Autonomic contributions to empathy: Evidence from patients with primary autonomic failure

When the body fosters empathy: The interconnectivity between bodily reactivity, meditation, and embodied abstract concepts

Empathy is a fundamental social ability that allows humans to infer others' emotions and intentions. Empathy is thought to be rooted in bodily sensations coming from the autonomic nervous system. In parallel, the functionality and perceptions coming from the autonomic nervous system could be improved by practicing activities that involve mind-body interactions, such as meditation. Furthermore, perceptions from the autonomic nervous system are thought to be important in the embodiment of abstract concepts. Consequently, in the current study, we collected data online from 581 participants and explored the associations between levels of empathy and (1) the practice of meditation, music, and sports; (2) the impact of self-report measures on bodily awareness and reactivity; and (3) the embodiment of abstract concepts in interoception. In line with previous studies, Meditators were found to have higher empathy scores than Non-Meditators. In addition, lower levels of autonomic reactivity in organs above the diaphragm were associated with higher empathy. Finally, we also observed that empathy was positively associated with interoceptive components of abstract concepts in those participants with high autonomic reactivity. Taken together, the results suggest that meditation practice and having low autonomic reactivity are associated with empathy, arguably through the downregulation of autonomic responses. Implications for mind-body interaction in meditation and its role in promoting empathy are discussed.

Gratitude Affects Inter-Subjective Synchronicity for Cognitive Performance and Autonomic Responsiveness

Recently, social neurosciences have been interested in the investigation of neurophysiological responses related to the experience of positive emotions, such as gratitude, during social interactions. Specifically, the aim of the present research was to investigate whether gratitude related to gift exchange could favor cooperative behavior and bond construction, by improving behavioral and autonomic responsivity. At this regard, the autonomic synchronization and behavioral performance of 16 friends coupled in dyads were recorded during a joint attentional task. Gift exchange could be occurred either at the beginning or in the middle of the task. For the recording of simultaneous autonomic activity [heart rate (HR) and skin conductance level (SCL)], a hyperscanning biofeedback paradigm was used. Intra-subjective analysis showed an increase in behavioral [accuracy (ACC)] and autonomic responses (HR and SCL) when the gift exchange took place at the beginning of the task rather than in the middle. Moreover, inter-subjective analysis revealed an increase in behavioral performance and greater autonomic synchronization of HR index. The present research, therefore, shows how gratitude and trust experienced following gift exchange can modify participants’ reactions by creating a shared cognition and the adoption of joint strategies.

When gratitude and cooperation between friends affect inter-brain connectivity for EEG

Background

Recently several studies in the psychological and social field have investigated the social function of gift exchange as a useful way for the consolidation of interpersonal and social relationships and the implementation of prosocial behaviors. Specifically, the present research wanted to explore if gift exchange, increased emotional sharing, gratitude and interpersonal cooperation, leading to an improvement in cognitive and behavioral performance. In this regard, neural connectivity and cognitive performance of 14 pairs of friends were recorded during the development of a joint attention task that involved a gift exchange at the beginning or halfway through the task. The moment of gift exchange was randomized within the pairs: for seven couples, it happened at task beginning, for the remaining seven later. Individuals’ simultaneous brain activity was recorded through the use of two electroencephalograms (EEG) systems that were used in hyperscanning.

Results

The results showed that after gift exchange there was an improvement in behavioral performance in terms of accuracy. For what concerns EEG, instead, an increase of delta and theta activation was observed in the dorsolateral prefrontal cortex (DLPFC) when gift exchange occurred at the beginning of the task. Furthermore, an increase in neural connectivity for delta and theta bands was observed.

Conclusion

The present research provides a significant contribution to the exploration of the factors contributing to the strengthening of social bonds, increasing cooperation, gratitude and prosocial behavior.

Empathy in Negative and Positive Interpersonal Interactions. What is the Relationship Between Central (EEG, fNIRS) and Peripheral (Autonomic) Neurophysiological Responses?

