The neuroscience of empathy: progress, pitfalls and promise

Affective empathy differs in male violent offenders with high- and low-trait psychopathy

This study investigated affective and cognitive empathic processes in incarcerated violent offenders with lower and higher psychopathic traits and healthy controls. Participants witnessed painful expressions of others displayed on video clips. Skin conductance responses (SCR) were recorded to assess autonomic emotional arousal, and various empathy ratings were used as measures of self-reported vicarious responses. Reduced SCRs occurred during the observation of pain in others in lower and higher psychopathic-trait participants alike, compared to controls. Despite these diminished autonomic responses indicating reduced vicarious responses, only inmates with higher psychopathic traits provided empathy ratings comparable to those of the controls. These findings indicate that violent offenders display reduced autonomic arousal in response to distress cues of others, irrespective of psychopathy. However, only higher psychopathic-trait offenders were able to provide self-report in a way that let them appear to be as empathic as controls-enabling them to know, yet not to feel, what others feel.

Competition between frontoparietal control and default networks supports social working memory and empathy

An extensive body of literature has indicated that there is increased activity in the frontoparietal control network (FPC) and decreased activity in the default mode network (DMN) during working memory (WM) tasks. The FPC and DMN operate in a competitive relationship during tasks requiring externally directed attention. However, the association between this FPC-DMN competition and performance in social WM tasks has rarely been reported in previous studies. To investigate this question, we measured FPC-DMN connectivity during resting state and two emotional face recognition WM tasks using the 2-back paradigm. Thirty-four individuals were instructed to perform the tasks based on either the expression [emotion (EMO)] or the identity (ID) of the same set of face stimuli. Consistent with previous studies, an increased anti-correlation between the FPC and DMN was observed during both tasks relative to the resting state. Specifically, this anti-correlation during the EMO task was stronger than during the ID task, as the former has a higher social load. Intriguingly, individual differences in self-reported empathy were significantly correlated with the FPC-DMN anti-correlation in the EMO task. These results indicate that the top-down signals from the FPC suppress the DMN to support social WM and empathy.

Oxytocin receptor and vasopressin receptor 1a genes are respectively associated with emotional and cognitive empathy

Empathy is the ability to recognize and share in the emotions of others. It can be considered a multifaceted concept with cognitive and emotional aspects. Little is known regarding the underlying neurochemistry of empathy and in the current study we used a neurogenetic approach to explore possible brain neurotransmitter pathways contributing to cognitive and emotional empathy. Both the oxytocin receptor (OXTR) and the arginine vasopressin receptor 1a (AVPR1a) genes contribute to social cognition in both animals and humans and hence are prominent candidates for contributing to empathy. The following research examined the associations between polymorphisms in these two genes and individual differences in emotional and cognitive empathy in a sample of 367 young adults. Intriguingly, we found that emotional empathy was associated solely with OXTR, whereas cognitive empathy was associated solely with AVPR1a. Moreover, no interaction was observed between the two genes and measures of empathy. The current findings contribute to our understanding of the distinct neurogenetic pathways involved in cognitive and emotional empathy and underscore the pervasive role of both oxytocin and vasopressin in modulating human emotions.

Common and distinct neural correlates of personal and vicarious reward: A quantitative meta-analysis

Individuals experience reward not only when directly receiving positive outcomes (e.g., food or money), but also when observing others receive such outcomes. This latter phenomenon, known as vicarious reward, is a perennial topic of interest among psychologists and economists. More recently, neuroscientists have begun exploring the neuroanatomy underlying vicarious reward. Here we present a quantitative whole-brain meta-analysis of this emerging literature. We identified 25 functional neuroimaging studies that included contrasts between vicarious reward and a neutral control, and subjected these contrasts to an activation likelihood estimate (ALE) meta-analysis. This analysis revealed a consistent pattern of activation across studies, spanning structures typically associated with the computation of value (especially ventromedial prefrontal cortex) and mentalizing (including dorsomedial prefrontal cortex and superior temporal sulcus). We further quantitatively compared this activation pattern to activation foci from a previous meta-analysis of personal reward. Conjunction analyses yielded overlapping VMPFC activity in response to personal and vicarious reward. Contrast analyses identified preferential engagement of the nucleus accumbens in response to personal as compared to vicarious reward, and in mentalizing-related structures in response to vicarious as compared to personal reward. These data shed light on the common and unique components of the reward that individuals experience directly and through their social connections.

Affective and cognitive empathy and social quality of life in schizophrenia: a comparison between a parallel process model and an integrative meditation model

Two alternative models of impaired cognitive and affective processing that may underlie reduced social quality of life (SQoL) of persons with schizophrenia, were examined. According to the parallel process model, impaired cognitive empathy and affective empathy make relatively independent contributions to the symptoms of schizophrenia and to the consequent reduction in SQoL. According to the integrative mediation model, the symptoms of schizophrenia and the reduction in SQoL associated with these symptoms are the products of a process by which impairments of cognitive empathy are contingent on impairments of affective empathy. 90 persons with schizophrenia were assessed for SQoL, symptoms and cognitive and affective empathy. Results support the integrative mediation model only for cognitive empathy and negative psychiatric symptoms. Only the negative links between cognitive empathy and negative symptoms served to mediate the positive relation between affective empathy and SQoL. Positive symptoms had a limited negative impact on SQoL and did not play a role in the paths that linked affective empathy to SQoL. Age had a statistically significant and negative indirect relationship to SQoL. Results are consistent with recent approach that distinguish between cognitive and affective empathy and specify how these two processes are integrated.

