{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T06:05:03Z","timestamp":1790229903521,"version":"4.1.0"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"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. Neurosci."],"abstract":"<jats:p>Leadership under pressure is often framed as a cognitive challenge, although consequential decisions are made by embodied agents whose cardiovascular, respiratory, autonomic, endocrine, and interoceptive states change with stress. We propose an asymmetric interpersonal brain-body model for high-stakes teams. Contextual demands alter a leader\u2019s regulatory state; this state shapes cognitive flexibility, social perception, communication, and action; and leader signals modify the team\u2019s regulatory environment and willingness to disclose uncertainty, dissent, revise plans, or withdraw. These responses feed back to the leader. The model builds on established evidence that bodily signals contribute to subjective feeling and decision-making, stress reorganizes large-scale neural processing, and social partners can alter neural and endocrine responses to threat. Its novel claim is narrower: hierarchy makes interpersonal regulation directionally asymmetric, linking brain-body dynamics to information flow and collective decision quality. Regulatory flexibility, i.e., context-sensitive mobilization and recovery, is proposed as more informative than tonic calm or physiological synchrony. A four-region color heuristic is retained as a translation layer, not as a neurobiological taxonomy. We specify competing explanations, failure criteria, and multimodal within-person and team-level designs for testing the framework in high-stakes teams and crisis simulations.<\/jats:p>","DOI":"10.3389\/fnins.2026.1957101","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T05:44:53Z","timestamp":1790228693000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Regulatory flexibility under pressure: an asymmetric brain-body model of leadership in high-stakes teams"],"prefix":"10.3389","volume":"20","author":[{"given":"Markus M.","family":"Luedi","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology, Rescue and Pain Medicine, HOCH Health Ostschweiz, Cantonal Hospital of St. Gallen","place":["St. Gallen, Switzerland"]},{"name":"Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern","place":["Bern, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Kohlrieser","sequence":"additional","affiliation":[{"name":"IMD Business School","place":["Lausanne, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"112142","DOI":"10.1016\/j.jclinane.2026.112142","article-title":"Beyond technical mastery: the inner work of leadership in medicine","volume":"110","author":"Baima","year":"2026","journal-title":"J. Clin. Anesth."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1016\/j.bpa.2022.05.003","article-title":"Building a well-balanced culture in the perioperative setting","volume":"36","author":"Bello","year":"2022","journal-title":"Best Pract. Res. Clin. Anaesthesiol."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1177\/1745691613504116","article-title":"Regulatory flexibility: an individual differences perspective on coping and emotion regulation","volume":"8","author":"Bonanno","year":"2013","journal-title":"Perspect. Psychol. Sci."},{"key":"ref4","first-page":"851","article-title":"Stress assessment by combining neurophysiological signals and Radio Communications of air Traffic Controllers","volume":"2020","author":"Borghini","year":"2020","journal-title":"Annu Int Conf IEEE Eng Med Biol Soc"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1032","DOI":"10.1111\/j.1467-9280.2006.01832.x","article-title":"Lending a hand: social regulation of the neural response to threat","volume":"17","author":"Coan","year":"2006","journal-title":"Psychol. Sci."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"655","DOI":"10.1038\/nrn894","article-title":"How do you feel? Interoception: the sense of the physiological condition of the body","volume":"3","author":"Craig","year":"2002","journal-title":"Nat. Rev. Neurosci."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.copsyc.2017.04.020","article-title":"Interoception and emotion","volume":"17","author":"Critchley","year":"2017","journal-title":"Curr. Opin. Psychol."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1038\/nn1176","article-title":"Neural systems supporting interoceptive awareness","volume":"7","author":"Critchley","year":"2004","journal-title":"Nat. Neurosci."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1375","DOI":"10.1016\/j.cub.2017.04.002","article-title":"Brain-to-brain synchrony tracks real-world dynamic group interactions in the classroom","volume":"27","author":"Dikker","year":"2017","journal-title":"Curr. Biol."