Emotional empathy is crucial to understand how we respond to interpersonal positive or negative situations. In the present research, we aim at identifying the neural networks and the autonomic responsiveness underlying the human ability to perceive and empathize with others' emotions when positive (cooperative) or negative (uncooperative) interactions are observed. A multimethodological approach was adopted to elucidate the reciprocal interplay of autonomic (peripheral) and central (cortical) activities in empathic behavior. Electroencephalography (EEG, frequency band analysis) and hemodynamic (functional Near-Infrared Spectroscopy, fNIRS) activity were all recorded simultaneously with systemic skin conductance response (SCR) and heart rate (HR) measurements as potential biological markers of emotional empathy. Subjects were required to empathize in interpersonal interactions. As shown by fNIRS/EEG measures, negative situations elicited increased brain responses within the right prefrontal cortex (PFC), whereas positive situations elicited greater responses within the left PFC. Therefore, a relevant lateralization effect was induced by the specific valence (mainly for negative conditions) of the emotional interactions. Also, SCR was modulated by positive/negative conditions. Finally, EEG activity (mainly low-frequency theta and delta bands) intrinsically correlated with the cortical hemodynamic responsiveness, and they both predicted autonomic activity. The integrated central and autonomic measures better elucidated the significance of empathic behavior in interpersonal interactions.

Pupil-size asymmetry is a physiologic trait related to gender, attentional function, and personality

A small difference in the size of the two pupils is common in healthy individuals, a condition termed benign or physiologic anisocoria (BA). Past research indicates that BA is probably caused by asymmetry in sympathetic nervous system (SNS) function [e.g., Rosenberg (2008). Physiologic anisocoria: A manifestation of a physiologic sympathetic asymmetry. Neuro-Ophthalmology, 32, 147-149]. This study is the first to show that BA varies with psychological factors linked to brain asymmetry and autonomic arousal, including gender, attention, and personality. Males exhibited a more directional BA than females, consistent with greater hemispheric lateralization in males. BA also varied with a self-report measure of attentional function, consistent with evidence of hemispheric asymmetry in visuospatial attention networks. Finally, BA varied with personality traits linked to autonomic arousal. Individuals exhibiting higher Meanness and Boldness, and lower Empathy scores tended to show more directional BA. This link between personality traits and BA may be related to brain asymmetries in autonomic arousal and emotion-related processing. If future studies employing direct measures of lateralized brain activity confirm the link between BA and SNS asymmetries, this new metric may prove useful in discovering new relationships between brain organization and psychological function, and how these relationships vary across individuals.

Abnormal cardiovascular sympathetic and parasympathetic responses to physical and emotional stimuli in depersonalization disorder

Background

Depersonalization disorder (DPD) is characterized by a subjective sense of unreality, disembodiment, emotional numbing and reduced psychogenic (sudomotor) sympathoexcitation.

Aims

Three related experiments utilized escalating physical and emotional challenges in 14 DPD participants and 16 controls aimed to elucidate (i) whether the cardiovascular sympathetic (SNS) and parasympathetic (PNS) nervous systems are implicated in DPD pathophysiology and (ii) if possible, to determine whether the blunted sympathoexcitation in DPD is peripherally or centrally mediated.

Method

Participants completed the Beck Anxiety Inventory (BAI), Dissociative Experience Scale (DES), and Cambridge Depersonalization Scale (CDS). Study I recorded heart rate (HR) and blood pressure (BP) during 5 min supine baseline, 3 min sustained handgrip (HG), 3 min cold pressor (CP) and 5 min 60° head-up tilt (HUT). In study II, HR, BP, and heart rate variability (HRV) were recorded during 5 min simultaneous 60° HUT and continuous presentation of unpleasant images (5 s per image). Study III examined HR and BP orienting responses (ORs) to simultaneous 60° HUT and pseudorandom presentation of unpleasant, neutral and pleasant images (5 s per image 3 min 25 s). OR data was grouped by image valence post hoc.

Results

DPD BAI (p = 0.0004), DES (p = 0.0002), and CDS (p ≤ 0.0001) scores were higher than controls. The DPD group produced diminished diastolic BP (DBP) (p = 0.045) increases to HG. Other indices were comparable between groups. DPD participants produced diminished systolic BP (SBP) (p = 0.003) and DBP (p = 0.002) increases, but greater (p = 0.004) HR increases to CP. In study II, DPD high frequency HRV (HF-HRV)—indicating parasympathetic vagal activity–was reduced (p = 0.029). In study III, DPD DBP was higher throughout the 5 s duration of HUT/pseudorandom unpleasant image presentation (1 s, p = 0.002, 2 s p = 0.033, 3 s p = 0.001, 4 s p = 0.009, 5 s p = 0.029).

Conclusions

Study I's BP pressor data supports previous findings of suppressed sympathoexcitation in DPD. The greater HR increases to CP, decreased HF-HRV in study II, and increased DBP during unpleasant ORs in study III implicates the SNS and PNS in DPD pathophysiology. These studies suggest the cardiovascular autonomic dysregulation in DPD is likely to be centrally-mediated.