Double dissociation of neural responses supporting perceptual and cognitive components of social cognition: evidence from processing of others' pain

Models on how perceptual and cognitive information on others' mental states are treated by the cognitive architecture are often framed as duplex models considering two independent systems. In the context of the neuroscience of empathy analogous systems have been described. Using event-related potentials (i.e., ERPs) technique, we tested the hypothesis of temporal dissociation of two functional systems. We implemented a design in which perceptual (i.e., painful or neutral facial expressions) and contextual (i.e., painful or neutral related sentences) cues on others' mental states were orthogonally manipulated. Painful expressions selectively modulated the early activity at 110–360 ms over fronto-central and centro-parietal regions, whereas painful contexts selectively modulated the late activity at 400–840 ms over these same regions. Notably, the reactions to pain triggered by these cues added up when both were available, that is the joint reaction was characterized by additive effects. These findings favor a model assuming distinct neural paths of perceptual and cognitive processing, at least when the cognitive component is triggered by language.

Variation in the oxytocin receptor gene is associated with behavioral and neural correlates of empathic accuracy

The neuromodulators oxytocin and serotonin have been implicated in regulating affective processes underlying empathy. Understanding this dependency, however, has been limited by a lack of objective metrics for measuring empathic performance. Here we employ a novel psychophysical method for measuring empathic performance that quantitatively measures the ability of subjects to decode the experience of another person's pain. In 50 female subjects, we acquired functional magnetic resonance imaging data as they were exposed to a target subject experiencing variable degrees of pain, whilst performing an irrelevant attention-demanding task. We investigated the effect of variation in the oxytocin receptor gene (OXTR) and the serotonin transporter gene (SLC6A4) on the psychophysical and neurometric variability associated with empathic performance. The OXTR rs2268498 and rs53576 polymorphisms, but not the SLC6A4 5-HTTLPR, were associated with significant differences in empathic accuracy, with CC- and AA-carriers, respectively, displaying higher empathic accuracy. For OXTR rs2268498 there was also a genotype difference in the correlation between empathic accuracy and activity in the superior temporal sulcus (STS). In OXTR rs2268498 CC-carriers, high empathic accuracy was associated with stronger responsiveness of the right STS to the observed pain. Together, the results show that genetic variation in the OXTR has significant influence on empathic accuracy and that this may be linked to variable responsivity of the STS.

Someone has to give in: theta oscillations correlate with adaptive behavior in social bargaining

During social bargain, one has to both figure out the others' intentions and behave strategically in such a way that the others' behaviors will be consistent with one's expectations. To understand the neurobiological mechanisms underlying these behaviors, we used electroencephalography while subjects played as proposers in a repeated ultimatum game. We found that subjects adapted their offers to obtain more acceptances in the last round and that this adaptation correlated negatively with prefrontal theta oscillations. People with higher prefrontal theta activity related to a rejection did not adapt their offers along the game to maximize their earning. Moreover, between-subject variation in posterior theta oscillations correlated positively with how individual theta activity influenced the change of offer after a rejection, reflecting a process of behavioral adaptation to the others' demands. Interestingly, people adapted better their offers when they knew that they where playing against a computer, although the behavioral adaptation did not correlate with prefrontal theta oscillation. Behavioral changes between human and computer games correlated with prefrontal theta activity, suggesting that low adaptation in human games could be a strategy. Taken together, these results provide evidence for specific roles of prefrontal and posterior theta oscillations in social bargaining.

Theory of mind, empathy and neuropsychological functioning in X-linked spinal and bulbar muscular atrophy: a controlled study of 20 patients

Recent studies have described brain involvement, mainly at frontal level, in patients with spinal and bulbar muscular atrophy (SBMA), a rare adult-onset motor neuron disease caused by a CAG repeat in the androgen receptor (AR) gene. The aim of our research was to investigate the poorly characterized neuropsychological and psychological profile of these patients, on the basis of previous literature. We administered a neuropsychological screening and tests relating to cognitive and affective empathy, attributed to the theory of mind (ToM) framework, to 20 males with SBMA, and to age- and education-matched controls. Although patients' neuropsychological performance was unimpaired, a clear dissociation emerged between their cognitive and affective empathy. Patients had distinctive deficits in mentalizing, as assessed with the Faux Pas Test, whilst affective empathy (i.e., sharing experience), assessed with the Reading the Mind in the Eyes test, appeared to be preserved. The likely implications of subtle frontal lobe impairments on the one hand, and a protective influence of androgen insensitivity in these patients on the other, are discussed in the light of our results.