},{"key":"ref10","doi-asserted-by":"crossref","first-page":"1835","DOI":"10.1177\/0956797610389191","article-title":"Listening to your heart. How interoception shapes emotion experience and intuitive decision making","volume":"21","author":"Dunn","year":"2010","journal-title":"Psychol. Sci."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"350","DOI":"10.2307\/2666999","article-title":"Psychological safety and learning behavior in work teams","volume":"44","author":"Edmondson","year":"1999","journal-title":"Adm. Sci. Q."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1016\/j.psyneuen.2014.04.005","article-title":"Cortisol increase in empathic stress is modulated by emotional closeness and observation modality","volume":"45","author":"Engert","year":"2014","journal-title":"Psychoneuroendocrinology"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1151","DOI":"10.1126\/science.1209603","article-title":"Stress-related noradrenergic activity prompts large-scale neural network reconfiguration","volume":"334","author":"Hermans","year":"2011","journal-title":"Science"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"4274","DOI":"10.1073\/pnas.1422930112","article-title":"Leader emergence through interpersonal neural synchronization","volume":"112","author":"Jiang","year":"2015","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref15","doi-asserted-by":"crossref","DOI":"10.4324\/9781315725895","volume-title":"Two Essays on Analytical Psychology","author":"Jung","year":"2014"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1016\/j.bpsc.2017.12.004","article-title":"Interoception and mental health: a roadmap","volume":"3","author":"Khalsa","year":"2018","journal-title":"Biol Psychiatry Cogn Neurosci Neuroimaging."},{"key":"ref17","volume-title":"Care to Dare: Unleashing Astonishing Potential through Secure Base Leadership","author":"Kohlrieser","year":"2012"},{"key":"ref18","volume-title":"Hostage at the Table: How Leaders Can Overcome Conflict, Influence Others and Raise Performance","author":"Kohlrieser","year":"2024"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"213","DOI":"10.3389\/fpsyg.2017.00213","article-title":"Heart rate variability and cardiac vagal tone in psychophysiological research-recommendations for experiment planning, data analysis, and data reporting","volume":"8","author":"Laborde","year":"2017","journal-title":"Front. Psychol."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1771470","DOI":"10.3389\/fnins.2026.1771470","article-title":"Integrating neural, physiological, and interoceptive measures in social interaction","volume":"20","author":"Lettieri","year":"2026","journal-title":"Front. Neurosci."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"912","DOI":"10.1073\/pnas.0807041106","article-title":"Psychosocial stress reversibly disrupts prefrontal processing and attentional control","volume":"106","author":"Liston","year":"2009","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"896","DOI":"10.1213\/ANE.0000000000005908","article-title":"The king's three questions: a short story I want my teams to understand","volume":"135","author":"Luedi","year":"2022","journal-title":"Anesth. Analg."},{"key":"ref23","doi-asserted-by":"publisher","first-page":"111985","DOI":"10.1016\/j.jclinane.2025.111985","article-title":"Leadership at the epicenter: professionalism and purpose in an era of seismic change","volume":"107","author":"Luedi","year":"","journal-title":"J. Clin. Anesth."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"e01935","DOI":"10.1213\/XAA.0000000000001935","article-title":"A call for mindfulness in anesthesiology and acute care medicine","volume":"19","author":"Luedi","year":"","journal-title":"A A Pract."},{"key":"ref25","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1213\/ANE.0000000000007617","article-title":"My inner picture: self-regulation and spiritual growth as a leader","volume":"143","author":"Luedi","year":"2026","journal-title":"Anesth. Analg."},{"key":"ref26","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1016\/j.bpa.2020.12.004","article-title":"Leading in the time of crisis: considerations for providing safe perioperative and intensive care","volume":"35","author":"Luedi","year":"2021","journal-title":"Best Pract. Res. Clin. Anaesthesiol."},{"key":"ref27","doi-asserted-by":"publisher","first-page":"112096","DOI":"10.1016\/j.jclinane.2025.112096","article-title":"Hope or erosion? Humor, cynicism, and the leadership challenge in perioperative medicine","volume":"109","author":"Martens","year":"2026","journal-title":"J. Clin. Anesth."