Alexithymia and empathy predict changes in autonomic arousal during affective stimulation

BACKGROUND

Alexithymia, the inability to describe one's own emotions, is linked to deficits in empathy, manifesting as a diminished capacity to recognize or understand the emotions and mental states of others. Several brain centers of autonomic control and interoception that are activated in empathy are thought to misfunction in alexithymia. We hypothesized that individual differences in autonomic changes under affective stimulation might be associated with differences in alexithymia and empathy.

METHODS

We studied 21 healthy volunteers, comparing their alexithymia and empathy scores with changes in their sympathetic autonomic arousal, indexed by the palmar skin potential level, during 3 tasks: playing a computer game, performing mental arithmetic, and watching a negative emotional valence video.

RESULTS

Both autonomic and subjective sense of arousal increased at the beginning of each task and then gradually subsided over the course of the task. Higher autonomic arousal at the onset of the computer game was associated with higher empathy scores, and at the onset of the negative video with higher scores for both empathy and alexithymia. Alexithymia delayed the habituation of autonomic arousal during the computer game, while the empathy score was related to a faster decline in arousal during the negative video task.

CONCLUSIONS

High alexithymia and high empathy scores were linked to increased autonomic arousal at the onset of emotional stimulation, but were distinguishable in the rates of habituation of the evoked arousal. Our data provide insight into the relationships among interacting psychological traits, physiologic regulation, and the arousal dimension of emotional experience.

Self-report, personality and autonomic system modulation in response to empathic conflictual versus non conflictual situation

The present study integrated three different measures of emotional empathic behaviour in a social context: verbal self-report measures (empathic response, emotional involvement, emotional significance, and valence), autonomic response (skin conductance, SCR, and heart rate, HR), and personal response to empathic scale (BEES). Thirty-five younger adults were presented with different interpersonal scene types (co-operation, non-co-operation, conflict, neutral). Different empathic sensitivity to these interpersonal situations was tested, since we hypothesised self-report on empathy, emotional involvement and valence varied as a function of interpersonal context. As supposed, self-report measures of empathy and autonomic measures were found to be related: SCR and HR increased in response to conflictual and non-co-operative situations. Moreover, high empathic subjects were more responsive (on both self-report and autonomic response) to empathy-related situations than low empathic subjects. The convergence of these multidimensional measures are discussed: emotional components of empathy are elucidated in relation to self-report, autonomic modulation, and personality trait variation.

Walking a fine line: is it possible to remain an empathic physician and have a hardened heart?

Establishing an empathic physician-patient relationship is an essential physician skill. This chapter discusses the sexually dimorphic aspects of the neural components involved in affective and cognitive empathy, and examines why men and women medical students or physicians express different levels of empathy. Studies reveal levels of medical student affective or cognitive empathy can help reveal which medical specialty a student will enter. The data show students or physicians with higher empathy enter into specialties characterized by large amounts of patient contact and continuity of care; and individuals with lower levels of empathy desire specialties having little or no patient contact and little to no continuity of care. Burnout and stress can decrease the empathy physicians had when they first entered medical school to unacceptable levels. Conversely, having a too empathetic physician can let patient conditions and reactions interfere with the ability to provide effective care. By learning to blunt affective empathic responses, physicians establish a certain degree of empathic detachment with the patient in order to provide objective care. However, a physician must not become so detached and hardened that their conduct appears callous, because it is still important for physicians, especially those in specialties with a large amount of patient contact, to use empathic communication skills.

Visceral influences on brain and behavior

Mental processes and their neural substrates are intimately linked to the homeostatic control of internal bodily state. There are a set of distinct interoceptive pathways that directly and indirectly influence brain functions. The anatomical organization of these pathways and the psychological/behavioral expressions of their influence appear along discrete, evolutionarily conserved dimensions that are tractable to a mechanistic understanding. Here, we review the role of these pathways as sources of biases to perception, cognition, emotion, and behavior and arguably the dynamic basis to the concept of self.

Emotional face recognition, empathic trait (BEES), and cortical contribution in response to positive and negative cues. The effect of rTMS on dorsal medial prefrontal cortex

The present study investigated the relationship between three different measures related to the affective empathy: facial expression detection in response to different emotional patterns (positive vs. negative), personal response to empathic scale [Balanced Emotional Empathy Scale (BEES)], and dorsal medial prefrontal cortex (dMPFC) contribution to mediate the facial detection task. Nineteen subjects took part in the study and they were required to recognize facial expression of emotions, after having empathized with these emotional cues. Repeated Transcranial Magnetic Stimulation (rTMS) method was used in the present research in order to produce a temporary virtual disruption of dMPFC activity. dMPFC disruption induced a worse performance, especially in response to negative expressions (i.e. anger and fear). High-BEES subjects paid a higher cost after frontal brain perturbation: they showed to be unable to correctly detect facial expressions more than low-BEES. Moreover, a "negative valence effect" was observed only for high-BEES, and it was probably related with their higher impairment to recognize negative more than positive expressions. dMPFC was found to support emotional facial expression recognition in an empathic condition, with a specific increased responsiveness for negative-valenced faces. The contribution of this research was discussed to explain the mechanisms underlying affective empathy based on rTMS application.