Empathic concern drives costly altruism

Why do we self-sacrifice to help others in distress? Two competing theories have emerged, one suggesting that prosocial behavior is primarily motivated by feelings of empathic other-oriented concern, the other that we help mainly because we are egoistically focused on reducing our own discomfort. Here we explore the relationship between costly altruism and these two sub-processes of empathy, specifically drawing on the caregiving model to test the theory that trait empathic concern (e.g. general tendency to have sympathy for another) and trait personal distress (e.g. predisposition to experiencing aversive arousal states) may differentially drive altruistic behavior. We find that trait empathic concern – and not trait personal distress – motivates costly altruism, and this relationship is supported by activity in the ventral tegmental area, caudate and subgenual anterior cingulate, key regions for promoting social attachment and caregiving. Together, this data helps identify the behavioral and neural mechanisms motivating costly altruism, while demonstrating that individual differences in empathic concern-related brain responses can predict real prosocial choice.

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Trait empathic concern predicts altruistic action.

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State distress, but not trait distress, predicts altruistic action.

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A network comprised of VTA, caudate and sgACC support other-oriented prosocial decisions.

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Neural evidence supporting caregiving model: social reward and attachment guides altruism.

Not as good as you think? Trait positive emotion is associated with increased self-reported empathy but decreased empathic performance

How is positive emotion associated with our ability to empathize with others? Extant research provides support for two competing predictions about this question. An empathy amplification hypothesis suggests positive emotion would be associated with greater empathy, as it often enhances other prosocial processes. A contrasting empathy attenuation hypothesis suggests positive emotion would be associated with lower empathy, because positive emotion promotes self-focused or antisocial behaviors. The present investigation tested these competing perspectives by examining associations between dispositional positive emotion and both subjective (i.e., self-report) and objective (i.e., task performance) measures of empathy. Findings revealed that although trait positive emotion was associated with increased subjective beliefs about empathic tendencies, it was associated with both increases and decreases in task-based empathic performance depending on the target’s emotional state. More specifically, trait positive emotion was linked to lower overall empathic accuracy toward a high-intensity negative target, but also a higher sensitivity to emotion upshifts (i.e., shifts in emotion from negative to positive) toward positive targets. This suggests that trait positive affect may be associated with decreased objective empathy in the context of mood incongruent (i.e., negative) emotional stimuli, but may increase some aspects of empathic performance in the context of mood congruent (i.e., positive) stimuli. Taken together, these findings suggest that trait positive emotion engenders a compelling subjective-objective gap regarding its association with empathy, in being related to a heightened perception of empathic tendencies, despite being linked to mixed abilities in regards to empathic performance. (Word count: 242).

Primary empathy deficits in frontotemporal dementia

Loss of empathy is an early central symptom and diagnostic criterion of the behavioral variant frontotemporal dementia (bvFTD). Although changes in empathy are evident and strongly affect the social functioning of bvFTD patients, few studies have directly investigated this issue by means of experimental paradigms. The current study assessed multiple components of empathy (affective, cognitive and moral) in bvFTD patients. We also explored whether the loss of empathy constitutes a primary deficit of bvFTD or whether it is explained by impairments in executive functions (EF) or other social cognition domains. Thirty-seven bvFTD patients with early/mild stages of the disease and 30 healthy control participants were assessed with a task that involves the perception of intentional and accidental harm. Participants were also evaluated on emotion recognition, theory of mind (ToM), social norms knowledge and several EF domains. BvFTD patients presented deficits in affective, cognitive and moral aspects of empathy. However, empathic concern was the only aspect primarily affected in bvFTD that was neither related nor explained by deficits in EF or other social cognition domains. Deficits in the cognitive and moral aspects of empathy seem to depend on EF, emotion recognition and ToM. Our findings highlight the importance of using tasks depicting real-life social scenarios because of their greater sensitivity in the assessment of bvFTD. Moreover, our results contribute to the understanding of primary and intrinsic empathy deficits of bvFTD and have important theoretical and clinical implications.

Affective and cognitive empathy in adolescents with autism spectrum disorder

The broad construct of empathy incorporates both cognitive and affective dimensions. Recent evidence suggests that the subjects with autistic spectrum disorder (ASD) show a significant impairment in empathic ability. The aim of this study was to evaluate the cognitive and affective components of empathy in adolescents with ASD compared to controls. Fifteen adolescents with ASD and 15 controls underwent paper and pencil measures and a computerized Multifaceted Empathy Test. All measures were divided into mentalizing and experience sharing abilities. Adolescents with ASD compared to controls showed deficits in all mentalizing measures: they were incapable of interpreting and understanding the mental and emotional states of other people. Instead, in the sharing experience measures, the adolescents with ASD were able to empathize with the emotional experience of other people when they express emotions with positive valence, but were not able to do so when the emotional valence is negative. These results were confirmed by the computerized task. In conclusion, our results suggest that adolescents with ASD show a difficulty in cognitive empathy, whereas the deficit in affective empathy is specific for the negative emotional valence.

