurosci."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1325","DOI":"10.1016\/j.neuroimage.2004.12.034","article-title":"A new SPM toolbox for combining probabilistic cytoarchitectonic maps and functional imaging data","volume":"25","author":"Eickhoff","year":"2005","journal-title":"NeuroImage"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1146\/annurev.psych.47.1.273","article-title":"Expert and exceptional performance: evidence of maximal adaptation to task constraints","volume":"47","author":"Ericsson","year":"1996","journal-title":"Annu. Rev. Psychol."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1018","DOI":"10.3389\/fpsyg.2018.01018","article-title":"Motivational influences on performance monitoring and cognitive control across the adult lifespan","volume":"9","author":"Ferdinand","year":"2018","journal-title":"Front. Psychol."},{"key":"ref22","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1037\/1089-2680.2.3.271","article-title":"The emerging field of emotion regulation: an integrative review","volume":"2","author":"Gross","year":"1998","journal-title":"Rev. Gen. Psychol."},{"key":"ref23","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1037\/0022-3514.85.2.348","article-title":"Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being","volume":"85","author":"Gross","year":"2003","journal-title":"J. Pers. Soc. Psychol."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1177\/0141076815620614","article-title":"The role of emotion in patient safety: are we brave enough to scratch beneath the surface?","volume":"109","author":"Heyhoe","year":"2016","journal-title":"J. R. Soc. Med."},{"key":"ref25","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1038\/nrn2332","article-title":"Control of mental activities by internal models in the cerebellum","volume":"9","author":"Ito","year":"2008","journal-title":"Nat. Rev. Neurosci."},{"key":"ref26","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1093\/occmed\/kqz004","article-title":"Emotion regulation and burnout in doctors: a systematic review","volume":"69","author":"Jackson-Koku","year":"2019","journal-title":"Occup. Med."},{"key":"ref27","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1037\/a0016755","article-title":"Conditions for intuitive expertise: a failure to disagree","volume":"64","author":"Kahneman","year":"2009","journal-title":"Am. Psychol."},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1089","DOI":"10.1093\/cercor\/bhi005","article-title":"Human functional neuroimaging of brain changes associated with practice","volume":"15","author":"Kelly","year":"2005","journal-title":"Cereb. Cortex"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1016\/j.neuroimage.2013.11.001","article-title":"Neural network of cognitive emotion regulation\u2014an ALE meta-analysis and MACM analysis","volume":"87","author":"Kohn","year":"2014","journal-title":"NeuroImage"},{"key":"ref30","volume-title":"Stress, Appraisal, and Coping","author":"Lazarus","year":"1984"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"5193","DOI":"10.1038\/s41598-024-55797-w","article-title":"Exploring the impact of immersive virtual reality on depression knowledge and stigma reduction: a cross-over RCT fMRI study","volume":"14","author":"Lem","year":"2024","journal-title":"Sci. Rep."},{"key":"ref32","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1111\/j.0956-7976.2004.00662.x","article-title":"Amygdala responses to emotionally valenced stimuli in older and younger adults","volume":"15","author":"Mather","year":"2004","journal-title":"Psychol. Sci."},{"key":"ref33","doi-asserted-by":"publisher","first-page":"503","DOI":"10.11477\/mf.1405902639","article-title":"Development of Japanese adult Reading test (JART) for predicting premorbid IQ in mild dementia","volume":"44","author":"Matsuoka","year":"2002","journal-title":"Seishin Igaku"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1016\/j.neubiorev.2016.11.014","article-title":"The effect of strategies, goals and stimulus material on the neural mechanisms of emotion regulation: a meta-analysis of fMRI studies","volume":"72","author":"Morawetz","year":"2017","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref35","doi-asserted-by":"publisher","first-page":"739","DOI":"10.1007\/s12311-022-01451-y","article-title":"Respective involvement of the right cerebellar crus I and II in syntactic and semantic processing for comprehension of language","volume":"22","author":"Nakatani","year":"2023","journal-title":"Cerebellum"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1037\/0033-295x.84.3.231","article-title":"Telling more than we can know: verbal reports on mental processes","volume":"84","author":"Nisbett","year":"1977","journal-title":"Psychol. Rev."},{"key":"ref37","doi-asserted-by":"publisher","first-page":"242","DOI":"10.1016\/j.tics.2005.03.010","article-title":"The cognitive control of emotion","volume":"9","author":"Ochsner","year":"2005","journal-title":"Trends Cogn. Sci."