},{"key":"ref28","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1056\/NEJM199801153380307","article-title":"Protective and damaging effects of stress mediators","volume":"338","author":"McEwen","year":"1998","journal-title":"N. Engl. J. Med."},{"key":"ref29","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1213\/ANE.0000000000004542","article-title":"Burnout in anesthesiology providers: shedding light on a global problem","volume":"130","author":"Milenovic","year":"2020","journal-title":"Anesth. Analg."},{"key":"ref30","doi-asserted-by":"publisher","first-page":"941","DOI":"10.1002\/job.413","article-title":"Making it safe: the effects of leader inclusiveness and professional status on psychological safety and improvement efforts in health care teams","volume":"27","author":"Nembhard","year":"2006","journal-title":"J. Organ. Behav."},{"key":"ref31","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1177\/1088868316628405","article-title":"Interpersonal autonomic physiology: a systematic review of the literature","volume":"21","author":"Palumbo","year":"2017","journal-title":"Personal. Soc. Psychol. Rev."},{"key":"ref32","doi-asserted-by":"publisher","first-page":"93","DOI":"10.3389\/fpsyg.2015.00093","article-title":"Somatic experiencing: using interoception and proprioception as core elements of trauma therapy","volume":"6","author":"Payne","year":"2015","journal-title":"Front. Psychol."},{"key":"ref33","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1016\/S0167-8760(01)00162-3","article-title":"The polyvagal theory: phylogenetic substrates of a social nervous system","volume":"42","author":"Porges","year":"2001","journal-title":"Int. J. Psychophysiol."},{"key":"ref34","volume-title":"Our Polyvagal World: How Safety and Trauma Change Us","author":"Porges","year":"2023"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"112429","DOI":"10.1016\/j.isci.2025.112429","article-title":"Physiologically informed predictability of a teammate's future actions forecasts team performance","volume":"28","author":"Qin","year":"2025","journal-title":"iScience."},{"key":"ref36","doi-asserted-by":"publisher","first-page":"1608824","DOI":"10.3389\/fnetp.2025.1608824","article-title":"Mutual information-based teamwork evaluation in real-world environments: an exploratory investigation with professional surgeons","volume":"5","author":"Ronca","year":"2025","journal-title":"Front. Netw. Physiol."},{"key":"ref37","doi-asserted-by":"publisher","first-page":"1702748","DOI":"10.3389\/fnrgo.2026.1702748","article-title":"Multi-method characterization of neurophysiological and biological stress responses in surgical teams during real surgical procedures","volume":"7","author":"Ronca","year":"2026","journal-title":"Front Neuroergon."},{"key":"ref38","doi-asserted-by":"publisher","first-page":"805","DOI":"10.1002\/jclp.22016","article-title":"Moving from acceptance toward transformation with internal family systems therapy (IFS)","volume":"69","author":"Schwartz","year":"2013","journal-title":"J. Clin. Psychol."},{"key":"ref39","volume-title":"Internal Family Systems Therapy","author":"Schwartz","year":"2019"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"14425","DOI":"10.1073\/pnas.1008662107","article-title":"Speaker-listener neural coupling underlies successful communication","volume":"107","author":"Stephens","year":"2010","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"353","DOI":"10.3389\/fnhum.2018.00353","article-title":"How breath-control can change your life: a systematic review on psycho-physiological correlates of slow breathing","volume":"12","author":"Zaccaro","year":"2018","journal-title":"Front. Hum. Neurosci."},{"key":"ref42","doi-asserted-by":"publisher","first-page":"12448","DOI":"10.1523\/JNEUROSCI.2586-16.2016","article-title":"Nasal respiration entrains human limbic oscillations and modulates cognitive function","volume":"36","author":"Zelano","year":"2016","journal-title":"J. Neurosci."}],"container-title":["Frontiers in Neuroscience"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnins.2026.1957101\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T05:44:55Z","timestamp":1790228695000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnins.2026.1957101\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,24]]},"references-count":42,"alternative-id":["10.3389\/fnins.2026.1957101"],"URL":"https:\/\/doi.org\/10.3389\/fnins.2026.1957101","relation":{},"ISSN":["1662-453X"],"issn-type":[{"value":"1662-453X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,24]]},"article-number":"1957101"}}