Focusing on the negative: cultural differences in expressions of sympathy

Feeling concern about the suffering of others is considered a basic human response, and yet we know surprisingly little about the cultural factors that shape how people respond to the suffering of another person. To this end, we conducted 4 studies that tested the hypothesis that American expressions of sympathy focus on the negative less and positive more than German expressions of sympathy, in part because Americans want to avoid negative states more than Germans do. In Study 1, we demonstrate that American sympathy cards contain less negative and more positive content than German sympathy cards. In Study 2, we show that European Americans want to avoid negative states more than Germans do. In Study 3, we demonstrate that these cultural differences in "avoided negative affect" mediate cultural differences in how comfortable Americans and Germans feel focusing on the negative (vs. positive) when expressing sympathy for the hypothetical death of an acquaintance's father. To examine whether greater avoided negative affect results in lesser focus on the negative and greater focus on the positive when responding to another person's suffering, in Study 4, American and German participants were randomly assigned to 1 of 2 conditions: (a) to "push negative images away" (i.e., increasing desire to avoid negative affect) from or (b) to "pull negative images closer" (i.e., decreasing desire to avoid negative affect) to themselves. Participants were then asked to pick a card to send to an acquaintance whose father had hypothetically just died. Across cultures, participants in the "push negative away" condition were less likely to choose sympathy cards with negative (vs. positive) content than were those in the "pull negative closer" condition. Together, these studies suggest that cultures differ in their desire to avoid negative affect and that these differences influence the degree to which expressions of sympathy focus on the negative (vs. positive). We discuss the implications of these findings for current models of sympathy, compassion, and helping.

Empathy: gender effects in brain and behavior

Evidence suggests that there are differences in the capacity for empathy between males and females. However, how deep do these differences go? Stereotypically, females are portrayed as more nurturing and empathetic, while males are portrayed as less emotional and more cognitive. Some authors suggest that observed gender differences might be largely due to cultural expectations about gender roles. However, empathy has both evolutionary and developmental precursors, and can be studied using implicit measures, aspects that can help elucidate the respective roles of culture and biology. This article reviews evidence from ethology, social psychology, economics, and neuroscience to show that there are fundamental differences in implicit measures of empathy, with parallels in development and evolution. Studies in nonhuman animals and younger human populations (infants/children) offer converging evidence that sex differences in empathy have phylogenetic and ontogenetic roots in biology and are not merely cultural byproducts driven by socialization. We review how these differences may have arisen in response to males' and females' different roles throughout evolution. Examinations of the neurobiological underpinnings of empathy reveal important quantitative gender differences in the basic networks involved in affective and cognitive forms of empathy, as well as a qualitative divergence between the sexes in how emotional information is integrated to support decision making processes. Finally, the study of gender differences in empathy can be improved by designing studies with greater statistical power and considering variables implicit in gender (e.g., sexual preference, prenatal hormone exposure). These improvements may also help uncover the nature of neurodevelopmental and psychiatric disorders in which one sex is more vulnerable to compromised social competence associated with impaired empathy.

Cognitive empathy contributes to poor social functioning in schizophrenia: Evidence from a new self-report measure of cognitive and affective empathy

Cognitive empathy impairments have been linked to poor social functioning in schizophrenia. However, prior studies primarily used self-reported empathy measures developed decades ago that are not well-aligned with contemporary models of empathy. We evaluated empathy and its relationship to social functioning in schizophrenia using the recently developed Questionnaire of Cognitive and Affective Empathy (QCAE). Schizophrenia (n=52) and healthy comparison (n=37) subjects completed the QCAE, Interpersonal Reactivity Index (IRI), and measures of neurocognition, symptoms, and social functioning. Between-group differences on the QCAE, and relationships between QCAE and IRI subscales, neurocognition, symptoms, and social functioning were examined. The schizophrenia group reported significantly lower cognitive empathy than comparison subjects, which was driven by low online simulation scores. Cognitive empathy explained significant variance in social functioning after accounting for neurocognition and symptoms. Group differences for affective empathy were variable; the schizophrenia group reported similar proximal responsivity, but elevated emotion contagion relative to comparison subjects. These findings bolster support for the presence and functional significance of impaired cognitive empathy in schizophrenia using a contemporary measure of empathy. Emerging evidence that some aspects of affective empathy may be unimpaired or hyper-responsive in schizophrenia and implications for the assessment and treatment of empathy in schizophrenia are discussed.

On the neglected role of stereotypes in empathy toward other-race pain

Recent studies on empathy toward other-race individuals demonstrate a preferential neural response to own-race members' pain. Based on the observation that existing studies, using different techniques, did not provide a convergent scenario on how implicit racial prejudice relate to empathy in cross-racial contexts, in the current commentary we claim that future efforts in this domain should distinguish between processes of racial prejudice and racial stereotypes. These concepts have been differentiated in social psychology, and two independent measures have been provided to assess them. We propose that these aspects should be taken into further consideration in future studies to fully understand the social neuroscience of empathy in cross-racial contexts.

The amygdala as a hub in brain networks that support social life

A growing body of evidence suggests that the amygdala is central to handling the demands of complex social life in primates. In this paper, we synthesize extant anatomical and functional data from rodents, monkeys, and humans to describe the topography of three partially distinct large-scale brain networks anchored in the amygdala that each support unique functions for effectively managing social interactions and maintaining social relationships. These findings provide a powerful componential framework for parsing social behavior into partially distinct neural underpinnings that differ among healthy people and disintegrate or fail to develop in neuropsychiatric populations marked by social impairment, such as autism, antisocial personality disorder, and frontotemporal dementia.