Empathy in cooperative versus non-cooperative situations: the contribution of self-report measures and autonomic responses

Shared representations, emotion comprehension, and emotion regulation constitute the basic macro components of social empathy. The present study integrated two different measures of empathic behavior in a social context: verbal self-report measures (empathic response, emotional involvement and emotional significance, and valence), and autonomic responses (facial expression-corrugator supercilii and zygomaticus major muscle-, SCR-skin conductance-, and HR-heart rate-). Participants (N = thirty-five) were presented with different interpersonal scene types (cooperation, non-cooperation, conflict, indifference). Different empathic sensitivity to these interpersonal situations was verified, since self-rating on empathy, emotional involvement and valence varied as a function of interpersonal context. Situation rated as more empathically significant were considered also as the most positive (cooperation) and negative (non cooperation and conflictual) and emotionally significant (high emotional significance of the scenes) in comparison with neutral scenes. Nevertheless, subjective empathic response and personal emotional involvement were found to be dissociated measures in non-cooperative condition. On the autonomic level, facial mimicry was linked to and coherent with the empathic response in cooperative, non-cooperative and conflictual conditions, whereas SCR and HR were increased only in response to cooperative and conflictual situation, rated as more involving by the subject. The convergence of these multidimensional measures was discussed: empirical evidences are far from able to warrant claims that processes of emotional contagion and simulation provide the sole, primary important way by which we come to know what others are feeling.

Interaction between cognition, emotion, and the autonomic nervous system

The mind and body are intrinsically and dynamically coupled. Perceptions, thoughts and feelings change, and respond to, the state of the body. This chapter describes the integration of cognitive and affective processes with the autonomic control of bodily arousal, focusing on reciprocal effects of autonomic responses on decision making, error detection, memory and emotions. Neuroimaging techniques are beginning to detail the neuronal substrates mediating these interactions between mental and physiological states, implicating cortical regions (specifically insular and cingulate cortices) alongside subcortical (amygdala) and brainstem (notably dorsal pons) in these mechanisms. The extent to which bodily states influence mental processes is determined in part by "interoceptive sensitivity," an index of individual differences in the ability to detect one's own bodily sensations. Moreover, the misidentification or misattribution of interoceptive responses is implicated in a number of pathologies such as depersonalization, schizophrenia, and anxiety. Increasing knowledge of the mechanisms of body-mind interactions has wide ranging implications, from decision making to empathy, and may serve elucidate potential avenues of intervention for stress-sensitive conditions in which psychological, cognitive, and emotional factors impact on the expression of physical symptoms.

Self-report measures, facial feedback, and personality differences (BEES) in cooperative vs. noncooperative situations: contribution of the mimic system to the sense of empathy

The present study integrated three different measures of emotional empathic behavior in a social context: verbal self-report measures (empathic response, emotional involvement, emotional significance, and valence), facial mimicry (activity of corrugator and zygomaticus muscles), and personal response to the Balanced Emotional Empathy Scale (BEES). Participants were presented with different interpersonal scene types (cooperation, noncooperation, conflict, indifference). Firstly, self-rating on empathy, emotional involvement, and valence varied as a function of interpersonal context. Secondly, corrugator activity increased in response to conflictual and noncooperative situations; zygomatic activity increased in response to cooperative situations. Third, high- and low-BEES subjects showed different empathic behavior: High-empathic subjects were more responsive to empathy-related situations than low-empathic subjects. The convergence and divergence of these multidimensional measures was discussed.

Mother and child in synchrony: thermal facial imprints of autonomic contagion

Mothers' ability to empathically share offspring's emotional feelings is considered integral to primary affective bonds and a healthy socio-emotional development. What neurobiological mechanism is responsible for this ability in humans? It has been proposed that the psychological and neural components of affective experiences are strictly associated with autonomic-visceral changes. Hence, the vicarious response of empathy may also embody a sharing of changes in body physiology. The present study aimed at investigating whether maternal empathy is accompanied by a synchrony in autonomic responses. We simultaneously recorded, in an ecological context with contact free methodology, the facial thermal imprints of mother and child, while the former observed the latter when involved in a distressing situation. The results showed a situation-specific parallelism between mothers' and children's facial temperature variations, providing preliminary evidence for a direct affective sharing involving autonomic responding. These findings support a multidimensional approach for the comprehension of emotional parent-child relationships.