},{"key":"ref38","doi-asserted-by":"publisher","first-page":"624","DOI":"10.1038\/s41583-019-0202-9","article-title":"The human imagination: the cognitive neuroscience of visual mental imagery","volume":"20","author":"Pearson","year":"2019","journal-title":"Nat. Rev. Neurosci."},{"key":"ref39","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.jneumeth.2006.11.017","article-title":"PsychoPy\u2014psychophysics software in Python","volume":"162","author":"Peirce","year":"2007","journal-title":"J. Neurosci. Methods"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"10","DOI":"10.3389\/neuro.11.010.2008","article-title":"Generating stimuli for neuroscience using PsychoPy","volume":"2","author":"Peirce","year":"2009","journal-title":"Front. Neuroinform."},{"key":"ref41","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1006\/nimg.2000.0596","article-title":"Imaging brain plasticity: conceptual and methodological issues\u2014a theoretical review","volume":"12","author":"Poldrack","year":"2000","journal-title":"NeuroImage"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1016\/j.neubiorev.2018.04.023","article-title":"Regulating emotion through distancing: a taxonomy, neurocognitive model, and supporting meta-analysis","volume":"96","author":"Powers","year":"2019","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref43","doi-asserted-by":"publisher","first-page":"15","DOI":"10.7876\/jmvr.17.15","article-title":"Effects of virtual reality practices as simulation-based education on multi tasks of nursing","volume":"17","author":"Sato","year":"2020","journal-title":"Jpn. J. Med. Virtual Reality"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1177\/1073858412440596","article-title":"The angular gyrus: multiple functions and multiple subdivisions","volume":"19","author":"Seghier","year":"2013","journal-title":"Neuroscientist"},{"key":"ref45","first-page":"1600","author":"Shanafelt","year":"2015"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"348","DOI":"10.14740\/jocmr4798","article-title":"A retrospective study on the relationship between cognitive function and social function in patients with schizophrenia","volume":"14","author":"Shimada","year":"2022","journal-title":"J. Clin. Med. Res."},{"key":"ref47","doi-asserted-by":"publisher","first-page":"e105","DOI":"10.1016\/j.ecns.2010.11.005","article-title":"Debriefing: the most important component in simulation?","volume":"7","author":"Shinnick","year":"2011","journal-title":"Clin. Simul. Nurs."},{"key":"ref48","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1016\/j.tics.2017.02.005","article-title":"The cerebellum: adaptive prediction for movement and cognition","volume":"21","author":"Sokolov","year":"2017","journal-title":"Trends Cogn. Sci."},{"key":"ref49","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1007\/s10548-021-00880-y","article-title":"It is not (always) the mismatch that beats you\u2014on the relationship between interaction of early and recent life stress and emotion regulation, an fMRI study","volume":"35","author":"Soko\u0142owski","year":"2022","journal-title":"Brain Topogr."},{"key":"ref50","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1162\/jocn.2008.21029","article-title":"The common neural basis of autobiographical memory, prospection, navigation, theory of mind, and the default mode: a quantitative meta-analysis","volume":"21","author":"Spreng","year":"2009","journal-title":"J. Cogn. Neurosci."},{"key":"ref51","doi-asserted-by":"publisher","first-page":"176","DOI":"10.4103\/2347-5625.177394","article-title":"Psychological stress and coping in recently discharged postsurgical cancer patients","volume":"3","author":"Taniguchi","year":"2016","journal-title":"Asia Pac. J. Oncol. Nurs."},{"key":"ref52","year":"2019"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"932","DOI":"10.1523\/JNEUROSCI.4227-13.2014","article-title":"Precuneus is a functional core of the default-mode network","volume":"34","author":"Utevsky","year":"2014","journal-title":"J. Neurosci."},{"key":"ref54","doi-asserted-by":"publisher","first-page":"120789","DOI":"10.1016\/j.neuroimage.2024.120789","article-title":"The critical mediating roles of the middle temporal gyrus and ventrolateral prefrontal cortex in the dynamic processing of interpersonal emotion regulation","volume":"300","author":"Wang","year":"2024","journal-title":"NeuroImage"},{"key":"ref55","doi-asserted-by":"publisher","first-page":"18883","DOI":"10.1038\/srep18883","article-title":"Tractography-based parcellation of the human middle temporal gyrus","volume":"5","author":"Xu","year":"2015","journal-title":"Sci. Rep."}],"container-title":["Frontiers in Behavioral Neuroscience"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnbeh.2026.1811561\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T06:04:02Z","timestamp":1785305042000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnbeh.2026.1811561\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,29]]},"references-count":55,"alternative-id":["10.3389\/fnbeh.2026.1811561"],"URL":"https:\/\/doi.org\/10.3389\/fnbeh.2026.1811561","relation":{},"ISSN":["1662-5153"],"issn-type":[{"value":"1662-5153","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,29]]},"article-number":"1811561"}}