Dementia care: using empathic curiosity to establish the common ground that is necessary for meaningful communication

Over the past two decades the advocates of person-centred approaches to dementia care have consistently argued that some of the negative impacts of dementia can be ameliorated in supportive social environments and they have given lie to the common but unfounded, nihilistic belief that meaningful engagement with people with dementia is impossible. This discussion paper contributes to this welcome trend by exploring how carers can use empathic curiosity to establish the common ground that is necessary to sustain meaningful engagement with people who have mild to moderate dementia. The first section of the paper gives a brief theoretical introduction to the concept of empathic curiosity, which is informed by perceptual control theory and applied linguistics. Three case examples taken from the literature on dementia care are then used to illustrate what empathic curiosity may look like in practice and to explore the potential impact that adopting an empathic and curious approach may have.

Enhanced emotional empathy after mineralocorticoid receptor stimulation in women with borderline personality disorder and healthy women

The mineralocorticoid receptor (MR) is highly expressed in the hippocampus and prefrontal cortex. MR have an important role in appraisal processes and in modulating stress-associated emotional reactions but it is not known whether the MR affects empathy. Borderline personality disorder (BPD) is characterized by disturbed emotion regulation and alterations in empathy. In the current study, we examined whether stimulation of the MR enhances empathy in patients with BPD and healthy individuals. In a placebo-controlled study, we randomized 38 women with BPD and without psychotropic medication, and 35 healthy women to either placebo or 0.4 mg fludrocortisone, an MR agonist. Subsequently, all participants underwent two tests of social cognition, the Multifaceted Empathy Test (MET) and the Movie for the Assessment of Social Cognition (MASC), measuring cognitive and emotional facets of empathy. Eighteen BPD patients and 18 healthy women received placebo, whereas 20 BPD patients and 17 healthy women received fludrocortisone. In the MET, fludrocortisone enhanced emotional empathy across groups, whereas cognitive empathy was not affected. In the MASC, no effect of fludrocortisone could be revealed. In both tests, BPD patients and healthy women did not differ significantly in cognitive and emotional empathy and in their response to fludrocortisone. Stimulation of MR enhanced emotional empathy in healthy women and in BPD patients. Whether fludrocortisone might have a therapeutic role in psychotherapeutic processes, remains to be elucidated.

Performance-based empathy mediates the influence of working memory on social competence in schizophrenia

Empathic deficits have been linked to poor functioning in schizophrenia, but this work is mostly limited to self-report data. This study examined whether performance-based empathy measures account for incremental variance in social competence and social attainment above and beyond self-reported empathy, neurocognition, and clinical symptoms. Given the importance of working memory in theoretical models of empathy and in the prediction of functioning in schizophrenia, we also examined whether empathy mediates the relationship between working memory and functioning. Sixty outpatients and 45 healthy controls were compared on performance-based measures of 3 key components of empathic responding, including facial affect perception, emotional empathy (affective responsiveness), and cognitive empathy (emotional perspective-taking). Participants also completed measures of self-reported empathy, neurocognition, clinical symptoms, and social competence and attainment. Patients demonstrated lower accuracy than controls across the 3 performance-based empathy measures. Among patients, these measures showed minimal relations to self-reported empathy but significantly correlated with working memory and other neurocognitive functions as well as symptom levels. Furthermore, cognitive empathy explained significant incremental variance in social competence (∆R (2) = .07, P < .05) and was found to mediate the relation between working memory and social competence. Performance-based measures of empathy were sensitive to functionally relevant disturbances in schizophrenia. Working memory deficits appear to have an important effect on these disruptions in empathy. Empathy is emerging as a promising new area for social cognitive research and for novel recovery-oriented treatment development.

Effect of empathy trait on attention to various facial expressions: evidence from N170 and late positive potential (LPP)

Background

The present study sought to clarify the relationship between empathy trait and attention responses to happy, angry, surprised, afraid, and sad facial expressions. As indices of attention, we recorded event-related potentials (ERP) and focused on N170 and late positive potential (LPP) components.

Methods

Twenty-two participants (12 males, 10 females) discriminated facial expressions (happy, angry, surprised, afraid, and sad) from emotionally neutral faces under an oddball paradigm. The empathy trait of participants was measured using the Interpersonal Reactivity Index (IRI, J Pers Soc Psychol 44:113–126, 1983).

Results

Participants with higher IRI scores showed: 1) more negative amplitude of N170 (140 to 200 ms) in the right posterior temporal area elicited by happy, angry, surprised, and afraid faces; 2) more positive amplitude of early LPP (300 to 600 ms) in the parietal area elicited in response to angry and afraid faces; and 3) more positive amplitude of late LPP (600 to 800 ms) in the frontal area elicited in response to happy, angry, surprised, afraid, and sad faces, compared to participants with lower IRI scores.

Conclusions

These results suggest that individuals with high empathy pay attention to various facial expressions more than those with low empathy, from very-early stage (reflected in N170) to late-stage (reflected in LPP) processing of faces.