Emotional face recognition, EMG response, and medial prefrontal activity in empathic behaviour

One important aspect of empathy is a "resonance mechanism", which includes emotional cue detection, facial mimicry (measured by electromyography, EMG) and a specific cortical response. This study explored the convergence of these three measures of affective empathy. The twenty students who took part in the study were required to empathise with the situation by entering into the other person's situation. The four emotions portrayed were anger, fear, happiness, and neutral, and the subjects were instructed to make a two-alternative response (emotion or no emotion) to each emotion. A repeated transcranial magnetic stimulation was used to produce a temporary inhibition of the medial prefrontal cortex (MPFC). The results support the hypothesis that there is a direct relationship between emotional cue recognition, EMG-measured facial response and prefrontal activity. First, both facial expression detection and autonomic mimicry in reaction to emotional faces were systematically modulated in response to inhibition of the MPFC. Second, the MPFC was implicated in facial cue detection and the subsequent autonomic response because an impaired performance on both measures was observed when this brain area was inhibited. Third, this effect increased when negative-valenced stimuli (angry and fearful faces) were presented to the subjects. These results revealed a significant effect of the MPFC on both cue detection and facial mimicry that was distinctly related to different types of emotions.

Resonance mechanism in empathic behavior BEES, BIS/BAS and psychophysiological contribution

Empathy is related to the natural human ability to understand emotions and feelings of others, where a sort of "resonance" mechanism between the observer and the observed permits a direct form of understanding. The present study explored four different measures related to empathic behavior in a social context: autonomic behavior (skin conductance--SCR, and heart rate--HR), personal response to empathic scale (BEES), approach-withdrawal attitudes (BIS/BAS), and verbal self-report measures. Participants were presented with different interpersonal scene types (cooperation, non-cooperation, conflict, indifference), and they were required to empathize with them. Different autonomic response patterns were found as a function of the interpersonal situations: SCR and HR increased in case of conflictual and non-cooperative situations. This result was confirmed by self-rating measures on empathy, since emotional involvement and valence attributed to the scenes varied in concomitance with psychophysiological parameters. Third, high and low BEES subjects showed different empathic behavior: high empathic subjects were more responsive (on both self-report and autonomic response) to empathy-related situations than low empathic subjects. Finally, BIS and BAS attitudes demonstrated a significant relationship with both BEES and autonomic patterns: high BAS subjects were more responsive and empathic with positive, cooperative situations, whereas high BIS empathized with more negative, conflictual situations. The convergence of these multidimensional measures was discussed.

Psychophysiology of neural, cognitive and affective integration: fMRI and autonomic indicants

Behaviour is shaped by environmental challenge in the context of homoeostatic need. Emotional and cognitive processes evoke patterned changes in bodily state that may signal emotional state to others. This dynamic modulation of visceral state is neurally mediated by sympathetic and parasympathetic divisions of the autonomic nervous system. Moreover neural afferents convey representations of the internal state of the body back to the brain to further influence emotion and cognition. Neuroimaging and lesion studies implicate specific regions of limbic forebrain in the behavioural generation of autonomic arousal states. Activity within these regions may predict emotion-specific autonomic response patterns within and between bodily organs, with implications for psychosomatic medicine. Feedback from the viscera is mapped hierarchically in the brain to influence efferent signals, and ultimately at the cortical level to engender and reinforce affective responses and subjective feeling states. Again neuroimaging and patient studies suggest discrete neural substrates for these representations, notably regions of insula and orbitofrontal cortex. Individual differences in conscious access to these interoceptive representations predict differences in emotional experience, but equally the misperception of heightened arousal level may evoke changes in emotional behaviour through engagement of the same neural centres. Perturbation of feedback may impair emotional reactivity and, in the context of inflammatory states give rise to cognitive, affective and psychomotor expressions of illness. Changes in visceral state during emotion may be mirrored in the responses of others, permitting a corresponding representation in the observer. The degree to which individuals are susceptible to this 'contagion' predicts individual differences in questionnaire ratings of empathy. Together these neuroimaging and clinical studies highlight the dynamic relationship between mind and body and help identify neural substrates that may translate thoughts into autonomic arousal and bodily states into feelings that can be shared.