Clinical expertise shifts psychological distancing from effortful regulation to reduced engagement on internally oriented processing during multitasking.

Background: 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. Methods: 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-behavior associations were examined separately for experienced nurses and nursing students. Results: 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. Conclusion: 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.