Self-rated and performance-based empathy in schizophrenia: the impact of cognitive deficits

People may be much less empathic than they think they are. It is not clear whether patients with schizophrenia who have impaired empathic abilities also exhibit diminished ability to accurately appraise their own such skills. The present study aimed to examine: (a) the accuracy of self-appraisal of empathy and (b) the impact of specific cognitive functions on both self-rated and performance-based empathy in schizophrenia patients and healthy volunteers. Self-reported empathy and performance-based empathy were assessed in 52 chronic patients with schizophrenia and 45 matched healthy participants with the empathy quotient and the empathy score in the Faux Pas test, respectively. Neuropsychological functioning and symptom severity were also assessed. No significant correlations between self-reported and performance-based empathy scores were found in patients, whereas these correlations were significant and positive in the control group, with the exception of Faux Pas recognition. Cognitive deficits, specifically in processing speed and theory of mind, negatively affected performance-based but not self-rated empathy in schizophrenia. Patients with less negative and more positive symptoms and lower set shifting ability reported higher empathic abilities. Self-reported empathy and empathic abilities do not show a simple relationship. Our findings highlight a double deficit related to empathic responding in schizophrenia: diminished performance associated with cognitive deficits and inaccurate self-appraisal of empathic abilities.

Partners' empathy increases pain ratings: effects of perceived empathy and attachment style on pain report and display

Pain can be influenced by its social context. We aimed to examine under controlled experimental conditions how empathy from a partner and personal attachment style affect pain report, tolerance, and facial expressions of pain. Fifty-four participants, divided into secure, anxious, and avoidant attachment style groups, underwent a cold pressor task with their partners present. We manipulated how much empathy the participants perceived that their partners had for them. We observed a significant main effect of perceived empathy on pain report, with greater pain reported in the high perceived empathy condition. No such effects were found for pain tolerance or facial display. We also found a significant interaction of empathy with attachment style group, with the avoidant group reporting and displaying less pain than the secure and the anxious groups in the high perceived empathy condition. No such findings were observed in the low empathy condition. These results suggest that empathy from one's partner may influence pain report beyond behavioral reactions. In addition, the amount of pain report and expression that people show in high empathy conditions depends on their attachment style.

Perspective

Believing that one's partner feels high empathy for one's pain may lead individuals to rate the intensity of pain as higher. Individual differences in attachment style moderate this empathy effect.

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The role of empathy and attachment style on pain was studied experimentally.

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Empathy from one's partner may influence pain report and behavioral reactions.

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Perceived high empathy from a partner may lead to higher pain ratings.

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Individual differences in attachment style moderate this empathy effect.

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Individual differences in attachment style also moderate facial display of pain.

Interfering with the neural activity of mirror-related frontal areas impairs mentalistic inferences

According to recently proposed interactive dual-process theories, mentalizing abilities emerge from the coherent interaction between two physically distinct neural systems: (1) the mirror network, coding for the low-level embodied representations involved in pre-reflective sociocognitive processes and (2) the mentalizing network per se, which codes for higher level representations subtending the reflective attribution of psychological states. However, although the latest studies have shown that the core areas forming these two neurocognitive systems do indeed maintain effective connectivity during mentalizing, it is unclear whether an intact mirror system (and, more specifically, its anterior node, namely the posterior inferior frontal cortex) is a prerequisite for accurate mentalistic inferences. Intraoperative brain mapping via direct electrical stimulation offers a unique opportunity to address this issue. Electrical stimulation of the brain creates a "virtual" lesion, which provides functional information on well-defined parts of the cerebral cortex. In the present study, five patients were mapped in real time while they performed a mentalizing task. We found six responsive sites: four in the lateral part of the right pars opercularis and two in the dorsal part of the right pars triangularis. On the subcortical level, two additional sites were located within the white matter connectivity of the pars opercularis. Taken as a whole, our results suggest that the right inferior frontal cortex and its underlying axonal connectivity have a key role in mentalizing. Specifically, our findings support the hypothesis whereby transient, functional disruption of the mirror network influences higher order mentalistic inferences.

Empathy and helping: effects of racial group membership and cognitive load

Previous research suggests that (a) racial group membership attenuates empathy, and subsequent prosocial helping behaviour, towards out-group members, and (b) helping behaviour is modified by the potential helper’s pool of cognitive resources. It remains unclear, however, how cognitive load influences empathy and helping towards racial in- versus out-group members. We investigated this question using a sample of 30 White females. After completing either a high or a low cognitive-load task, participants viewed video clips depicting distressed White or Black females. We examined cardiovascular responses, self-reported empathic responses, and helping behaviour in response to the clips. We found no effect of racial group membership on empathic responding or on helping behaviour across cognitive-load conditions. However, results suggested that high cognitive load attenuates empathic responding, leading to decreased helping behaviour towards both racial in- and out-group members. Interestingly, a high internal motivation to respond without prejudice was associated with increased helping towards out-group members, but only under conditions of low cognitive load.

Episodic simulation and episodic memory can increase intentions to help others

Empathy plays an important role in human social interaction. A multifaceted construct, empathy includes a prosocial motivation or intention to help others in need. Although humans are often willing to help others in need, at times (e.g., during intergroup conflict), empathic responses are diminished or absent. Research examining the cognitive mechanisms underlying prosocial tendencies has focused on the facilitating roles of perspective taking and emotion sharing but has not previously elucidated the contributions of episodic simulation and memory to facilitating prosocial intentions. Here, we investigated whether humans' ability to construct episodes by vividly imagining (episodic simulation) or remembering (episodic memory) specific events also supports a willingness to help others. Three experiments provide evidence that, when participants were presented with a situation depicting another person's plight, the act of imagining an event of helping the person or remembering a related past event of helping others increased prosocial intentions to help the present person in need, compared with various control conditions. We also report evidence suggesting that the vividness of constructed episodes--rather than simply heightened emotional reactions or degree of perspective taking--supports this effect. Our results shed light on a role that episodic simulation and memory can play in fostering empathy and begin to offer insight into the underlying mechanisms.

Two distinct neural mechanisms underlying indirect reciprocity

Cooperation is a hallmark of human society. Humans often cooperate with strangers even if they will not meet each other again. This so-called indirect reciprocity enables large-scale cooperation among nonkin and can occur based on a reputation mechanism or as a succession of pay-it-forward behavior. Here, we provide the functional and anatomical neural evidence for two distinct mechanisms governing the two types of indirect reciprocity. Cooperation occurring as reputation-based reciprocity specifically recruited the precuneus, a region associated with self-centered cognition. During such cooperative behavior, the precuneus was functionally connected with the caudate, a region linking rewards to behavior. Furthermore, the precuneus of a cooperative subject had a strong resting-state functional connectivity (rsFC) with the caudate and a large gray matter volume. In contrast, pay-it-forward reciprocity recruited the anterior insula (AI), a brain region associated with affective empathy. The AI was functionally connected with the caudate during cooperation occurring as pay-it-forward reciprocity, and its gray matter volume and rsFC with the caudate predicted the tendency of such cooperation. The revealed difference is consistent with the existing results of evolutionary game theory: although reputation-based indirect reciprocity robustly evolves as a self-interested behavior in theory, pay-it-forward indirect reciprocity does not on its own. The present study provides neural mechanisms underlying indirect reciprocity and suggests that pay-it-forward reciprocity may not occur as myopic profit maximization but elicit emotional rewards.

Motivated empathy: the mechanics of the empathic gaze

Successful human social interactions frequently rely on appropriate interpersonal empathy and eye contact. Here, we report a previously unseen relationship between trait empathy and eye-gaze patterns to affective facial features in video-based stimuli. Fifty-nine healthy adult participants had their eyes tracked while watching a three-minute long "sad" and "emotionally neutral" video. The video stimuli portrayed the head and shoulders of the same actor recounting a fictional personal event. Analyses revealed that the greater participants' trait emotional empathy, the more they fixated on the eye-region of the actor, regardless of the emotional valence of the video stimuli. Our findings provide the first empirical evidence of a relationship between empathic capacity and eye-gaze pattern to the most affective facial region (eyes).

Empathy for social exclusion involves the sensory-discriminative component of pain: a within-subject fMRI study

Recent research has shown that experiencing events that represent a significant threat to social bonds activates a network of brain areas associated with the sensory-discriminative aspects of pain. In the present study, we investigated whether the same brain areas are involved when witnessing social exclusion threats experienced by others. Using a within-subject design, we show that an ecologically valid experience of social exclusion recruits areas coding the somatosensory components of physical pain (posterior insular cortex and secondary somatosensory cortex). Furthermore, we show that this pattern of activation not only holds for directly experienced social pain, but also during empathy for social pain. Finally, we report that subgenual cingulate cortex is the only brain area conjointly active during empathy for physical and social pain. This supports recent theories that affective processing and homeostatic regulation are at the core of empathic responses.

Mentalizing and the Role of the Posterior Superior Temporal Sulcus in Sharing Others' Embarrassment

The experience of embarrassment provides a highly salient cue for the human moral apparatus. Interestingly, people also experience embarrassment on behalf of others' inappropriate conditions. The perceiver's embarrassment often lacks an equivalent expression of embarrassment in the social counterpart. The present study examines this phenomenon and distinguishes neural circuits involved in embarrassment with and embarrassment for another person's mishaps. Using functional magnetic resonance imaging, we show that the embarrassment on behalf of others engages the temporal pole and the medial prefrontal cortex, central structures of the mentalizing network, together with the anterior insula and anterior cingulate cortex. In contrast, sharing others' embarrassment additionally stimulated the posterior superior temporal sulcus (STS), which exhibited increased functional integration with inferior parietal and insular cortex areas. These findings characterize common neural circuits involved in the embodied representation of embarrassment and further unravel the unique role of the posterior STS in sharing others' affective state.

Personality disorders, attachment and psychodynamic psychotherapy

While attachment has been a fruitful and critical concept in understanding enduring individual templates for interpersonal relationships, it does not have a well-understood relationship to personality disorders, where impairment of interpersonal functioning is paramount. Despite the recognition that attachment disturbances do not simply reflect nonoptimal caretaking environments, the relationship of underlying temperamental factors to these environmental insults has not been fully explored. In this paper we provide an alternate model for the role of neurobiological temperamental factors, including brain circuitry and neuropeptide modulation, in mediating social cognition and the internalization and maintenance of attachment patterns. The implications of these altered attachment patterns on personality disorders and their neurobiological and environmental roots for psychoanalytically based treatment models designed to ameliorate difficulties in interpersonal functioning through the medium of increased access to mature forms of mentalization is discussed.

Neural underpinnings of the identifiable victim effect: affect shifts preferences for giving

The "identifiable victim effect" refers to peoples' tendency to preferentially give to identified versus anonymous victims of misfortune, and has been proposed to partly depend on affect. By soliciting charitable donations from human subjects during behavioral and neural (i.e., functional magnetic resonance imaging) experiments, we sought to determine whether and how affect might promote the identifiable victim effect. Behaviorally, subjects gave more to orphans depicted by photographs versus silhouettes, and their shift in preferences was mediated by photograph-induced feelings of positive arousal, but not negative arousal. Neurally, while photographs versus silhouettes elicited activity in widespread circuits associated with facial and affective processing, only nucleus accumbens activity predicted and could statistically account for increased donations. Together, these findings suggest that presenting evaluable identifiable information can recruit positive arousal, which then promotes giving. We propose that affect elicited by identifiable stimuli can compel people to give more to strangers, even despite costs to the self.

A comparison of counselors and matched controls in maintaining different brain responses to the same stimuli under the self-perspective and the other-perspective

To perceive the world from the perspective of their clients, counselors need to transpose themselves into the inner states of their clients when empathizing with them. Without a self-other distinction, the counselors may confuse their clients' experience with that of their own, which leads to personal distress and has detrimental effects on their well being. The present study recorded event-related potentials (ERP) of two groups of participants (counselors and matched controls) watching the same sets of unpleasant and neutral pictures from either the self-perspective or the other-perspective. The results revealed significant differences in the N2 component over the frontal-central regions between the self-perspective and the other-perspective and in the late positive potential (LPP) component over the central-parietal regions, irrespective of the stimulus type. The differences detected in LPP were specific to the counselor group. Moreover, unpleasant pictures elicited smaller N2 and larger LPP activations compared with neutral pictures. Our results indicated that the counselors' self-other distinction began at the early automatic process stage and continued until the late cognitive evaluation stage. The counselors' ability to maintain a self-other distinction might prevent them from being overly involved in the clients' experiences and relieve their personal distress.

Intuitive Prosociality

Prosocial behavior is a central feature of human life and a major focus of research across the natural and social sciences. Most theoretical models of prosociality share a common assumption: Humans are instinctively selfish, and prosocial behavior requires exerting reflective control over these basic instincts. However, findings from several scientific disciplines have recently contradicted this view. Rather than requiring control over instinctive selfishness, prosocial behavior appears to stem from processes that are intuitive, reflexive, and even automatic. These observations suggest that our understanding of prosociality should be revised to include the possibility that, in many cases, prosocial behavior—instead of requiring active control over our impulses—represents an impulse of its own.

Empathic accuracy and cognition in schizotypal personality disorder

Interpersonal dysfunction contributes to significant disability in the schizophrenia spectrum. Schizotypal Personality Disorder (SPD) is a schizophrenia-related personality demonstrating social cognitive impairment in the absence of frank psychosis. Past research indicates that cognitive dysfunction or schizotypy may account for social cognitive dysfunction in this population. We tested SPD subjects and healthy controls on the Empathic Accuracy (EA) paradigm and the Reading of the Mind in the Eyes Test (RMET), assessing the impact of EA on social support. We also explored whether EA differences could be explained by intelligence, working memory, trait empathy, or attachment avoidance. SPD subjects did not differ from controls in RMET, but demonstrated lower EA during negative valence videos, associated with lower social support. Dynamic, multimodal EA paradigms may be more effective at capturing interpersonal dysfunction than static image tasks such as RMET. Schizotypal severity, trait empathy, and cognitive dysfunction did not account for empathic dysfunction in SPD, although attachment avoidance is related to empathic differences. Empathic dysfunction for negative affect contributes to decreased social support in the schizophrenia spectrum. Future research may shed further light on potential links between attachment avoidance, empathic dysfunction, and social support.

Weighing the stigma of weight: An fMRI study of neural reactivity to the pain of obese individuals

Explicit negative attitudes and blameful beliefs (e.g. poor diet, laziness) towards obese individuals are well documented and are pervasive even among health professionals. Here we sought to determine whether obesity stigma is reflected in a fundamental feature of intersubjectivity namely the automatic neural resonance with others' affective experiences. During fMRI, normal-weight female participants observed short clips depicting normal-weight (NW) and obese (Ob) models experiencing pain. Importantly, participants believed that half of the Ob were overweight due to a hormonal disorder (HormOb) and ignored the cause of obesity of the remaining models (Unknown obese models; UnkOb). Analyses of hemodynamic responses showed reduced activity to the pain of Ob compared to that of NW in areas associated with pain processing and early visual processing. The comparison between the two Ob conditions revealed a further decrease of activity to HormOb's pain compared to UnkOb's (and NW) pain in the right inferior frontal gyrus, an area associated with emotional resonance. Our study demonstrates that stigma for obese individuals can be observed at implicit levels, and that it is modulated by knowledge concerning the etiology of obesity, with the seemingly surprising result that obesity due to disease may result in greater stigmatization. Moreover, the perceived similarity with the models and the ambivalent emotion of pity may index biased brain responses to obese individuals' pain. The study highlights a possibly important neural link between resonance with the pain of others and obesity stigma.